The Microtensile Bond Test: A Review

David H. Pashleya/ Ricardo M, Carvalhob/ Hidehiko SanoV Masatosiii Nakajima^/ Masahiro Yoshiyama^/YasuoSinonoV Carios A. FernandesS/ Franklin Tay'^

Purpose: The purpose of this review is to describe ail of the various modifications of the microtensile bond test in one paper, so that investigators can select the modification that best suits their needs. Methods: The essence of the microtensile test is the division of resin-bonded teeth into siabs between 0.5 and 1.0 mm thick that are then trimmed in such a manner that tensile force will be concentrated on the bonded interface during testing. Among the many advantages of the technique are that each tooth produces multiple specimens. Further, there is no need for a matrix to limit the bonded surface area, since the area is determined by the dimensions of the trimmed specimens. Results: The various modifications of the microtensile test have been used to measure differences in regional bond strength across occiusal dentin, down the external surface of teeth from crown through roots, down the internal surface of root oanals from cervical to apical thirds, as well as tc ccmpare normal vs caries-affected occiusai dentin and normal vs sclerotic cervical dentin. The technique is ideal for evaiuating the long-term duraiiity of resin-hard-tissue bonds. Conclusion: The microtensile test methods offer versatility that cannot be achieved by conventional methods. It is more labor-intensive than conventional testing, but holds great potential for providing insight into the strength of adhesion of restorative materiais to clinicaiiy reievant sites and substrates. JAddesive Dent 1999; 1:299-309. Submitted for pulication:11.08.99: accepted forputilication:17.09.99.

any laboratories use simple shear or tensile a Regent's Professor, Department of Orai Bioiogy and Maxiilofacial bond tests to compare products or evaluate Pathology, School of Dentistry, Medicai College of Georgia. Authe infiuence of exprimentai variables on resingusta. Georgia. USA. dentin bond strength. Generally, they limit the iocab Assistant Professor. Department of Operative Dentistry, Bauru tion of the bond to the center of the occiusai or Schooi of Dentistry. University cf Sao Pauio, SP, Brazii. c Professor, Department of Operative Dentistry. School of Dentistry, iabiai surface of midcoronal normal dentin. The bonded surface is demarcated using a 3- or 4-mmHokloido University. Sapporo. Japan. diameter hole punched in sticky tape, or some type d instructor. Department of Operative Dentistry, Tokyo Medical and of matrix is used that is 3 to 4 mm in diameter (7 to Dental University, Tokyo, Japan, e Assistant Professor. Department of Consen/ative Dentistry School 12 mm2). These simpie tests served well when resin-dentin bond strengths were reiatively low (ca of Dentistry, Tokushima University, Tokushima. Japan. f Assistant Professor, Department of Operative Dentistry, Kyushu 10 to 15 MPa). iHowever, as bonding techniques and materials improved, the bond strengths beDentai Coilege, Kitakyushu City, Japan, g Assistant Professor, Department of Operative Dentistry. School of came high enough to cause cohesive faiiures in dentin. That is, dentin broke from dentin, leaving Dentistry. University of Estadual De Ceaia. Fortaleza, Brazil, h Assistant Professor. Department of Conservative Dentistry, The the resin-dentin interface intact. The frequency of Prince Philip Dentai Hospital. Hong Kong, China. cohesive failures of dentin can be as high as 80% when bond strengths reach 25 iViPa.^ Such faiiures Reprint requests: Dr. David H. Pashiey, Dept of Orai Bioiogy and of the substrate preciude measurement of interfaMaxWofaoiai Pathoiogy, Schooi of Dentistry Medicai Coiiege of Geor- cial bond strengths and limit further improvements gia. Augusta. Georgia 30912-1129. USA. Tei: ++1-706-721-2033, Fax: ++1-706-721-6252, e-maii: dpashley@maii.mcg.edu

