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Tensile Bond Strength of Composite to

Air-Abraded Enamei
Klaus-R. JahnyBirgit GeitelVEckehard KostkaVRegine Wischnewski*"/
Jean-Franois Roulet^

Purpose: The purpose of this study was to test the tensile bond strength of composite resin to enamel surfaces treated with kinetic cavity preparation (KCP| and acid etching, respectively.
Materials and Methods: Plane labial surfaces of 280 human maxiiiary centrai incisors were treated with
either KCP by varying treatment conditions or phosphoric acid gel. Composite sampies were bonded to the
pretreated surfaces with a bonding resin. After 24 hours specimens were leaded in tension in an Instron
testing machine until bond failure, A two-way anaiysis of variance was used to determine significant differences. The failure sites were qualitativeiy evaluated by SEM,
Resuits: The determined tensile bond strengths and obsen/ed failure modes demonstrated that acid-etched
enamei has a significantly higher bond strength tc composite resih than KCP-treated enamei surfaces,
Conciusion: KCP-prepared enamei has to be acid etched before bondingto composite resin,
J Adhesive Denl 1999:1:25-30

Submitted for pubiication: 20.07.98: accepted for publication: 31.08.98.

S a rule, cavities are irregular in shape because


before and after caries excavation, the shape of
the cavity has to be changed to meet the requirements of the filling materiai. This is usually carried
out with rotary instruments. However, their use is
not without probiems,^ Alternatives to rotary instruments are oscillating diamond burs" or air-abrasive
technology, calied kinetic cavity preparation (KCP),
This technology uses a narrowly focused particie

i Professor, Department of Operative and Preventive Dentistry and


Endodontics. Humboldt-University Beriin (Charit). Germany.
" Assistant Professor. Department of Operative and Preventive Dentistry and EnOodontics. Humboldt-University Berlin Charit). Germany.
'^ Associate Professor. Department of Operative and Preventive Dentistry and Endodontics, Huniboldt-University Beriin (Charit). Germany.
" Dentist, private practice. Beriin, Germany.
^ Professor and Chairman. Department of Operative and Preventive
Dentistry and Endodontics. Hurnboidt-University Berlin (Charit),
Germany.
Reprint requests: Prof Dr K.-R. Jahn. Department of Operative and
Preventive Dentistry and Endodontics. Humboldt-University Berlin
(Charit). Fhrer Str. 15, D-13353 Berlin. Germany.

Vol 1, No 1, 1999

Stream that abrades tooth structures in proportion


to the particle size, air pressure, nozzle distance,
and angle between nozzle and prepared surface
employed. According to many authors, KOP's advantages include less stress for the patient and less
trauma to the pulpal-dentin system,s Some authors
even claim that the KCP technique may be used to
condition the enamel surface instead of enamel
etching with phosphoric acid^'''^' and that the
restorative procedure wiii thus be easier if the KCP
technique is used. One way to determine if this is
true is to measure the bond strength of composite
to such conditioned enamei surfaces.

MATERIALS AND METHODS


Two hundred eighty human maxillary central incisors, stored in 20% alcohol, were cieaned and
embedded with the iabiai surface facing downward
with a PMMA material (Paiadur R, Kulzer, Wehrheim, Germany) into molds 30 mm in diameter.
After poiymerization ofthe resin, the surfaces were
ground with sandpaper in a polishing machine
(Struers DP-U4, Copenhagen) to expose an enamel

25

of the mold was removed and, to insure the proper


relation of the connector to the Instron fixture (90
degrees to the enamel surface), a screw holder was
placed on top ofthe mold (Eig 1, part B). After having set a screw into the composite, it was polymerized from the lateral aspect for 10 seconds. The
screw was manually loaded against the top surface
of the sample. After separation of the sample from
the screw holder and the mold, composite excesses
at the bottom of the composite cylinder were removed with a scalpel blade, and the sample was
cured from two sides at an angle of 45 degrees for
10 seconds each.
Fig 1 Sample with a half of the moid (part A and the screw
holder (part B).

