title: Influence of a 3-step tooth disinfection procedure on dentin bond strength.
abstract: BACKGROUND
  Clinicians have used disinfection materials to remove surface contaminants during cavity preparation. It has been postulated that disinfection materials may negatively affect shear bond strength of restorative materials. If so, large numbers of restorations may be predestined for early failure with the use of a disinfection protocol.
  
  
  OBJECTIVE
  The purpose of this study was to determine whether there is a difference in the bond strength between dentin and resin composite with a 3-step disinfection technique compared to a conventional bonding technique without the additional disinfection protocol.
  
  
  METHODS
  Sixty human molar teeth were sectioned parallel to the occlusal surface to expose mid-coronal dentin and mounted parallel to a bond shearing device on a universal testing machine and divided into 2 groups. In the 3-step disinfection group (n = 30), specimens were treated with chlorhexidine, Tubulicid red, and sodium hypochlorite before dentin bonding, following the manufacturer's instructions for All Bond 2. In the control group (n = 30), specimens were treated only with the bonding protocol of All Bond 2. To ensure a uniform bond surface area, core paste was syringed into a cylindrical mold (2.38-mm diameter and 2.00-mm height) that was in contact with the dentin bonding surface of each specimen and allowed to polymerize under constant force. All specimens were subjected to fracture by shear loading in a universal testing machine at a uniform crosshead speed of 0.05 mm per minute and expressed as MPa. Statistical analysis was performed using the Student t test (alpha = .05). The mode of failure was noted after a visual examination using a light microscope under x30 magnification. Failures were recorded as adhesive, cohesive or mixed, and statistical analysis was performed using a chi-square of homogeneity (alpha = .05).
  
  
  RESULTS
  A significantly higher shear bond strength was found for the 3-step disinfection group (mean shear bond strength, 25.3 +/- 4.6 MPa) compared to the control group (mean shear bond strength, 20.5 +/- 3.4 MPa) (P < .0001). Most failures were adhesive for the control group, but the fracture modes were evenly divided for the 3-step disinfection protocol group. A chi-square test of homogeneity showed a value of 12.3, df = 2, P = .0012.
  
  
  CONCLUSIONS
  The 3-step disinfection technique group showed a significantly stronger dentin shear bond strength compared to the conventional bonding technique without disinfection.
authors.affiliation: School of Dentistry, Virginia Commonwealth University, Richmond, 23298, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Pappas
authors.forename: David R
authors.initials: DR
authors.lastname: Burns
authors.forename: Peter C
authors.initials: PC
authors.lastname: Moon
authors.forename: James P
authors.initials: JP
authors.lastname: Coffey
mesh_terms: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D003188:Composite Resins; D001840:Dental Bonding; D019551:Dental Disinfectants; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D003804:Dentin; D017220:Dentin-Bonding Agents; D006801:Humans; D008422:Materials Testing; D008689:Methacrylates; D008963:Molar; D019279:Resin Cements; D033081:Shear Strength; D012973:Sodium Hypochlorite
chemical_list: D000891:Anti-Infective Agents, Local; D003188:Composite Resins; D019551:Dental Disinfectants; D017220:Dentin-Bonding Agents; D008689:Methacrylates; D019279:Resin Cements; C100742:All-Bond 2; D012973:Sodium Hypochlorite; D002710:Chlorhexidine