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Adhesive strength of cervical composite restorations
- Authors: Razumova S.N.1, Brago A.S.1, Ruda O.R.1, Talandis A.G.1, Khaskhanova L.M.1, Mendosa E.Y.2, Rusanov F.S.3
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Affiliations:
- Peoples’ Friendship University of Russia
- Russian University of Medicine
- Central Research Institute of Dentistry and Maxillofacial Surgery
- Issue: Vol 29, No 1 (2025)
- Pages: 13-20
- Section: Experimental and Theoretical Investigations
- Submitted: 30.10.2024
- Accepted: 27.11.2024
- Published: 01.03.2025
- URL: https://rjdentistry.com/1728-2802/article/view/639931
- DOI: https://doi.org/10.17816/dent639931
- ID: 639931
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Abstract
BACKGROUND: The effectiveness of universal adhesives for restorations remains a subject of debate. The long-term reliability of adhesive bonds in cervical cavities, depending on the functional role of the tooth (chewing vs. biting), has not been sufficiently studied. Numerous studies on ensuring reliable adhesion indicate that this topic remains relevant for further investigation.
AIM: To assess the adhesive bond strength of composite restorations to hard dental tissues in laboratory samples of anterior and posterior teeth before and after thermocycling.
MATERIALS AND METHODS: The study included extracted teeth (n = 60) obtained from elderly (60–75 years) and senile (75–90 years) patients due to periodontal indications. The teeth were divided into two groups (n = 30 each) based on the adhesive system used: Group 1, Universal Bond II; Group 2, OptiBond Solo Plus. Both groups used the flowable photopolymer EsFlow and the universal composite Point 4. Each group was further divided into two subgroups based on function: anterior (A) and posterior (P) teeth (n = 15 in each), and subsequently, into two additional subgroups based on thermocycling: (a) before thermocycling and (b) after thermocycling. Cervical cavities (5 × 5 × 3 mm) were prepared in all samples using a high-speed dental handpiece under water cooling. The specimens underwent 1000 thermocycles alternating for 30 s each (with a 30-second intermediate interval) at a temperature regime of (5 ± 2) °C and (60 ± 2) °C. The adhesive strength of the teeth was then evaluated under compressive load.
RESULTS: The adhesive strength under compression in subgroups 1Aa and 2Aa was 1663.6 [1574.6; 2175.1] N and 2151.5 [967.9; 3970.3] N, respectively. The difference between them was statistically insignificant (p = 0.538), confirming group homogeneity. The adhesive strength values in subgroups 1Ab and 2Ab were 1353.3 [1219.2; 2096.8] N and 1620.7 [847.2; 2434.7] N, respectively (p = 0.868). Statistically significant differences were observed between subgroups 1Aa and 1Ab (p = 0.017) and between 2Aa and 2Ab (p = 0.017). In the posterior tooth groups, the adhesive strength in subgroups 1Pa and 2Pa was 4100.0 [2818.1; 48401.4] N and 3800.0 [2000.0; 4500.0] N, respectively (p = 0.476), indicating the effectiveness of both adhesive systems. In subgroups 1Pb and 2Pb, the adhesive strength was 3479.5 [2708.8; 3995.6] N and 1999.0 [1646.3; 3120.8] N, respectively (p = 0.153), confirming the effectiveness of adhesion and the integrity of the restoration–tooth complex.
CONCLUSION: Posterior teeth withstand higher loads compared to anterior teeth. A decrease in bond strength was observed in all groups after thermocycling, which is influenced not only by the type of adhesive system but also by the anatomical characteristics of posterior teeth, including their shape, surface area, and relief.
Keywords
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BACKGROUND
Dental caries and periodontal diseases rank among the most prevalent oral conditions in adults [1–3].
According to the World Health Organization (2022), more than one third of the global population is affected by dental caries. Untreated dental caries of permanent teeth is the most widespread disease worldwide, affecting more than 2 billion individuals [4–7].
Insufficient personal oral hygiene in the cervical area and irregular dental prophylaxis lead to the development of carious lesions localized as Black’s class V cavities [8, 9]. Cervical carious lesions of hard dental tissues are common and progress rapidly, spreading toward the peripulpal dentin and contributing to complications [10–12].
