Journal of Investigative and Clinical Dentistry (2013), 4, 112

ORIGINAL ARTICLE
Oral rehabilitation

In vitro bonding effectiveness of three different one-step

self-etch adhesives with additional enamel etching
Charu Batra1, Rajni Nagpal2, Shashi Prabha Tyagi2, Udai Pratap Singh2 & Naveen Manuja3
1 Department of Operative Dentistry, Seema Dental College, Rishikesh, Utrakhand, India
2 Department of Operative Dentistry, Kothiwal Dental College, Moradabad, Uttar Pradesh, India
3 Department of Pedodontics, Kothiwal Dental College, Moradabad, Uttar Pradesh, India

Keywords Abstract
additional enamel etching, enamel surface Aim: To evaluate the effect of additional enamel etching on the shear bond
morphology, one-step self-etch adhesives, strength of three self-etch adhesives.
shear bond strength.
Methods: Class II box type cavities were made on extracted human molars.
Correspondence
Teeth were randomly divided into one control group of etch and rinse adhesive
Naveen Manuja, Associate Professor, and three test groups of self-etch adhesives (Clearfil S3 Bond, Futurabond NR,
Department of Pedodontics, Kothiwal Dental Xeno V). The teeth in the control group (n = 10) were treated with AdperTM
College, Moradabad-244001, Single Bond 2. The three test groups were further divided into two subgroups
UttarPradesh, India. (n = 10): (i) self-etch adhesive was applied as per the manufacturers instruc-
Tel: +91-9997048380 tions; (ii) additional etching of enamel surfaces was done prior to the applica-
Email: [email protected]
tion of self-etch adhesives. All cavities were restored with Filtek Z250. After
Received 24 June 2012; accepted 26 January
thermocycling, shear bond strength was evaluated using a Universal testing
2013. machine. Data were analyzed using ANOVA independent samples t test and
Dunnetts test. The failure modes were evaluated with a stereomicroscope at a
doi: 10.1111/jicd.12039 magnification of 109.
Results: Additional phosphoric acid etching of the enamel surface prior to the
application of the adhesive system significantly increased the shear bond
strength of all the examined self-etch adhesives.
Conclusions: Additional phosphoric acid etching of enamel surface significantly
improved the shear bond strength.

as it does not require a separate etch and rinse step. Cur-

Introduction
rent self-etch adhesives contain different monomer com-
Bonding of restorative material to tooth structure began ponents, which are able to modify the enamel and dentin
during the 1950s when Buonocore suggested the bonding surface and promote the diffusion of the monomers into
of resin monomer to acid-etched enamel using 85% phos- the dental hard tissue structure and mediate a strong
phoric acid.1 The basic mechanism of bonding to enamel bond between these hard tissues and the restorative com-
and dentin is essentially an exchange process involving posite. These hydrophilic monomers are dissolved in
replacement of minerals removed from the hard dental water miscible solvents including pure water, ethanol
tissues by resin monomers that upon in situ setting water or acetonewater mixtures.3 With water being an
become micromechanically interlocked in the created integral component in these nonrinsing adhesives, the
porosities. Depending on the clinical approach, three ambiguity in providing the optimal moisture condition
mechanisms of adhesion are currently in use with modern for maintaining the integrity of a demineralized collagen
adhesive systems: etch and rinse, self-etch, and glass iono- matrix in the etch and rinse technique is eliminated.4
mer approaches.2 Self-etch adhesives can be subdivided according to their
The self-etch approach is the most promising from a acidity: ultramild (pH  2.5), mild (pH  2), interme-
standpoint of user-friendliness and technique sensitivity, diate (pH  1.5) and strong (pH  1).5,6 Strong

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Shear bond strength of self-etch adhesives C. Batra et al.

