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Year : 2019  |  Volume : 22  |  Issue : 12  |  Page : 1675-1679

Efficiency of self-adhering flowable resin composite and different surface treatments in composite repair using a universal adhesive

Department of Restorative Dentistry, Faculty of Dentistry, Altnıbaş University, Istanbul, Turkey

Date of Submission26-Apr-2019
Date of Acceptance07-Jun-2019
Date of Web Publication3-Dec-2019

Correspondence Address:
Dr. S Sismanoglu
Department of Restorative Dentistry, Faculty of Dentistry, Altinbas University, Bakirköy, TR-34147 Istanbul
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_233_19

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Aims: The aim of this in vitro investigation was to evaluate the efficiency of self-adhering flowable resin composite (Vertise Flow, Kerr, Orange, CA, USA) and different surface treatments in the repair microtensile bond strength (μTBS) of aged nanofill resin composites using a universal adhesive. Materials and Methods: Aged substrates (×5000 thermocycling) were prepared using a nanofill (Filtek Ultimate; 3M ESPE) resin composite and randomly assigned to different surface treatments: (1) no treatment (control), (2) acid etching with 37% phosphoric acid, (3) Al2O3sandblasting, and (4) sandblasting with CoJet (3M ESPE). After surface treatment, specimens were further divided into two groups: no universal adhesive application and universal adhesive application. Vertise Flow was added to the substrates at 2-mm layer increments to a height of 5 mm and light cured. Restored specimens were sectioned to obtain 1.0-mm2 beams for μTBS testing. Data were analyzed with two-way analysis of variance and Tukey's honest significant difference tests (P < 0.05). Results: The lowest μTBS values were recorded in the control and acid etching groups with no universal adhesive application (P < 0.05). Universal adhesive application significantly increased the repair μTBS values of all surface treatments (P < 0.05), except CoJet treatment. There were no significant differences between Al2O3sandblasting, CoJet application, and acid etching groups with the universal adhesive application (P > 0.05). Conclusion: Vertise Flow can be used effectively in the repair of old nanofill resin composites. The usage of universal adhesive with prior acid etching to obtain acceptable repair performance would be the practical choice under clinical conditions.

Keywords: Bond strength, composite repair, resin composites, sandblasting, universal adhesives

How to cite this article:
Sismanoglu S. Efficiency of self-adhering flowable resin composite and different surface treatments in composite repair using a universal adhesive. Niger J Clin Pract 2019;22:1675-9

How to cite this URL:
Sismanoglu S. Efficiency of self-adhering flowable resin composite and different surface treatments in composite repair using a universal adhesive. Niger J Clin Pract [serial online] 2019 [cited 2023 Jan 29];22:1675-9. Available from:

   Introduction Top

Composite restorations have been preferred more than amalgam in posterior region due to their aesthetic properties and elimination of mercury-related concerns.[1] Although great developments have been achieved in the development of adhesive procedures and resin composites, failures such as microleakage, wear, fracture, discoloration, and secondary caries may occur due to various reasons.[2] In such cases, total replacement of the restoration may result in disadvantages such as loss of sound dental substrates and risk of pulpal trauma. For these reasons, it is recommended to give priority to restoration repair, which is a more conservative approach rather than restoration renewal.[3],[4] The success of the repair process depends on the bond strength between the old, defective, and the new repair composite. The bond between the two composite layers is achieved by the nonpolymerized oxygen inhibition layer.[5],[6] However, aging and water absorption lead to the removal of the oxygen inhibition layer and the reduction of unsaturated double carbon–carbon bonds, thus causing reduction in microtensile bond strength (μTBS) between defective and repair resin composites when repair is required.[7],[8]

Various surface treatments including macromechanical, micromechanical, and chemical are applied to the restoration surface to be repaired, to improve μTBS values.[9],[10] Roughing of the defective composite by methods such as bur abrasion, acid etching, laser irradiation, and air abrasion increases mechanical bonding, while application of agents to the defective composite such as adhesive resin and silane contributes to chemical bonding. Tribochemical coating (silica-coated silane sandblasting) is also used to increase both mechanical and chemical bonding.[11],[12],[13] However, there is still no consensus on the most efficient composite repair protocol.[14] Among all these surface treatments, adhesive resin application to the bur-abraded old resin composite surfaces is the most commonly used method in clinical conditions. It has been reported that roughening the defective composite with diamond burs enhances the surface energy by removal of the superficial layer, thus increasing the mechanical retention of the repair material.[15],[16]

Recently, self-adhering, flowable resin composites are gaining popularity with simplified application technique. With their simplified application, self-adhering flowable resin composites could be used in the repair of defective direct composite restorations. Therefore, the aim of this in vitro study was to evaluate efficiency of self-adhering flowable resin composite in the repair μTBS of defective nanofill resin composite using different surface treatments. The null hypotheses were as follows: (1) there would be no differences between the surface treatments and (2) surface treatment would not increase the μTBS values.