Restoration of cervical defects is complicated by proximity to the gingiva, difficulty in maintaining proper isolation, and increased occlusal load depending on the clinical situation. The cervical area of teeth is a zone of stress concentration during mastication [13]. Diagnosis and management of cervical hard tissue pathology require understanding the etiology of these defects and a clear treatment plan for their restoration. The morphology of hard dental tissues largely determines marginal adaptation of the restoration and, consequently, its longevity. A major challenge in restoring cervical lesions is the need for bonding to three histologic substrates—enamel, dentin, and cementum. Dentin and cementum contain a higher percentage of organic components than enamel, which complicates adhesion with 4th- and 5th-generation dental adhesives [14, 15]. Adhesive bond strength between the restoration and dental tissues when using 4th- and 5th-generation systems depends on two factors: dentin moisture and the integrity of the collagen network remaining after demineralization during acid etching. Insufficient tissue hydration leads to collagen network collapse and prevents monomer penetration. In the opposite scenario, when dentin is excessively moist, monomer molecules have difficulty displacing residual water and subsequently penetrating the collagen fibrils [16–21]. Studies have shown that the best marginal adaptation and the lowest microleakage occur at the enamel interface when using nanohybrid composites, whereas in the cementum region these outcomes are achieved with tri-cure resin-modified glass ionomer cement [22, 23]. Cementum and root dentin are more susceptible to acid exposure and demineralization in a mildly acidic environment, which may result in root caries.
Advances in dental materials, as well as improvements in their properties and clinical protocols, have helped overcome these restorative challenges. The introduction of universal adhesives with different surface pretreatment strategies allows clinicians to adapt their use according to the clinical situation.
In an in vitro study, Jacker-Guhr et al. compared the bond strength of various universal adhesives to enamel and dentin with and without additional phosphoric acid etching (before and after thermocycling). The study demonstrated that bond strength of universal adhesives to dental tissues increased after phosphoric acid etching, reaching up to 30 MPa, particularly on enamel surfaces [24].
Similarly, Chen et al. evaluated the microtensile bond strength of 5 universal adhesives (Prime&Bond Elect, Scotchbond Universal, All-Bond Universal, Clearfil Universal Bond, and Futurabond U) in vitro and found that both the adhesive formulation and the testing conditions (with or without thermocycling) significantly influenced the microtensile strength [25].
Kawazu et al. compared the bond strength to dentin of a universal adhesive and 2 phosphoric acid–etch adhesive systems. Single Bond Plus (5th generation) demonstrated higher shear bond strength and greater stability with dentin after thermocycling. In contrast, the bond strength of the 3-step system Scotchbond Multi-Purpose Plus (4th generation) decreased with long-term degradation. The universal adhesive system Scotchbond Universal (8th generation) produced dentin bonds whose shear strength remained unchanged compared with baseline under all degradation conditions [26].
In a study by Follak, the condition of dentin was shown to influence bond strength. Universal adhesives (Scotchbond Universal, All-Bond Universal, Prime&Bond Elect) and control adhesives (Adper Single Bond 2, 5th generation; and Clearfil SE Bond, 6th generation) were applied to sound and artificially caries-affected bovine dentin. Microtensile bond strength and microleakage were assessed. All universal adhesives exhibited bond degradation over time when applied to caries-affected dentin, regardless of the adhesive used. On sound dentin, bond degradation was observed when adhesives were applied using the total-etch technique. The authors concluded that universal adhesives are unable to maintain long-term stable bonding on caries-affected dentin [27].
The inconsistency of research findings regarding the effectiveness of universal adhesives for restorations underscores the need for further investigation. The long-term reliability of adhesive bonds in cervical cavities, depending on the functional role of the tooth (chewing/biting), remains insufficiently studied. The primary functional stresses for posterior and anterior teeth are compressive and lateral loads. Numerous studies on achieving durable adhesive bonding confirm the continued relevance of this issue.
This work aimed to evaluate the adhesive bond strength of composite restorations to hard dental tissues in laboratory samples of anterior and posterior teeth before and after thermocycling.
METHODS
Study Design
- Preparation of test specimens.