self-etch adhesives exhibit rather deep demineralization in a Class II box type cavity and to evaluate the effect
effects and lead to a bonding mechanism and ultramor- of additional phosphoric acid etching of the enamel sur-
phology similar to that produced by etch and rinse adhe- face. The null hypothesis set forth is that, additional
sives. On the other hand mild self-etch adhesives partially phosphoric acid etching of enamel will not affect the
dissolve the dentin surface, leaving residual hydroxyapa- shear bond strength of the investigated self-etch
tite still attached to collagen.2,7 adhesives.
In spite of the above advantages, the one-step self-etch
adhesives have a number of shortcomings. They produce
Materials and methods
relatively low bond strength to enamel and dentin
compared to multistep self-etch and etch and rinse adhe- Eighty-four freshly extracted human molars were
sives.811 Concern remains regarding the enamel etching collected. The teeth were stored in 0.5% chloramine solu-
capability of mild self-etch adhesives. Some studies have tion, and used within 3 months of extraction.
reported that both one-step self-etch and etch and rinse
adhesives perform equally well on ground enamel.1215
Preparation of samples for shear bond strength testing
However, other studies have reported that one step self-etch
adhesives bond less effectively to enamel than etch and rinse Seventy teeth were used for shear bond strength testing.
systems that use phosphoric acid.1619 This may be due Class II box type cavities of standard dimensions 4 mm
either to inadequate etching of enamel or to the poor poly- buccolingual, 4 mm occlusogingival and 2 mm mesiodis-
merization of resin once it is infiltrated into the etched tal width were made on all the teeth using a digital cali-
surface.20 per. All the cavities were prepared with cylindrical flat
Since enamel bonding is primarily based on microme- diamond burs. Bur was replaced after preparation of
chanical interlocking of a low viscosity resin into micro- every four cavities. The teeth were then divided into
porosities,21 the extent and depth of the etching pattern three test groups (n = 20 each) according to the self-etch
should logically influence the bonding performance of an adhesives used. Clearfil S3 Bond, Futurabond NR, Xeno
adhesive. Scanning electron microscopy (SEM) studies V and one control group (n = 10) of etch and rinse
indicate that an enamel etching pattern caused by self- adhesive; AdperTM Single Bond 2 (Table 1). Each test
etching adhesive is not as deep and appears to be less group was further subdivided into two groups of 10 teeth
retentive compared with the etching pattern resulting each. For each test group the first group was treated with
from phosphoric acid treatment.12,22,23 adhesive systems as per the manufacturers instructions
In order to increase the enamel bond strength, the (Table 1), whereas in the second group adhesive systems
manufacturers of all-in-one self-etch adhesives recom- were applied after etching of the enamel surface. The
mend adjunctive use of phosphoric acid especially in case enamel surface was etched with 36% phosphoric acid for
of non-instrumented enamel, while other manufacturers 15 s followed by 10 s of rinsing with a three-way syringe
do not recommend enamel pre-etching with phosphoric and air dried while preventing extensive dehydration.
acid.20 The adhesive systems were light-cured with a quartz
Numerous in vitro studies have evaluated the shear tungstenhalogen unit for 10 s at 600 mW/cm2. A mylar
bond strength of one-step self-etch adhesives to enamel strip was then applied to cover the proximal box. Filtek
with additional phosphoric acid etching with controver- Z250 (3M ESPE), a hybrid composite was packed in
sial results. Some studies have reported the benefits of 2-mm-thick horizontal increments. The last layer was
additional etching with phosphoric acid,2426 reaffirming made flush with the enamel cavosurface margins. Each
the fact that etch and rinse adhesives still remain the gold layer was exposed to the curing light for at least 40 s
standard when bonding to enamel. While other studies from the occlusal side. The final finishing and polishing
state that the benefit of additional etching depends on the were done with medium and fine Sof-lex disks (3M
brand of the self-etch adhesive tested, suggesting that ESPE). All the specimens were placed into a 37C water
some self-etch adhesives may be able to provide an effec- bath for 24 h. They were then thermocycled for 10 000
tive bond to enamel without the additional step of cycles from 5 to 55C. The dwell time was 30 s in each
enamel etching.27 Moreover, most of these studies have water bath, with a transfer time of 30 s between each
been performed on flat enamel surfaces that do not simu- bath. After thermocycling, they were placed back into the
late clinical conditions. These studies do not relate to 37C water bath for 24 h.
more critical and demanding clinical conditions such as For shear bond strength testing, the specimens were
high C-factor cavities. placed in a fixture that positioned them for loading at an
Therefore, the aim of this in vitro study is to compare angle of 45.28 For this purpose, metallic rings with 1 in
the shear bond strength of one step self-etch adhesives diameter and 2 in length were used. The upper half of

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C. Batra et al. Shear bond strength of self-etch adhesives

Table 1. Composition, pH, manufacturers details and instructions for application of adhesive systems