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Pashiey et al in bonding formulations, since the tests can no longer detect improved adhesion. Such cohesive failures in dentin do not mean that the resin-dentin bonds are uniformiy stronger than the intrinsic strength of dentin, but that the manner in which the bond is stressed is so non-uniform that it is concentrated or focussed at one highiy iocaiized region where it opens a crack in dentin, that then failsThese stress concentrations often exceed 100 MPa, even though the calcuiated average bond strength is only 25 MPa,20-22 To avoid cohesive failures of dentin during bond testing, it IS necessary to improve stress distributions during testing. This can be accomplished by the singie-plane lap-shear system,^ or by the microtensile bond testing methods described in this review. Both are more iabor-intensive methods than conventional methods, but both avoid inducing cohesive faiiures in dentin. Both methods tend to iower the variance associated with testing to 10% to 25%, instead o f t h e more common 30% to 50% variance seen in conventionai testing. Both methods have been used to evaluate regionai differences in the strength of dentin or resin-dentin bonds, although this is more easiiy accompiished with the microtensiie method. Regionai differences in r e s i n - d e n t i n bond s t r e n g t h have been reported,12.is indicating that these differences are greater than tooth-to-tooth variations. In some parts of the world, it is difficult to obtain extracted teeth, especially intact premolars and third molars. The microtensile testing method permits multiple specimens to be prepared from each tooth. Thus, there is a trade-off between the extra labor involved in using this method, and the extra data that can be obtained per tooth, Microtensile bond testing was originaiiy designed to permit evaiuation of bond strengths between adhesive materiais and smaii regions of dental tissue (eg, occiusal vs middle vs cervical third of enamei,^^ normai vs adjacent caries-affected dentin,^ occiusal vs gingivai walis of Class V wedge-shaped iesions),2^ One advantage of the technique is that the bonded interface of smail (ca 1 mm2) specimens has a better stress distribution during loading, so that there are fewer cohesive failures in dentin than are found with more conventional testing.8 This is thought to be due to a reduction in flaw density. Using this method often results in higher apparent bond strengths at failure than are found using large specimens,2 Since the introduction ofthe technique,i3 a num300 ber of iaboratories have made numerous modifications to it. The purpose of this review is to describe all of the various modifications of the microtensile bond test in one paper so that investigators can select the modification that best suits their testing needs. The advantages and disadvantages of the various techniques are aiso discussed.

MATERIALS AND METHODS The original microtensile testing was done on mineraiized dentin to measure its ultimate tensile strength (iJTS) and moduius of eiasticity," To measure UTS, the specimens were trimmed to an hourgiass profiie (simiiar to Fig IF) to produce uniform stressing of the smaiiest oross-sectional area. To measure the modulus of eiasticity in tension, the need of a known gauge-iength required that the specimens be trimmed to the outline of an " I " beam,!'' j ^ a t approach has also been used to measure the UTS and eiastic moduius of the demineraiized dentin matrix^^ by protecting the mineraiized ends of the specimens with nail varnish, whiie the central region was demineralized in EDTA, in the originai microtensiie bond test, the occiusai surface of the tooth was ground fiat (Fig IB), The entire surface was bonded, and a iarge resin composite buiidup was created (Fig IC), The need for a matrix or mold that defined the bonded surface area was eliminated, and with it, attendant concerns about uneven thickness of adhesives, meniscus effects, creation of flashing, etc.s Indeed, there is theoreticaily no need to produce a fiat surface using polishing devices. The surface to be bonded can be fractured, polished, or bur cut. This concept has never been evaluated, but could easily be tested, Microtensile testing can be done en teeth prepared exactly as they are restored ciinicaiiy, because the bonded surface area is determined a f t e r b o n d i n g , not before bonding, by trimming (Fig I C to F), if bond strengths are relatively iow (ca 5 to 7 MPa), the use of a high-speed handpiece to trim the specimen may cause premature failure of the bond. This is due to slight eccentric movements ofthe bur which cause vibrations in the specimen, as well as uneven cutting force when trimming is done "freehand." Another method of trimming is to create a plexiglass table on an Isomet saw (Buehler, Lake Forest, IL, USA) and trim the specimen under microscopic The Journal of Adhesive Dentistry

