Immediate dentin sealing improves bond strength of indirect restorations.

STATEMENT OF PROBLEM Delayed dentin sealing is traditionally performed with indirect restorations. With this technique, dentin is sealed after the provisional phase at the cementation appointment. It was demonstrated that this chronology does not provide optimal conditions for bonding procedures. Immediate dentin sealing (IDS) is a new approach in which dentin is sealed immediately following tooth preparation, before making the impression. PURPOSE The purpose of this study was to determine whether there were differences in microtensile bond strength to human dentin using IDS technique compared to delayed dentin sealing (DDS). MATERIAL AND METHODS Fifteen freshly extracted human molars were obtained and divided into 3 groups of 5 teeth. A 3-step etch-and-rinse dentin bonding agent (DBA) (OptiBond FL) was used for all groups. The control (C) specimens were prepared using a direct immediate bonding technique. The DDS specimens were prepared using an indirect approach with DDS. Preparation of the IDS specimens also used an indirect approach with IDS immediately following preparation. All teeth were prepared for a nontrimming microtensile bond strength test. Specimens were stored in water for 24 hours. Eleven beams (0.9 x 0.9 x 11 mm) from each tooth were selected for testing. Bond strength data (MPa) were analyzed with a Kruskal-Wallis test, and post hoc comparison was done using the Mann-Whitney U test (alpha=.05). Specimens were also evaluated for mode of fracture using scanning electron microscope (SEM) analysis. RESULTS The mean microtensile bond strengths of C and IDS groups were not statistically different from one another at 55.06 and 58.25 MPa, respectively. The bond strength for DDS specimens, at 11.58 MPa, was statistically different (P=.0081) from the other 2 groups. Microscopic evaluation of failure modes indicated that most failures in the DDS group were interfacial, whereas failures in the C and IDS groups were both cohesive and interfacial. SEM analysis indicated that for C and IDS specimens, failure was mixed within the adhesive and cohesively failed dentin. For DDS specimens, failure was generally at the top of the hybrid layer in the adhesive. SEM analysis of intact slabs demonstrated a well-organized hybrid layer 3 to 5 microm thick for the C and IDS groups. For DDS specimens the hybrid layer presented a marked disruption with the overlying resin. CONCLUSIONS When preparing teeth for indirect bonded restorations, IDS with a 3-step etch-and-rinse filled DBA, prior to impression making, results in improved microtensile bond strength compared to DDS. This technique also eliminates any concerns regarding the film thickness of the dentin sealant.