Adhesive
systems Composition pH Manufacturers instructions Manufacturer

Adper Single Dimethacrylates, 2-hydroxyethyl methacrylate 0.05  0.03 Apply etchant on the enamel and dentin 3M ESPE, St. Paul,
Bond 2 (HEMA), polyalkenoid acid copolymer, surfaces for 15 s USA
5 nm silane treated colloidal silica, ethanol, Rinse for 10 s with three way syringe
water, photoinitiator Slight air dry to prevent extensive
dehydration
Apply 23 consecutive coats of
adhesive with gentle agitation
Air dry for 5 s
Light cure for 10 s
Conditioner 36 Phosphoric acid (36%), highly dispersed Dentsply De Trey,
silicon dioxide, detergent, pigment, water Konstanz,
Germany
Clearfil S3 Bond 10-methacryloxydecyl dihydrogen phosphate, 2.7 Apply adhesive with gentle agitation Kuraray Medical
bisphenol A diglycidyl methacrylate, HEMA, for 20 s Inc, Tokyo, Japan
dicamphorquinone, ethanol, water, Air dry for 5 s
silanated colloidal silica Light cure for 10 s
Futurabond NR Liquid A: polyfunctional adhesive monomers 1.4 Mix 1 drop of liquid A and 1 drop of VOCO, Cuxhaven,
(methacroyl-phosphorus-acid-ester, liquid B on a mixing palette for 5 s Germany
methacroyl-carbon-acid-ester), Apply the adhesive and massage into
dimethacrylates, functionalized SiO2 tooth substrate for 20 s
nanoparticles, initiators Air dry for 5 s
Liquid B: ethanol, water, hydrophilic Light cure for 10 s
adhesive monomers, fluorides
Xeno V Bifunctional acrylates, acrylic acid, acid <2 Apply adhesive with gentle agitation Dentsply De Trey,
phosphoric, functionized ester, acid for 20 s Konstanz,
acrylicate water, tertiary butanol, Air dry for 5 s Germany
phosphine oxide initiator, stabilizer Light cure for 20 s

the ring was cut at a 45 angle to the long axis of the

Preparation of samples for analysis of surface
ring. The rings were filled with autopolymerzing acrylic
morphology using SEM
resin up to their uppermost margin. All the specimens
were placed in the rings with the roots covered with The effect of conditioning with 36% phosphoric acid and
acrylic resin. The specimens were placed perpendicular to self-etch adhesives on ground enamel was analyzed using
the acrylic resin surface. Bond strength between the a scanning electron microscope. Fourteen molars (two
restorative material and tooth surface was measured in samples per group) were used for SEM analysis. After
the shear mode with the Universal testing machine. removing the roots with a slow-speed saw and a diamond
A straight knife edge rod 2 mm wide was applied at the impregnated disk, the labial surface of the molars was
tooth restoration interface at a crosshead speed of 2 mm/ ground on wet 210 grit SiC paper to a flat enamel sur-
min. This resulted in a shear force at a 45 angle to the face. Each tooth was then mounted in self-curing acrylic
tooth surface (Figure 1). Load was applied until restora- resin to expose the flattened area; they were then placed
tion fracture occurred. Bond strength was recorded in in tap water to reduce the temperature rise caused by the
newtons and converted into megapascals by dividing it by exothermic polymerization reaction of acrylic resin. The
total bonded surface area. The total bonded surface area final finish was accomplished by grinding on wet 600 grit
of the proximal box cavity preparation was 40 mm2, and SiC paper. After ultrasonic cleaning with distilled water
it was calculated as the sum of the surface area of the gin- for one minute to remove excess debris, the surfaces were
gival wall (8 mm2), facial wall (8 mm2), lingual wall washed and dried with oil-free compressed air.
(8 mm2) and axial wall (16 mm2). The mode of failure of For the control group phosphoric acid was applied for
the bond to tooth restoration interface was determined 15 s and then rinsed with water for 10 s. For the three
with a stereomicroscope at 109 magnification, then clas- test groups, in half the specimens self-etch adhesive was
sified into three categories: adhesive, cohesive and mixed applied as per the manufacturers instructions while in
type of failures. the remaining half additional etching with phosphoric

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Shear bond strength of self-etch adhesives C. Batra et al.

