Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques

Objective: This study evaluated the effect that different techniques for removing dental caries had on the strength of the microtensile bond to caries-affected human dentine created by three bonding agents. Materials and methods: Forty-five human molar teeth containing carious lesions were randomly divided into three groups according to the technique that would be used to remove the caries: a conventional bur, an Er:YAG laser or a chemo-mechanical Carisolv (R) gel (n = 15). Next, each of the three removal-technique groups was divided into three subgroups according to the bonding agents that would be used: Clearfil (R) SE Bond, G-Bond (R), or Adper (R) Single Bond 2 (n = 5). Three 1 mm(2) stick-shaped microtensile specimens from each tooth were prepared with a slow-speed diamond saw sectioning machine fitted with a diamond-rim blade (n = 15 specimens). For each removal technique one dentine sample was analysed using scanning electron microscopy. Results: There were statistically significant differences in the resulting tensile strength of the bond among the techniques used to remove the caries and there were also statistically significant differences in the strength of the bond among the adhesive systems used. The etch-and-rinse adhesive system was the most affected by the technique used to remove the caries; of the three techniques tested, the chemo-mechanical removal technique worked best with the two-step self etch adhesive system. Conclusion: The bond strength values of the etch-and-rinse adhesive system were affected by the caries removal techniques used in the present study. However, in the one- and two-step self etch adhesive systems, bond strength values were not affected by the caries removal techniques applied. While a chemo-mechanical caries removal technique, similar to Carisolv (R), may be suggested with self etch adhesive systems, in caries removal techniques with laser, etch-and-rinse systems might be preferred. Clinical significance: Caries removal methods may lead to differences in the characteristics of dentine surface. Dentine ultra structure generally affects the bonding of adhesive materials commonly used in restorative dentistry. Whereas etch-and-rinse system, like the ones used in the present study, are affected by these changes, the self etch systems are not affected. Hence, clinicians may opt for caries removal methods and systems appropriate for each patient and practice. (c) 2012 Elsevier Ltd. All rights reserved.