surface of approximately 30 mm^ in the center of


the resm cylinder. The last step was performed with
sandpaper of 1200 grit.
Next, the 28C teeth were randomly divided into
20 groups of 14 mcisors. Sixteen groups were
treated with KCP (Whisperjet, American Dental
Technologies, San Carlos, CA) using different parameters (Table 1), but the blasting time was consistent (10 seconds). In three groups the enamel was
etched with a phosphoric acid gel (De Trey etch,
Dentsply, Konstanz, Germany) for 2C, 40, and 60
seconds (positive control), and in one group the
enamel was left untreated (negative control). In
order to obtain almost flat surfaces, the samples
were steadily moved manually in the KCP particle
stream for 10 seconds at a constant distance from
the nozzle of 1 and 3 mm. respectively. The powder
and the enamel debris were continually removed
with a dental aspirator. Final cleaning was performed with a blast of dry air.
Next, all enamel surfaces were treated with Optibond XR adhesive (Kerr, Glendora, CA) for 20 seconds. The adhesive was thinned out with a blast of
air, and a split mold (accordingto ISO/TC 1 0 6 / S C l /
W G l l but with an inner diameter of 4 mm, made of
brass) was placed on top of the sample (Fig 1, part
A). Eirst, the inner wall of the mold and the surface
of the enamel were covered with a thin layer of
composite (Herculite XR, Kerr) and the material was
polymerized for lC seconds with a plasma light-curing unit (ADT 1000 Plasma ARC Curing System,
American Dental Technologies). Then the mold was
filled with a defined volume of composite. One half
26

Twenty-four hours later, a tensile strength test


was performed using an Instron dynamic testing
machine (Model 8501, Canton, MA). The cross-head
speed was 0.5 mm/min. A 5 kN load cell was used
and the sampling rate was 0.02 kHz. After separation, the fracture interfaces were investigated with
loupes at a power of 2x. Furthermore, the enamel
surfaces were replicated with a polyvinylsiloxane
impression material (Silagum, DMG, Hamburg, Germany; Siliplast, Detax, Ettlingen, Germany) and an
epoxy resin (Stycast 1266, Emeerson & Cumming,
Westerlo-Oevel, Belgium). The replicas and the resin
samples were mounted on SEM holders with a conducting glue (Leit-C-Plast, Neugebauer, Mnster,
Germany). After sputtering with a Balzers sputter
device (Model SCD 030, Balzer Union, Liechtehstein) for 2 minutes at 40 mA, C.05 bar, the samples were investigated n a scanning electron
microscope (Model 1810 SEM, Amray, Bedford,
MA).

RESULTS
The results are summarized in Tables 1 and 2. The
most important result is that regardless of the conditions used, the bond strength to etched enamel
was significantly higher than the bond to enamel
treated by KCP (one-way ANOVA, Student-Newmah
Keuls test). As shown in Table 1, the particle size
had a more important influence than the air pressure on the bond strength, as was revealed by a
two-way ANOVA (by pooling the other factors, distance and angle. Table 3). The 27-pm particles
yielded a higher bond strength than the 50-|jm particles. Single comparisons between groups (f test,
adjusted according to Bonferroni) revealed that the
27-Mm particles yielded a higher bond strength with
an air pressure of 0.97 MPa.

The Journal of Adhesive De ntistry

ahnet al
Table 1 Test parameters and tensile bond strength of composite to
blasted enamei
Distance
Angle
of nozzle of nozzle
( >

1
1
1
1
1
1
1
1
1
1
1
1
3
3
3
3

Air
pressure
(MPal

Particle
size
(pm)

0.28
0.55
0.69
0.83
0.97
1.10
0.28
0.55
0.69
0.83
0.97
1.10
0.S3
0.83
0.83
0.S3

27
27
27
27
27
27
50
50
50
50
50
50
27
50
27
50

SO
80
80
80
80
80
80
80
80
SO
SO
SO
SO

so
45
45

Strength (MPa)
(standard deviation)
3.25
3.25
3,50
3,24
4,82
3.86
2.5-1
3.52
3.02
2.72
2.46
2.33
2.46
1.98
2.54
3,36

(1.37)
(1.15)
n
(1,03)
(1.72) n
(1.45) J *
(1.86)
(1.04)
(1.66)
(1.03)
(0.82)
(0.68)
(1.54)
(1.51)
(0.90)
-|
(0.98)
(0.99)
J

- P 0.01

Table 2 Tensiie bond strengtb of composite to acid-etcbed enamei at


various etching times
Tensile bohd strength [MPs|
(stahdard deviation)

Etching tirhe(s)
20
40
60
untreated ehamel

19,54
19,66
14,44
1,12

(3,96)
n
(3,38) ~|
'
~\
(3.47) J " J -|_
(0.99)
J'J

- P 5 0.01

Tabie 3 Two-way ANOVA: influence of particie size and air pressure on


tensiie bond strength

Bond strength
fhaih effects
(combined)
d
P
Two-way ihteractions, p*d
Model
Residual
Total

Sum of
squares

df

Mean
square

31,098
25.167
7.4S8
26.799
57.897
213.846
271.743

6
1
5
5
11
122
133

5.1S3
25,167
1,498
5.360
5.263
1,753
2.043

2.957
14.358
0.854
3,058
3.003

Sig.

0,010
0.000
0.514
0.012
0,001

d - particle sife.
p = arr pressure.