- Determination of the compressive bond strength of composite restorations using laboratory methods (compressive bond strength test):
- before thermocycling
- after thermocycling.
- Statistical analysis performed with SPSS Statistics software (IBM, USA).
Study Setting
The study was conducted at the Department of Propaedeutics of Dental Diseases, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia (RUDN University, Moscow); the Laboratory of Materials Science, Central Research Institute of Dentistry and Maxillofacial Surgery (Moscow); and Technodent LLC (Belgorod).
Intervention
Extracted teeth (n = 60) obtained for periodontal indications were used as specimens. The sample included elderly (60–75 years) and senile individual (75–90 years).
After extraction and removal of dental calculus using an ultrasonic scaler, the teeth were randomly assigned to 2 groups according to the adhesive system applied (n = 30 in each group). Standardized cervical cavities (5 × 5 × 3 mm) were prepared in all specimens using a high-speed dental handpiece under water cooling with carbide round burs: ISO 001/021 (Mani, Japan) and ISO 500 204 001 190 021 (NTI, Germany).
In Group 1, restorations were performed using the universal adhesive system Universal Bond II (Tokuyama, Japan), applied according to the manufacturer’s instructions, followed by the flowable photopolymer composite EsFlow (Spident, Korea) with light curing, and the universal composite Point 4 (Kerr, USA) inserted incrementally with subsequent light curing. In Group 2, restorations were performed using the fifth-generation adhesive OptiBond Solo Plus (Kerr, USA) according to the manufacturer’s instructions, followed by EsFlow (Spident, Korea) with light curing and Point 4 (Kerr, USA) applied incrementally with subsequent light curing.
The specimens of groups 1 and 2 were subdivided by functional type into anterior (A) and posterior (P) teeth (15 teeth in each). Each subgroup was further divided randomly into subgroups a (before thermocycling) and b (after thermocycling) (see Table 1).
Table 1. Specimen groups
Teeth | Specimen groups | |
Anterior teeth | 1Aa | 1Ab |
n = 15 | n = 15 | |
2Aa | 2Ab | |
n = 15 | n = 15 | |
Total | 30 | 30 |
Posterior teeth | 1Pa | 1Pb |
n = 15 | n = 15 | |
1Pa | 2Pb | |
n = 15 | n = 15 | |
Total | 30 | 30 |
Total specimens | 60 | |
Note. 1, universal adhesive; 2, fifth-generation adhesive; A, anterior teeth; P, posterior teeth; a, before thermocycling; b, after thermocycling.
Thermocycling was performed at Technodent LLC (Belgorod). The specimens of subgroups 1b and 2b were placed in a perforated tray and subjected to 1000 thermocycles, alternating 30 s immersions (with 30 s intermediate intervals) at (5 ± 2) °C and (60 ± 2) °C. The specimens were then subjected to further testing.
During compressive bond strength testing, the occlusal surface or incisal edge of each tooth was sectioned with a disk to create a flat surface. Each specimen was fixed in a metal mold using self-curing acrylic resin Re-Fine Bright (Yamahachi Dental, Japan).
Prepared specimens were mounted in a universal testing machine Z010 (Zwick/Roell, Germany) between 2 parallel plates for subsequent evaluation. A compressive load was applied uniformly to the teeth at a crosshead speed of 0.6 mm/min until either restoration debonding or specimen fracture occurred (see Fig. 1). The mean Fmax value was recorded, representing the maximum load in newtons (N) at which loss of integrity (restoration debonding or tooth fracture) occurred.
Fig. 1. Specimen mounted in the Z010 testing machine (Zwick/Roell, Germany). © Eco-Vector, 2024.
Ethics Approval
This study was approved by the Ethics Committee of the Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia (RUDN University), Moscow (protocol excerpt No. 12, November 17, 2022).
Statistical Analysis
Data were processed using SPSS Statistics software (IBM, USA). Results are presented as median with interquartile range, Me [Q1–Q3]. Statistically significant differences within groups were evaluated using the paired t-test.