Figl Schernatic illustrating the essence of the microtensiie bond testing technique. A tooth surface is prepared (B| and a resin composite crown is created (C). One day later the restored tooth is vertically serially sectioned into 0.7- to 1.0-nimthick slabs (D|. Each slab (E) is then trimmed to concentrate the stress to the bonded interface of interest, using a gentle curve (F] or a slot (G. A single siab (E can be further divided into two specimens (E') that can be trimmed (E"). When dividing the restored tooth into slabs (D), the tooth can be rotated 90 and the slabs converted into sticks (D'). Each stick can be tested without trimming (D") or it can be turned in a microlathe to form an hourglass cylindrical shape (D"').

observation, using the device like a table saw. This creates a very narrow channel of removal of dentin and resin composite {Fig lG).i' The width of this channef can be increased by mal<ing multiple passes or by placing a shim on one side of the blade to make it eccentric, thereby cutting a wider swath through the specimen as it turns (Dr Robert Chappeii, personal communication). There has been no systematic evaluation of the effect of shape of the trimmed specimen on measured bond strength, aithough Phrukkanon et al found that
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there was no effect of cylindrical vs rectanguiar cross sections.ii Due to the strong effect of cross-sectional area on resin-dentin bond strength,^^ ^ g important to make certain that there is no statistically significant difference in bonded cross-sectional areas between exprimentai groups, if differences exist, then one must adjust for the covariant of bonded area using the Least-Squares Means test, which adjusts for such differences prior to comparing bond strengths. We prefer to trim specimens to 0.8 to 1.0 mm^.
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Fig2 Schematic illustration of the crown of a tooth that was used to measure regional differences in resin-enamel bond strength (A], Bonded specimens (B) were then divided in half tc provide lingual and buccal specimens (C), Each half was then vertically serially sectioned tc produce multipie siabs that were trimmed to the appropriate cross-sectional area (D) and site. From Shono et al^^ with permission.

In tbe original method, a large resin-bonded molar yielded 5 to 8 siabs when vertically sectioned (Fig lC to F), depending upon the thickness of the blade and the desired thickness of the slabs. Thus, eacb tooth yieided 5 to 8 specimens for bond testing, instead of a singie specimen using conventionai testing. This also creates statisticai problems. Should one calcuiate a mean standard deviation per tooth or pool the specimens of severai teeth? We prefer tbe latter approach. This will be discussed in more depth below. To determine the relationship between resindentin bond strength and tootb location, one must divide dentin into small specimens, Watanabe et al reported differences in the intrinsic strength of dentin in different regions,23 However, Shono et al found no consistent influence of region on resindentin bond strengths on occiusal surfaces.^^ They also found no differences in resin-enamei bond strengths between buccal and lingual surfaces.^^ Pbrukkanon et al, using a modification of tbe microtensile technique [Fig ID"), reported there was little difference in resin-dentin bond strengths witb location or in tensile vs shear testing,12 The original method has been modified by Carvalbo (unpublished observations] by dividing the flat occlusai plane of dentin (Fig IB) into two equai halves by lightiy scoring a line across the surface
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with a bur. One side of the tooth can serve as a control. This provides paired specimens for improved statistics. Another modification is to vertically divide siabs into two halves to double the number of specimens that can be created from a single siab (Fig IE' and F"), Carvalho has aiso divided a single large slab into three smaller siabs, each of which can be trimmed. In a simiiar manner, Shono et al divided molars into buccai vs Iinguai halves, and eacb halt was then divided into 4 individual slabs (Fig 2),i8 The use of such small specimens requires speciai testing jigs that insure application of pure tensiie forces and avoidance of torquing forces. This has been done using the Bencor Multi-T (Fig 3, ieft) device (Danville Engineering, Danville, CA, USA) operated in an instron machine (Instron, Canton, MA, USA). More recently, severai groups have begun using an even smaller jig designed by Dr Bernard Ciucch|9'io and shown in Fig 3 (right), A natural progression of siab reduction into smaiier and smaller components was the creation of what we cali the non-trimming microtensile bond strength test. In this technique, each of the 5 or 6 siabs is cut into 7 to 8 sticks or beams (Fig 4)^ the top half of which is resin composite end the bottom haif of which is dentin. Using this technique, a single tooth yields 25 to 30 such specimens with
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Fig 3 Schematic illustration of two testing devices. The Bencor Multi-T device (ieft) was designed to permit a wide variety of shear and tensile testing. It was modified for trie micro-tensile test by creating opposing flat surfaces on stainless steel cylinders. The Ciucchi device (right) is much smaller (note tlie scale) and is not avaiiabie commercially although any machinist could duplicate it. Due to the small size of the test specimens, they can not De "gripped" in the classic sense, but are glued to the testing apparatus with quick-set cyanoacryiate. The devices insure that pure tensile loads are applied during testing. Fig 4 Schematic illustration of the non-trimming microtensile test. The restored tooth (A) is vertically sectioned (B) into siabs with care taken to identify the buccolingusi and mesiodistal location of each slab and of each subsequently created stick (C). Each stick is glued to the flat stainless steel "grip" with cyanoacryiate (D). In actual testing, the cyanoacryiate covers the entire surfaces of both ends of the stick to increase the surface area of the cyanoacrylate-stainiess steei bond. If too little cyanoacryiate is used, the strength of the resin-dentin bond may exceed the strength of the cyanoacryl3te-steei bond, requiring re-gluing.