Straight knife
edge rod

Long axis of
the tooth

Tooth mounted
perpendicular
to the acrylic
surface
Class II box
type composite
restoration

Metallic ring
filled with acrylic

Figure 1. Schematic diagram showing tooth

with Class II preparation mounted in
aluminium molds with load acting at 45
angle to long axis of tooth.

acid was carried out prior to the application of self-etch values (in MPa) and standard deviations for each test
adhesives. This was followed by rinsing with copious groups. When comparing the three self-etch adhesive
absolute ethanol instead of being light cured to remove systems with the control group, that is, etch and rinse
the self-etch adhesive. The teeth were then dehydrated in system, the shear bond strength values for the control
ascending ethanol concentrations (50%, 75%, and 95% group was significantly higher than the three self-etch
for 20 min each and 100% for 2 h), and then transferred systems (P < 0.001). Phosphoric acid etching of the
to a critical point dryer for 30 min. The specimens were enamel surface prior to the application of the adhesive
then gold sputter coated and the etched enamel surfaces system led to an increase in the shear bond strengths of
were examined in a SEM at 200050009 magnification. all one-step self-etch adhesives, regardless of the adhesive
system used (P < 0.001) (Table 2). The highest shear
bond strength values among all the tested adhesive
Statistical analysis
systems were measured for CS-E (7.04 MPa) which was
Statistical analysis of shear bond strength values was per- significantly higher than ASB (P = 0.043) and XV-E
formed using one-way ANOVA, Dunnetts test and the (P = 0.027), but the difference was insignificant when
independent samples t test. compared to FB-E (Table 3).
Stereomicroscopic evaluation of the fractured surfaces
showed mainly adhesive fractures between the tooth sur-
Results
face and the adhesive. After conditioning with phosphoric
Table 2 presents the maximum load values in newtons. acid, a slight increase in the mixed type of fracture was
Table 3 and Figure 2 show the mean shear bond strength observed for all self-etch adhesives. (Figure 3)

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C. Batra et al. Shear bond strength of self-etch adhesives

Table 2. Maximum load values in newtons as failure stress at 45

Sample Control
number group (N) Group Ia (N) Group Ib (N) Group IIa (N) Group IIb (N) Group IIIa (N) Group IIIb (N)

1 242.0 190.3 203.1 183.9 267.6 205 370.9

2 296.0 147.1 284.9 167.9 328.4 186.0 355.1
3 258.8 167.4 164.5 199.0 289.4 141.8 239.9
4 260.3 148.6 211.7 208.4 323.9 193.5 270.7
5 164.5 192.4 210.7 188.9 238.0 152.8 278.8
6 219.9 162.0 262.0 146.6 226.0 160.1 277.5
7 196.4 194.6 220.5 172.0 232.0 142.6 248.0
8 246.2 171.1 266.0 168.1 260.4 184.0 268.9
9 280.1 174.2 282.4 162.3 252.2 142.6 192.0
10 221.8 148.1 198.2 133.3 262.6 131.2 213.6

Table 3. Mean shear bond strength (MPa) values of the individual

test groups

Group Code n Mean (MPa) SD

Control ASB 10 5.97a 0.98

Group Ia Clearfil S3 CS 10 4.10b 0.65
Group Ib Clearfil S3 (etched) CS-E 10 7.04dc 1.33
Group IIa Futurabond NR FB 10 4.33b 0.57
Group IIb Futurabond NR (etched) FB-E 10 6.70da 0.89
Group IIIa Xeno v XV 10 4.24b 0.46
Group IIIb Xeno v (etched) XV-E 10 5.76a 1.02

Values with the same superscript letters indicate no statistically signifi-

cant differences.

Figure 3. Distribution of the various fracture types in the individual

experimental groups. , cohesive; , mixed; , adhesive

Figure 2. Box plot showing mean and standard deviation of all

experimental groups.

Scanning electron microscopy evaluation (Figures 47) Figure 4. SEM micrograph of ground enamel following treatment
with phosphoric acid, showing uniform surface etching with a charac-
showed that conventional phosphoric acid etching pro-
teristic honeycomb pattern.
duced the greatest topographical changes in the enamel
surfaces. Among the other three self-etch adhesives used,
Futurabond NR showed a more retentive enamel surface. depressions. However, with prior phosphoric acid etching,
For Clearfil S3 and Xeno V, the enamel surfaces were a slightly more retentive etching pattern could be
relatively unetched with some grooves and shallow observed for all the three self-etch adhesives.