RESULTS
Primary Results
Comparative evaluation of compressive bond strength showed that in anterior teeth before thermocycling (subgroups 1Aa and 2Aa), values were 1663.6 [1574.6–2175.1] N and 2151.5 [967.9–3970.3] N, respectively. The difference between groups was not statistically significant (p = 0.538), confirming group homogeneity. After thermocycling, compressive bond strength in subgroups 1Ab and 2Ab was 1353.3 [1219.2–2096.8] N and 1620.7 [847.2–2434.7 N, respectively. The difference between groups was not statistically significant (p = 0.868). Statistically significant differences were observed between subgroups 1Aa and 1Ab (p = 0.017) and between 2Aa and 2Ab (p = 0.018) (see Table 2).
Table 2. Comparative evaluation of compressive bond strength in anterior and posterior teeth
Teeth | Groups | p | |
Anterior teeth | 1Aa | 1Ab | |
1663.6 [1574.6; 2175.1] | 1353.3 [1219.2; 2096.8] | 0.017291 | |
2Aa | 2Ab | ||
2151.5 [967.9; 3970.3] | 1620.7 [847.2; 2434.7] | 0.011719 | |
p | 0.538193 | 0.868652 | |
Posterior teeth | 1Pa | 1Pb | |
4100.0 [2818.1; 48401.4] | 3479.5 [2708.8; 3995.6] | 0.017961 | |
1Pa | 2Pb | ||
3800.0 [2000.0; 4500.0] | 1999.0 [1646.3; 3120.8] | 0.017961 | |
p | 0.476973 | 0.153230 | |
* Differences between anterior and posterior teeth were statistically significant (p < 0.05).
In posterior teeth, compressive bond strength before thermocycling (subgroups 1Pa and 2Pa) was 4100.0 [2818.1–48401.4] N and 3800.0 [2000.0–4500.0] N, respectively. The difference between groups was not statistically significant (p = 0.476973), indicating the effectiveness of both adhesive systems. After thermocycling, compressive bond strength in subgroups 1Pb and 2Pb was 3479.5 [2708.8–3995.6] N and 1999.0 [1646.3–3120.8] N, respectively. The difference between groups was not statistically significant (p = 0.153230), confirming the effectiveness of adhesion and the integrity of the restoration–tooth complex.
Secondary Results
Comparison of compressive bond strength between anterior and posterior teeth showed higher bond strength in posterior teeth compared with anterior teeth before thermocycling (p < 0.05). After thermocycling in Group 1 (universal adhesive), a statistically significant difference in compressive bond strength was found between subgroups 1Ab and 1Pb (p < 0.05). In Group 2 (fifth-generation adhesive), no statistically significant differences were observed between anterior and posterior subgroups.
DISCUSSION
When comparing compressive bond strength before thermocycling, Group 1 (universal adhesive) demonstrated values in posterior teeth (1Pa) nearly 2.5 times higher than those in anterior teeth (1Aa) (p = 0.005). In Group 2 (fifth-generation adhesive), a statistically significant difference was also observed before thermocycling between anterior (2Aa) and posterior (2Pa) specimens, with posterior teeth showing 1.76 times higher bond strength (p = 0.023). After thermocycling, a statistically significant difference in compressive bond strength was observed in the universal adhesive group between posterior and anterior subgroups (1Pb vs 1Ab) (p = 0.023), with a 2.57-fold difference. However, specimens in the fifth-generation adhesive group did not demonstrate statistically significant differences in compressive bond strength between anterior and posterior teeth after thermocycling (2Ab, p = 0.269; 2Pb, p = 0.251). The absence of differences in compressive bond strength may be related to the viscosity of the adhesive or the thickness of the adhesive layer. Under compressive stress, an adhesive exhibits impact toughness, defined as the maximum energy absorbed per unit area of the bonded interface until bond failure under impact loading, expressed in kJ/m2. Impact toughness depends on factors such as adhesive viscosity, layer thickness, joint configuration, specimen size, angle of impact, environmental humidity, and test temperature. Adhesive strength directly correlates with impact toughness. When the elastic modulus of the adhesive is low, impact toughness increases with adhesive layer thickness. It is possible that in this experiment, with cavity dimensions standardized, bond strength was determined primarily by the viscosity of the adhesive or the thickness of the adhesive layer1.