   Materials and Methods Top

Ninety-six specimens were fabricated for this study. Nanofill restoration material (Filtek Ultimate A3.5; 3M ESPE, St. Paul, MN, USA) was loaded into a Teflon mold (5-mm cubiform) incrementally (2 mm maximum thickness) and a polyethylene strip was used by covering the top layer to obtain smooth surface. The resin composite specimens were light-cured for 20 s using an LED curing light (Elipar DeepCure; 1750 mW/cm2; 3M ESPE), and the light intensity was controlled before each curing operation. After removal from the mold, the samples were further polymerized for 20 s on all surfaces. All samples were kept in distilled water at 37°C for 24 h. Next, the polymerized samples were immersed in a water bath and aged by thermocycling (5000 cycles, 5°C and 55°C with a dwell time of 30 s). The upper surfaces of the aged resin composites were wet-ground flat with 320-grit silicon carbide paper[2] and randomly divided into five groups in accordance with the surface treatments:

Group 1: no treatment (as a control, n = 24).

Group 2: resin composite surfaces were etched for 20 s with 37% phosphoric acid (Scotchbond Etchant; 3M ESPE) and rinsed (n = 24).

Group 3: sandblasting was applied using a sandblaster (Basic quattro IS; Renfert GmbH, Hilzingen, Germany) from a 10-mm distance at 2.5 bar pressure, and 50 μm Al2O3 particles (Cobra; Renfert GmbH) were used (n = 24).

Group 4: silica-coated sand particles (CoJet Sand; 30 μm; 3M ESPE, Seefeld, Germany) were used to treat resin composite surfaces using the same sandblaster as described in Group 3 (n = 24).

After the completion of surface treatment procedures, the specimens were randomly divided into two subgroups according to the adhesive application: no universal adhesive application and universal adhesive (Single Bond Universal; 3M ESPE) application in accordance with the manufacturer's recommendations [Table 1]. A self-adhering flowable resin composite material (Vertise Flow; Kerr Dental, Italy) was applied as 2-mm-thick increments as a repair and light-cured for 20 s using the same curing device. Polymerized resin samples were stored at 37°C for 24 h in distilled water. The repaired specimens were sectioned across the adhesive interfaces using a precision sawing machine (Isomet; Buechler, Lake Bluff, IL, USA) to acquire 1-mm2 sticks. The resin–resin sticks in the peripherals of the specimens were not included in μTBS testing. Then, the sticks were fixed to a jig with cyanoacrylate for μTBS testing (Microtensile Tester; Bisco Inc., Schaumburg, IL, USA). The tensile load was performed until failure at a crosshead speed of 0.5 mm/min and recorded in megapascal. Failure modes were examined with a stereomicroscope at 30× magnification. The failure modes were categorized as adhesive failure, cohesive failure, or mixed failure.
Table 1: Composition, pH, and application strategy of the universal adhesive used

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Statistical analysis

The data were analyzed using a two-way analysis of variance (ANOVA), to determine the effects of surface treatments and universal adhesive application on the repair μTBS values. Post hoc analyses were done using Tukey's honest significant difference, and α = 0.05 was considered as statistically significant threshold.

   Results Top

Microtensile repair bond strength values of the repaired specimens are given in [Table 2]. The two-way ANOVA exhibited significant differences between the study groups (P< 0.05). The lowest μTBS values were recorded in the no surface treatment (6.54 ± 1.88) and acid etching (7.26 ± 1.66) groups with no universal adhesive application (P< 0.05). No significant difference was detected between no surface treatment and acid etching groups with no universal adhesive application (P > 0.05). On the other hand, the highest μTBS values were recorded in the CoJet application (12.10 ± 2.02; P < 0.05), followed by Al2O3 sandblasting (10.28 ± 1.87).
Table 2: Mean and standard deviation microtensile bond strength (MPa) values

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Universal adhesive application significantly increased the repair μTBS values of all surface treatments (P< 0.05), except CoJet. In addition, there were no significant differences between Al2O3 sandblasting, CoJet application, and acid etching groups with universal adhesive application (P > 0.05). Lowest repair μTBS values were exhibited by no surface treatment (control) group (P< 0.05).

Two-way ANOVA results indicated that universal adhesive application and surface treatment–type significantly influenced the repair μTBS values (P< 0.001). Also, an interaction was detected among these two factors (P< 0.001). The findings of the failure mode observations are presented in [Figure 1]. The universal adhesive application reduced adhesive failure rates and increased the mixed and cohesive failure rates.
Figure 1: Failure mode distribution

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   Discussion Top

This study aims to evaluate the efficiency of self-adhering flowable resin composite in the repair μTBS of defective nanofill resin composite using universal adhesive application and different surface treatments. In this in vitro study, universal adhesive application and surface treatments increased the repair μTBS values significantly. Therefore, both hypotheses were rejected.

