title: An ultrastructural study of the application of dentine adhesives to acid-conditioned sclerotic dentine.
abstract: OBJECTIVE
  This in vitro study examined the ultrastructure of resin-infiltrated sclerotic dentine following the application of a self-etching primer, with or without the adjunctive use of phosphoric acid pre-conditioning.
  
  
  METHODS
  Non-carious, natural cervical sclerotic lesions were hand-cleaned with a slurry of pumice and chlorhexidine and bonded without further cavity preparation. One group was bonded using Clearfil Liner Bond 2V (Kuraray Co. Ltd, Osaka, Japan) alone. Specimens from the other group were pre-conditioned with K-etchant (40% phosphoric acid gel, Kuraray) prior to the application of the same self-etching primer. Artificially prepared wedge-shaped lesions were also made in sound bicuspids, bonded using the two methods, and used as controls for the two groups. For SEM examination, each specimen was cryofractured into two halves through a pre-formed slit made on the lingual surface, after the respective conditioning treatment. Different locations within the lesions were examined after rinsing of the phosphoric acid/self-etching primer and specimen dehydration. For TEM investigation, specimens were bonded with the adhesive. Both demineralised and undemineralised ultrathin sections were prepared from the occlusal, gingival and deepest part of the wedge-shaped bonded lesions following specimen fixation, dehydration and resin embedding.
  
  
  RESULTS
  A hypermineralised surface layer was present on the surface of etched sclerotic dentine. This layer was thicker in the deepest part of the natural lesions, where bacterial colonisation of the lesion surface was also apparent. Both treatment protocols were unable to effectively dissolve sclerotic casts that occluded the dentinal tubules. Depending upon the thickness of the surface layers at different locations in the natural lesion, self-etching primer treatment alone resulted in reduction of the thickness of the authentic hybrid layer (i.e. hybridised intertubular dentine). This was also true of phosphoric acid pre-conditioning along the deepest part of the natural lesions. Within this region, intertubular dentine completely devoid of an authentic hybrid layer could be seen in both treatment groups. Resin tags were also sparsely observed in such regions.
  
  
  CONCLUSIONS
  Adhesive strategies that rely mostly on micromechanical retention alone may be compromised by the sporadic absence of the hybrid layer and resin tags in sclerotic dentine. Based on the ultrastructural features presented, it is further speculated that adaptive strategies such as removal of the surface layers and extended etching time may not be completely effective in improving bonding efficacy in highly sclerotic dentine. Interdisciplinary research should be continued to develop alternative procedures for bonding resins equally well to sound and sclerotic dentine.
authors.affiliation: Faculty of Dentistry, The University of Hong Kong, The Prince Philip Dental Hospital, SAR, Hong Kong, People's Republic of China.
authors.forename: S M
authors.initials: SM
authors.lastname: Kwong
authors.forename: F R
authors.initials: FR
authors.lastname: Tay
authors.forename: H K
authors.initials: HK
authors.lastname: Yip
authors.forename: L H
authors.initials: LH
authors.lastname: Kei
authors.forename: D H
authors.initials: DH
authors.lastname: Pashley
mesh_terms: D000134:Acid Etching, Dental; D000269:Adhesives / Q000737:chemistry*; D001419:Bacteria / Q000648:ultrastructure; D001641:Bicuspid; D002114:Calcinosis / Q000473:pathology*; D001840:Dental Bonding; D003804:Dentin / Q000382:microbiology / Q000648:ultrastructure; D003809:Dentin, Secondary / Q000648:ultrastructure*; D017220:Dentin-Bonding Agents / Q000737:chemistry*; D006801:Humans; D008689:Methacrylates / Q000737:chemistry; D008854:Microscopy, Electron; D008855:Microscopy, Electron, Scanning; D010756:Phosphoric Acids / Q000008:administration & dosage; D013499:Surface Properties; D019237:Tooth Cervix / Q000648:ultrastructure
chemical_list: D000269:Adhesives; C112274:Clearfil Liner Bond 2; D017220:Dentin-Bonding Agents; D008689:Methacrylates; D010756:Phosphoric Acids