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Shear bond strength of self-etch adhesives C. Batra et al.

(a) (b)

Figure 5. (a) SEM micrograph of ground enamel following treatment with Clearfil S3 Bond, showing predominantly unetched and smooth
surface, with some deep and large grooves present on the enamel surface. (b) SEM micrograph of ground enamel following treatment with phos-
phoric acid plus application of Clearfil S3 Bond. A slightly more retentive etching pattern can be seen, with more shallow depressions.

(a) (b)

Figure 6. (a) SEM micrograph of ground enamel following treatment with Futurabond NR. An overall increase in porosity was evident along the
entire enamel surface compared to the two other self-etch adhesives. (b) SEM micrograph of ground enamel following treatment with phosphoric
acid plus application of Futurabond NR, showing surface roughening that is not uniform along the entire surface.

(a) (b)

Figure 7. (a) SEM micrograph of ground enamel following treatment with Xeno V, showing relatively smooth surface with few shallow depres-
sions. (b) SEM micrograph of ground enamel following treatment with phosphoric acid plus application of Xeno V, showing a slightly more reten-
tive pattern with predominant demineralization of prism peripheries.

stresses, are a combination of the resultant normal stres-

Discussion
ses and the shearing stresses.29,30 In a study conducted by
Shear bond strength (SBS) tests have been the method of Yaman and others,31 load was applied at 0, 13.5, and
choice for testing tooth bonding and are included in the 30 to long axis of tooth in Class II approximal slot resto-
international organization for standardization for testing rations. Here 0 represents the fully compressive stresses,
dental materials and adhesives ISOs TR 11405.2 It has 13.5 is the typical loading angle used in dental applica-
been shown through three-dimensional finite element tions,32,33 and 30 loading simulates a load that includes
modeling that in a tooth composed of brittle materials the effect of high shearing stresses. Furthermore, an
the stresses responsible for failure, called Von Mises increase in the loading angle significantly increases the

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C. Batra et al. Shear bond strength of self-etch adhesives