27

Air pranur piPa] n^.

tching tim \^

Fig 2 Tensile bond strength of composites bonded to enamei treated with KCP applied with different conditions (particle size, air
pressure, beam angle) at a constant distance of 1 mrr and a constant time (10 seconds). As controis, tensile bond strength of
comoosites on etched enamei (positive) and untreated enamei (negative) are shown (* P < 0,01),

No main effects were found for the angie, Oniy


with 50-|jm partioies a higher bond strength was
found with a 45-degree angle between the surface
ofthe sample and the direction ofthe nozzle.
The sampies in which the enamel was etohed for
60 seconds shov/ed significantly iower bond
strength than those with etching times of 20 and
40 seconds (Tabie 2, Fig 2). The negative control
(untreated enamel) showed the iowest bond
strength (P < 0,01), which was lower than etched
enamel, but aiso lower than enamei treated with
KCP (Fig 2),
As a rule, adhesive faiiure modes were observed
in the samples where the enamel was conditioned
with KCP, A typicai example is shown in Fig 3, The
same was true for the samples with untreated
enamei. Ail samples in which the enamel was
etched for 20 seconds showed cohesive fractures
28

of the composite (Fig 4), whereas 40 seconds of


etching time also produced mostly cohesive composite fractures except in two cases: in one case an
enamel fracture was observed (Fig 5) and in the
other sampie there was a mixed fracture. The sampies in which the enamei was etched for 60 seconds showed the foiiowing fracture modes: 64%
mixed, 29% cohesive, and 7% adhesive fractures.

DISCUSSION
Based on our results, it is obvious that the bond
strength of composite to etched enamel is much
higher than to enamei treated with KOP, As compared to untreated enamel, a significant but small
increase of bond strength could be observed forthe
KCP sampies. It is more than questionabie whether
The Journal cf Adhesive Dentistry

Fig 3 Adhesive fracture at the enamel-composite interface.


Enamel was conditioned with KCP, (a) Enamel after separation from adhesive and composite material, (b) Enamel not
bonded. (SEM, 25x)

Fig 5 Cohesive fracture within the enamei (enamel etched


for 60 seconds}, (a) Enamei prisms. [b Enamel surface, c)
Exposed dentin due to enamel fracture. (SEM, 23x

Fig 4 Cohesive fracture within the composite. The hole in


the center was created by the separation from the screw tip,
enamel etched for 20 seconds, (a) Enamei. (b) Composite
(SEM, 25x)

the tensile bond values ofthe KCP samples are sufficient to withstand the polymerization shrinkage
stress^ in a clinical situation. Our results are congruent with those of Wiedemann et al,12 who
showed with profiiometry and tensile bond tests a
iow, but as compared with etched enamei, insufficient increase ofthe composite-enamei bond after
KCP treatment. Berry and Ward,i Nikado et al,^
Roeder et al,io and Valentino and Nathanson^ihave demonstrated that conditioning the enamei
with KCP IS not sufficient to obtain a good bond to
composites. The bond strength values reported by
Valentino and Nathanson,ii who used maleic and
orthophosphoric acid as a conditioning agent, were
much lower than those in the present study. This
couid be explained by either the thermocyciing or
the different test used (shear bond], Roeder et al^o
reported simiiar bond strength values also using
Optibond and Herculite. However, no details about
the air pressure used for biasting were given. Berry
and Ward^ reported values between 8.5 and 13.8
MPa based on tensiie tests. This is substantiaily
higher than the tensile strength reported in the present study. However, they did not specify the particie
size used for blasting.
In contradiction to our results, Laureli et a l ' and
Keen et al^ reported equal shear bond strength val29

ues for etched and KCP-treated enamel. However,


these results are only partly comparable because of
the different methodology (shear bond test). Also,
the details of their investigations are unknown for a
vaiid comparison,5 Furthermore, their values are
higher than the accepted standard in the literature
for shear bond strength on etched enamel.
The results of the fracture interface evaluation
reported in the present study support the superiority of the etching technoiogy. All sampies in which
the enamel was conditioned with KCP showed adhesive fracture modes, whereas the majority of the
etched samples showed cohesive fractures indicating that the bond strength at the interface is higher
than either the strength of enamel or composite.

CONCLUSION
Since the bond strength of composite bonded to
KCP-treated enamel is considerabiy lower than that
of composite bonded to etched enamel, KCP cannot be used as a substitute for etching technoiogy.
As a consequence, if the KOP technique were used
for cavity preparation, the enamel margins should
be etched before the insertion of the composite.

30

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2, Burrow MF, Tagami J, Negishi T, Nikaido T, Hosoda H, Early
tensile bend strengths of severai enamei and dentin bonding
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The Journal of Adhesive Dentistry

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