The absence of an oxygen inhibition layer is a problem in the repair of defective, old resin composite restorations. To solve this problem, it is tried to increase the mechanical retention by roughening the old composite surface.[17] Many methods such as laser irradiation, Al2O3 blasting,[18],[19],[20] CoJet application,[19] acid etching with hydrofluoric acid,[21],[22] or phosphoric acid[18],[21],[22] have been investigated by the researchers. However, no consensus has yet been reached on the best surface treatment protocol. Clinicians often abrade the old composite surface with a bur before repairing resin composite restorations. Therefore, the surfaces of aged composites were roughened using 320-grit abrasive paper, in this study.[2] The lowest repair μTBS values were observed in the groups with no surface treatment. Peterson et al.[19] observed the lowest repair μTBS values in the no treatment group. They also found that the etch-and-rinse adhesive application increases the repair of Vertise Flow. These findings are in parallel with the results of this study.

Silanes are often preferred in repair processes because they act as a binding agent between the filler particles and the organic matrix. It is also known that silanes increase the wettability of the surface by modifying the surface energy.[12] In this study, a silane-containing universal adhesive was used for adhesive applications. Studies have reported that there was no significant difference between the use of additional silane application and silane-containing universal adhesives.[23] In this study, it was observed that the application of silane-containing universal adhesive significantly increased repair values compared with the control group.

Fornazari et al.[23] examined the influence of surface treatments and universal adhesive on the repair microshear bond strength (μSBS) values. Similarly, in this study, Al2O3 sandblasting and universal adhesive application have been found to increase repair μSBS values. On the other hand, they found that there was no significant difference between the universal adhesive application and Al2O3 sandblasting. Their findings coincided with this study. According to the two-way ANOVA, there was no significant difference between repair μTBS values of Al2O3 sandblasting (10.28 ± 1.87) and universal adhesive application (9.69 ± 1.36). In another study, Atalay et al.[18] reported that Al2O3 sandblasting increased the repair μTBS more than etching with phosphoric acid prior to universal adhesive application. In this study, no significant difference was found between surface treatments (Al2O3 sandblasting, CoJet application, and acid etching) prior to universal adhesive application. Vertise Flow contains glycerol phosphate dimethacrylate (GPDM) monomers. GPDM features a high hydrophilicity that results in a strong etching effect and a superior dentin wettability compared with other monomers.[24] Thus, the self-adhering, flowable composites possibly were able to wet the roughened resin composite surface better than conventional resin composites. Therefore, differences in composition between repair materials may be the reason of differences between two studies. On the other hand, it was reported that 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) monomers can chemically interact with zirconia.[25] Considering the presence of the zirconium filler in the Filtek Ultimate resin composite material, another reason for the universal adhesive application to improve the repair μTBS values may be that it contains 10-MDP monomer. When universal adhesives are applied, the inability of the surface treatments to make a significant difference on the repair μTBS values may also be attributed to 10-MDP monomer in the composition of the universal adhesive used.

The application of phosphoric acid increases the surface area by creating alterations on the resin composite surface and reveals the composite surface under the superficial layer.[26] However, Loomans et al.[22] investigated the effect of various acid etching methods on repair bond strength and reported that phosphoric acid alone did not result in a significant increase in repair bond strength. Similarly, the findings of our study showed that phosphoric acid application alone did not increase the repair μTBS values compared with the control group. The universal adhesive, which is applied after phosphoric acid etching, exhibited higher repair μTBS values than the universal adhesive application alone. In a different study, it has been reported that acid etching prior to universal adhesive application does not increase repair μTBS.[18] This difference may be related to the use of self-adhering flowable resin composite as repair material in this study.

   Conclusion Top

According to the result obtained, it can be concluded that self-adhering, flowable resin composite material can be used effectively in the repair of old nanofill resin composite restorations. Besides, it can also be estimated that additional surface treatments are required to increase repair μTBS. CoJet application and Al2O3 sandblasting surface treatments with no universal adhesive application enhanced the repair μTBS values. A significant improvement in repair μTBS was observed with the application of universal adhesive to bur-abraded old composite surface. However, there was no significant difference between Al2O3 sandblasting, CoJet application, and acid etching after universal adhesive application. Therefore, the findings of this in vitro study suggest the usage of universal adhesive with prior acid etching to obtain acceptable repair performance under clinical conditions.

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Conflicts of interest

There are no conflicts of interest.

   References Top

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  [Figure 1]

  [Table 1], [Table 2]

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