square cross sections of 0.7 to 1,2 mm^, depending upon hovii it is done (Fig ID and D'), These sticks are created using the piexigiass table on an Isomet saw under microscopic observation. Alternatively, tbe composite resin buildup can be sectioned into 5 or 6 slabs with care, so that the blade does not pass entirely through the base. The tooth is then rotated 90 degrees and another 5 to 6 sections are made, resulting in 25 to 30 sticks that remain attached to the base. After iabeling each stick, they are separated from the base of the tooth for testing (Fig ID*'], If care is taken to identify the buccal, lingual, mesial, and distal regions of the tooth, this method can be used to evaluate the uniformity of bond strength across an occlusal surface,19 Although that study showed that bonding to dentin is not very uniform, there was no consistent variation in bond strength as a function of location. The non-trimming method apparentiy piaces less stress on adhesive bonds, because it

has been able to measure the bond strengths of m a t e r i a l s t h a t produce relativeiy low bond strengths. Bond strengths as iow as 5 MPa have been measured using the non-trimming technique. Recently, a finite element (FE) analysis was made on the stress distributions of the hourglass profile of trimmed specimens vs the same crosssectional area from a cylindricai f o r m , i i The FE analysis cieariy demonstrated the improved stress distribution of the cylindricai hourglass configuration, aithough actuai testing of specimens made in

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Application ol adhesive on the cavity and build-up of resin composite Sectioning into 15 slabs (0,75 mm thick) at right angles to the iong axis enamel coronai dentin C6r\/ical dentin middie root dentin apicai root dentin

Preparation of along cavity in enamel and fniddie dentin of a cuspid tooth

Measurement ot tensile bond strengths at a cross-head speed ot 1 mm/min Trimming ot bonded surfaces to give a bonded surface area ot 1

Fig 5 Schematic illustration of the long class V cavity preparation that begins in enamel and foilows the labial surface of the tooth to the apex of the root. After conditioning, priming and appiying of adhesive, the tooth is incrementally restored in resin composite that is over-ccntoured to provide additional bulk for handling. Muitipie horizontal serial sections are made with care to note the location. These sections are piaced on moistened paper towels to prevent drying. Each section is then trimmed to provide a 1 x 1 mm test area, and then giued to the test device. This technique offers simple screening of the regionai differences in bond strength of adhesive materiais. if a water-fiiied tube is placed in the apex of the root and the tooth is suspended from the tube 15 to 20 cm below the height of the meniscus in the tube, the bonding and storage can be done under physiological pulpal pressure.