The adhesive bond strength of restored teeth is commonly evaluated by tensile or shear testing, depending on standards adopted in different countries. Compressive bond strength is rarely assessed because it does not conform to these standards. However, compressive testing reflects not only the strength of the restoration but also the integrity of the restoration–tooth complex. In most cases, compressive strength has been investigated in relation to restorative materials. A study by Walia et al. evaluating the resistance of restorative materials—Ketac Molar, Giomer, Zirconomer, and Ceram-X—to occlusal loads demonstrated the highest compressive strength for Giomer [28].
In the present study, posterior teeth withstood higher loads than anterior teeth, which was consistent with previous research. In all groups, bond strength decreased after thermocycling. This reduction is influenced by the type of adhesive systemand by the anatomical characteristics of posterior teeth, including their morphology, surface area, and occlusal relief.
CONCLUSION
In anterior teeth, compressive bond strength before thermocycling was 1663.6 [1574.6–2175.1] N with the universal adhesive and 2151.5 [967.9–3970.3] N with the fifth-generation adhesive; after thermocycling, values were 1353.3 [1219.2–2096.8] N and 1620.7 [847.2–2434.7] N, respectively. In posterior teeth, compressive bond strength before thermocycling was 4100.0 [2818.1–48401.4] N with the universal adhesive and 3800.0 [2000.0–4500.0] N with the fifth-generation adhesive; after thermocycling, values were 3479.5 [2708.8–3995.6] N and 1999.0 [1646.3–3120.8] N, respectively. These findings indicate that both thermocycling and tooth group (anterior vs posterior) significantly influence compressive bond strength.
ADDITIONAL INFORMATION
Funding sources: No funding.
Disclosure of interests: The authors have no relationships, activities, or interests (personal, professional, or financial) with third parties (for-profit, not-for-profit, or private entities) whose interests may be affected by the content of this article. The authors also report no other relevant relationships, activities, or interests within the past three years.
Author contributions: S.N. Razumova, A.S. Brago: conceptualization, methodology, writing—original draft, writing—review & editing; O.R. Ruda, A.G. Talandis: software, formal analysis, investigation; O.R. Ruda: writing—original draft; L.M. Khaskhanova, E.Yu. Mendosa: formal analysis; F.S. Rusanov: investigation. All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
1 GOST 9454-78 Metals. Method of impact bending test at low, room, and elevated temperatures (with Amendments No. 1, 2). Moscow, Russia: Standards Publishing House; 1994.
About the authors
Svetlana N. Razumova
Peoples’ Friendship University of Russia
Email: razomova-sn@rudn.ru
ORCID iD: 0000-0002-9533-9204
SPIN-code: 6771-8507
MD, Dr. Sci. (Medicine), Professor
Russian Federation, MoscowAnzhela S. Brago
Peoples’ Friendship University of Russia
Email: anzhela_bogdan@mail.ru
ORCID iD: 0000-0001-8947-4357
SPIN-code: 2437-8867
MD, Cand. Sci. (Medicine), Associate Professor
Russian Federation, MoscowOxana R. Ruda
Peoples’ Friendship University of Russia
Author for correspondence.
Email: oxaruda@yandex.ru
ORCID iD: 0000-0001-9068-4722
SPIN-code: 7871-6802
Russian Federation, Moscow
Artur G. Talandis
Peoples’ Friendship University of Russia
Email: talandis_ag@pfur.ru
ORCID iD: 0009-0003-4955-360X
Russian Federation, Moscow
Lamara M. Khaskhanova
Peoples’ Friendship University of Russia
Email: Minutka7@yandex.ru
ORCID iD: 0000-0002-8167-7720
SPIN-code: 4209-0600
Russian Federation, Moscow
Elena Yu. Mendosa
Russian University of Medicine
Email: Mendosae@mail.ru
ORCID iD: 0000-0001-7517-4361
SPIN-code: 3192-8412
Russian Federation, Moscow
Fedor S. Rusanov
Central Research Institute of Dentistry and Maxillofacial Surgery
Email: diadya-fedor@yandex.ru
ORCID iD: 0000-0001-5280-0294
SPIN-code: 8739-0116
MD, Cand. Sci. (Medicine)
Russian Federation, MoscowReferences
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