the two configurations showed no differences. That group aiso demonstrated no difference in the strength of dentin whether it was shear or tensile tested, when the specimen cross-sectional areas were small.^^ Due to variations in the structure of dentin between coronal and radicular dentin, the strength of resin-dentin bonds may vary. Another modification of the miorotensiie test that is very useful in rapidiy evaiuating regional differences in bond strength is calied the "iong Class V cavity preparation."^e Using diamond burs in a high-speed handpiece with copious air-water spray, about 1 mm of enamel and 2 mm of coronal dentin and cementum-root dentin Is removed to form a cavity that is about 4 mm wide X 2 mm deep x 12 to 16 mm long (Fig 5).26^27 When the surfaces are acid etohed, rinsed, primed, and bonded, the original contour of the tooth is restored with a light-cured composite. The surface

and margins are then finished using standard ciinicai polishing techniques. The restored tooth is then placed in 37C water for 24 h. The next day, the specimens are removed, and the restored surfaces are acid etched with 35% phosphoric acid gei for 15 s and rinsed. Subsequently, a bonding agent is appiied, and a iarge excess of composite resin is applied to the originai composite. The buildup is done in 1.5-mm increments with 40 s light curing to a depth of about 3 to 4 mm. The restored tooth with the excess iabiai composite resin is placed in an Isomet saw, and serial slabs about 1.0 mm thick are cut and placed in the order that they were cut onto a piece of moist paper towel. By knowing the originai length of the prepared cavity, the thickness of the biade, and the thickness of each siice, one can caicuiate whence the slab originated (eg, cervicai, middle, apical third of root dentin, etc). The specimens are then trimmed to an hourglass shape

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Fige Illustration of the preparation of post space in a root (A-D). Some systems include a brush (E) to olean out debris. After inserting a post or flowabie composite, the root is serialiy sectioned horizontally (F), trimmed into equal halves (G) and then a test site is seiected and isolated (H) by trimming so that the smallest cross-sectionai area (cs 0,8 x 1,C mm) exists at the test site. Excess cyanoacryiate is used to giue both ends of the trimmed specimen to the testing device (I),

and tested in the tensiie tester (Fig 5), Although this technique does not simuiate ciinicai practice, it provides a convenient survey of bonding to enamei and ooronal and rootdentin.26.2"^ Another variation of this technique is usefui for measuring regional variations in resin bond strength to endodontic posts or the inside of root canais, Fernandes and Pashiey (unpubiished corporate report) recently developed that technique which is shown in Fig 6, To better simuiate ciinicai practice, Yoshiyama et ai obtained extracted teeth with wedge-shaped cervicai iesions.2^ These were bonded with one of three adhesive systems and restored as one wouid do in clinical practice. The controi teeth were extracted normai teeth with no cervicai lesions. Wedge-shaped cavities were prepared in them that had the same shape and depth as the authentic iesions (Fig 7A and A'). These teeth were bonded just like the other teeth. One day iater, the finished composites and surrounding dentin were acid etched, treated with bonding agent, and excess composite resin was added (Fig 7B and B'), Four to six slabs were made in a buccoiinguai direction, each 0,7 to

0,8 mm thick (Fig 7C and D'), The first slab was trimmed to an hourgiass profile, with the narrowest area at the bonded interface at the occiusai floor of the wedge-shaped lesion (Fig 7D), The second slab was trimmed so that the narrowest region was at the resin-dentin interface of the gingival floor of the wedge-shaped lesion (Fig 7E), By using alternate siabs, one can evaiuate the bond strengths of both walls of wedge-shaped lesions in the same restoration. Alternate siabs could also be used to evaiuate the bond strength of the peripheral half vs the central half of the gingival fioor aione, Ciucchi^ was the first to use the microtensiie method to evaluate resin-dentin bonds to different regions of restored MOD preparations (Fig 8A to F), This study was technicaiiy demanding, but demonstrated the utiiity of this innovative approach. The non-trimming (stick-forming) method couid also have been used in this type of study. The essence of the Ciucchi method is the different planes used to section compiex restorations (Fig SC vs C). These preparations have compiex C-factors,"* but these can be controiied for through proper exprimentai design,^'i
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D'
Fig 7 Schematic illustrattng the use of the mtcrotensile test to measure resin-denttn bond strength to the upper and lower margins of wedge-shaped sclerotic dentin. Wedge-shaped lesion (natural or artificial) (A, A'). After restoration to contour, excess composite is added (B, B'j to provide enough bulk for specimen preparation C. Alternate slabs of the vertical serial sections are trimmed at the upper (D) vs the lower (E) margins.

Through careful trimming, the microtensiie bond testing method permits isolation of specific types of dentin in addition to specific locations. Nai^ajima et al^ were the first to use this method to measure the bond strengths of resin adhesives to caries-affected dentin {Fig 9). Using caries-detector stain to identify the presence of infected dentin, the occlusai surfaces of carious dentin were ground down untii hard, opaque, caries-affected dentin was reached, surrounded by normai dentin (Fig 9B|. After bonding and creating a composite resin crown (Fig 9C), serial vertical sections were made through the entire crown, creating a series of slabs through both normal and caries-affected dentin. Using a high-speed handpiece and an uitrafine diamond bur, the normal dentin surrounding canes-affected dentin was removed from both sides to create an hourglass shaped specimen (Fig 9D and E). This insured that the entire test area was iocated in caries-affected

dentin. Slabs of normal dentin were trimmed in the same manner to the same cross-seotional area to serve as controls. This technique demonstrated that the use of 10% phosphoric or maleic acid on caries-affected dentin produced lower bond strengths, and that the combination of 32% to 35% phosphoric acid and moist bonding produced resin bonds to caries-affected dentin that were as high as those made to normal dentin.^.^ Similar studies need to be done on caries-affected dentin in complex preparations where the C-factors are higher than those obtained on flat surfaces.'^'2i in the past, few studies have been done on the bond strength of resin-dentin bonds aiiowed to function in vivo for more than a day, because the testing methods required large flat surfaces. Recently, Sano et al placed composite resins in large Class V preparations in moni<ey teeth in vivo.^^ They extracted teeth at 1 day, 6 months, or 12
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Fig 8 Use of the microtensiie testing technique to measure resin-dentin bond strengths to different regions of a MOD resincomposite restoration (A], When serially-sectioned in the mesipdistal direction (B, C, D), the slabs can be trimmed tc isolate the pulpal or gingival resin-dentin bonds (E) or the bonds to the axial walls (F), When sectioned in tine buccolinguai direction (B'j, other regions can be tested (C, D', E).

Fig 9 Schematic iliustrating the use of the microtensiie technique for measuring resin bond strength to normal and cariesaffected dentin in the same tooth. The occlusal surface (A) was ground flat after staining the carious lesion with caries-detector solution. Flat surfaces avoid the complications Pf varying C-factors,'' After reaching hard, opaque caries-affected dentin (B), the entire surface was then bonded and a resin composite crown created C), that was verticaliy-sliced into siabs ID), Note that some of the siabs were composed entireiy of normai dentin, whiie other slabs contained caries-affected dentin surrpunded by normal dentin (D, Using an ultrafine diamond bur, the normal dentin was removed so that the entire bonded interface was on caries-affected dentin (E, Similar t r i m m i n g was done to specimens bonded to normal dentin as controls.

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months, and prepared them for microtensile bond tests. The Ciearfii Liner 2 (Kuraray, Osaka, Japan) bond strengths were ail about 19 MPa, regardiess of time in function, but SEM examination of the failed bonds demonstrated a deterioration of both the composite resin and the hybrid iayer at 6 and 12 months. Indeed, the small size of the bonded interface permits both sides of the failed bond to be placed on the same SEM stub. The number of tubules per mm^ in middle dentin is about 20,000 to 30,000. Thus, even a 0,5- x 0,5-mm specimen with a surface area of 0.25 mm^ contains 5000 to 7500 tubuies. However, these can be readily surveyed by SEM, This permits good correlations to be made between the bond strength of tbat specimen and the SEM appearance of the interface.^ These small specimens aiso facilitate the examination of the bonded interface by TEM (Tay, unpublished observations). Hopefully, as more investigators understand the broad utility of the microtensile test methods, more long-term in vivo evaluations of composite resin bond strength will be performed. Since the trimmed specimens are very small, they can be prepared from restored teeth that have been in function for varying periods of time,i6 This same technique can be used to measure changes in the strength of resin-cement iuted castings to dentai tissue. That is, one would perform such experiments on teeth that were scheduied to be extracted for periodontal, orthodontic, or prosthodontic reasons. The cemented casting would be allowed to function for a defined period and then the tooth would be surgically removed. After cleaning the casting with an air abrasion system, the crown would be embedded in resin. After polymerization, serial verticai sections would be made through the extracted tooth and excess resin to form multiple slabs. The slabs would be trimmed carefully so that the thinnest portion of the specimen was at the point of interest (eg, resin cement-dentin interface). In conclusion, the microtensiie bond testing methods offer versatility that cannot be achieved by conventional methods. It is more labor-intensive than conventional testing, but hoids great potential for providing insight into the strength of adhesion of restorative materials used in dentistry as a function of time.

ACKNOWLEDGMENTS
This wurk was siippurted, in pan, by grant DE 0642'? from the NIDCR (10 DHP) and FAPESP grant 95/3895-9 (to RM<-'l

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TheJournal of Adhesive Dentistry

Pashiey et al 17, Schreiner RF, Ohappeii RP, Glaros AG, Eick JD. Microtensile testing cf dentin adhesives. Dent Mater 1998:14:194-202. IS. Shone V, Terashita M, Pashiey EL. Brewer PD, Pashiey OH. Effects of surface area on resin-enamel tensiie bond strength. Deni Mater 1997;13;290-296. 19. Shono Y, Ogawa T. Terashita M, Oarvalhc RM, Pashiey EL, Pashiey DiH, Regionai measurements of resin-dentin bonding as an array. J Dent Res 1999;78:699-705. 20. Samsfi S, Van Noort R, Do dentin bond strength tests sefve a useful purpose? J Adhes Dent 1999;1;57-B7. 21. Van Noort R, Norcczi S. Howard IC, Cardew G. A critique of bond strength measurements. J Dent 1989; 17:61-67. 22. Versiuis A, Tantbirojn D, Dougias WiH. Why do shear bond tests pull out dentin? J Dent Res 1997:76:1298-1307. 23. Watanabe LG. fviarshaii GW. Marshaii SJ, Dentin shear strength; Effects of tubuie orientation and intratooth iocation. Dent Mater 1996:12:109-115. 24. Voshikawa T, Sano H, Burrow MF, Tagami J, Pashiey OH. Effects of dentin depth and cavity configuration on bond strengths to dentin. J Oent Res 1999:78:898-905. 25. Yoshiyama M, Sano H. Ebisu S, Tagami J. Ciucchi B, Oarvaiho RM, Johnson MiH, Pashiey DH. Regionai strengths of bonding agents to cervical sclerotic dentin, J Dent Res 1996:75:

ORAL HEALTH
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his booi< focuses on practicai, preventive T oral hygiene measures for the orthodontic patient. The authors emphasize patient education and motivation, as well as preventive techniques, with the goai of optimal orthodontic results. Also presented is a fundamentai analysis of the detailed factors involved in the deveiopment and prevention of caries and periodontitis in the orthodontic patient. Using this book, the entire dental team can develop individuaiized preventive programs for patients with orthodontic appliances.

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26. Yoshiyama M, Oarvaiho RM, Sano i-l. Homer JA, Brewer PD, Pashiey DiH. Regicnai bond strengths of resin to human rcot dentine. J Dent 1996:24:435-442. 27. Ycshiyama M, Matsuo T Ebisu S, Pashiey DH. Regionai bond strengths of self-etching/seif-priming adhesive systems. J Dent 1998:26:609-616. 28. Zhang Y, Agee K, Nor J, Carvaiho RM. Sachar B, Russell OM, Pashiey DH, Effects of acid-etching on the tensiie properties of demineralized dentin matrix. Dent Mater 1998:14:222228.

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Effects of Orthodontic Treatment on Oral Health Evaluation of Oral Health and Measurement of Risk Professional Measures for Reducing Oral Bacteria Home-Care Measures for Reducing Oral Bacteria Pharmaceutical Adjuvants for Preventing Caries and Periodontai Disease Systematic Program for Preventing Caries and Periodontai Disease in
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