shearing stresses, and an increase in the latter conse- has been reported that correlation exists between the pH
quently creates larger Von Mises stresses. This implies of self-etch adhesive and length of the produced enamel
that the critical Von Mises stress value can be reached at resin tags.46 On ground enamel, a relationship between
smaller load levels for larger loading angles.31 Therefore, pH value and the ability to create a microretentive surface
in this study load was applied at 45 to the long axis of has been found.23 Intermediary strong adhesives create an
tooth to simulate the effect of high shearing stresses simi- irregular, nonhomogenous etch pattern, whereas phos-
lar to the study of Gupta and Tewari.28 However, as the phoric acid removes the enamel smear layer and leads to
correlation between SBS and Von Mises stress is not yet a honeycomb structure surface.16,47 The demineralization
established, using the tested stress (in newtons) and divid- depth of enamel surface is lower for self-etch adhesives
ing by the total area for SBS seemed not substantial. In compared to the etch and rinse approach (1.53.2 vs
fact, the tested stress, in 45, could further become the 6.9 lm).39
three-dimensional stress component s1, s2 and s3. There- In the present study also, SEM analysis has shown a
fore, in the present study results are presented in newtons difference in the enamel morphology produced by phos-
as failure stress at 45. phoric acid and the self-etch adhesives used. Phosphoric
In this study the three self-etch adhesives have shown acid produced the greatest topographical changes in
significantly lower mean bond strength values as com- enamel surfaces. The enamel surfaces treated with mild
pared to the control group, i.e. etch and rinse adhesive self-etch adhesives (Clearfil S3 bond and Xeno V) were
system. There are various studies to support this result predominantly unetched and smooth, intercalated with
which state that most user friendly one-step self-etch some deep, large grooves and shallow depressions. The
adhesives produced a lower bond strength than the etch intermediary strong self-etch adhesive (Futurabond NR)
and rinse system and they are considered to be less reli- produced an etching pattern more retentive than the one
able when bonding to enamel and dentin.10,11,3436 Suffi- produced by the mild self-etch adhesives, but did not
cient enamel etching ability of 36% phosphoric acid and resemble that of 36% phosphoric acid etching. Although
the presence of polyalkenoic acid copolymers in AdperTM well-defined enamel etching patterns and resin tag forma-
Single Bond 2 lead to good bonding to both enamel and tion are not prerequisites for achieving strong enamel
dentin.3,37 Moreover, repeated formation of the calcium bonds,23 they have been associated with the stability48
polyalkenoic acid complex causes continuous stress relax- and improved survival rate of enamel bonds created
ation.38 in vivo.49
Studies have shown that the enamel surface is not In the current study no direct correlation could be
etched to the same degree with self-etch adhesive systems established between the pH of the self-etch adhesives
when compared with traditional phosphoric acid condi- tested and the SBS values observed. Although Clearfil S3
tioning.17,39,40 Concern has been expressed that the result- Bond, which is an ultramild self-etch adhesive, depicted
ing bond to enamel surfaces produced by self-etch the lowest SBS and Futurabond NR, which is an interme-
adhesives may not be as durable as etch and rinse diary strong self-etch adhesive, showed the highest SBS,
systems.41 the differences between the three self-etch adhesives were
The quality of etched enamel depends on the acid con- not significant. Literature has also shown little correlation
centration used, time and type of enamel structure.42,43 between pH of self-etch adhesives and their SBS val-
Acid aggressiveness is related to its dissociation constant ues.17,50 The pH of the adhesive is not the only factor
(pKa). Self-etch adhesive systems are formed by acidic determining bond strength. Other factors that might
monomers that are susceptible to polymerization, which affect bond strength include substrate related factors, vari-
contain a mono- or di-ester as a functional group.12,44 ations in adhesive viscosity, surface tension, functional
Thus, at least one or two hydrogen atoms of phosphoric monomers, water concentration and the other compo-
acid are substituted by a methacrylate group. The dissoci- nents of the bonding system, and cohesive strength of the
ation potential of a di-ester of phosphoric acid is lower adhesive and resin composite.13,51,52
than phosphoric acid and thus is considered a less aggres- This study, evaluated the overall SBS of self-etch adhe-
sive acid.45 sives to both enamel and dentin substrates in prepared
The self-etch systems used in the current study can be Class II cavities and therefore the poor bonding potential
classified according to the pH values as ultramild, mild, to both enamel and dentin may be responsible for the
or intermediary strong systems. Because of their higher lower SBS values observed. Interaction of the self-etch
pH, the self-etch adhesives result in shallower enamel adhesives with dentin may be limited by many factors
demineralization compared with that of phosphoric acid. from both the substrate and the adhesive itself. Main rea-
Studies have also shown that the degree of enamel etching sons for poor bonding performance of all-in-one self-etch
depends on the pH of the self-etching solution.13,16,25 It adhesives in dentin are: (i) the presence of highly

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Shear bond strength of self-etch adhesives C. Batra et al.

hydrophilic monomers that are sensitive to water sorption Shear bond strength values recorded in this study are
from the underlying dentin, increasing hybrid layer per- lower, in the range of 3.289.27 MPa. These are the total
meability, and nanoleakage;53 (ii) a high concentration of bond strength values obtained by resin composites to
protic solvents and dissolved molecular oxygen within the both enamel and dentin surfaces. These lower values
adhesive layer as a result of poor evaporation; (iii) the could be attributed to polymerization shrinkage forces
limited thickness of the adhesive layer,54 which may also with a high C-factor in Class II cavities that have a large
magnify the oxygen inhibition effect on adhesive poly- bonded surface area. According to Feilzer et al.,65 restora-
merization;55,56 (iv) during solvent evaporation, the tions with a C-factor < 1 are more likely to survive poly-
monomer/water ratio may change and subsequently result merization contraction stresses and remain bonded to the
in phase separations and blistering;57 (v) they behave as tooth. Bouillaguet et al.66 reported a 20% reduction in
semi-permeable membranes after polymerization;58 (vi) bond strength in the cavity bonding group as compared
further, it has been reported that an adverse acidbase to those measured in the flat bonding group. The nega-
reaction and adhesive permeability may contribute to the tive effect of the C-factor is also supported by a study of
incompatibility between some simplified adhesives and Marques et al.67 in which self-etch adhesives showed
resin composites.59,60 significantly higher bond strength on flat surfaces
When the adherent enamel surfaces were treated with (C-factor = 0) than in cavities (C-factor = 3).
36% phosphoric acid, significant increases in bond Another reason of lower bond strength values obtained
strengths were observed for all three self-etch adhesives. in the present study is the thermocycling. A literature
With additional phosphoric acid etching, Clearfil S3 Bond review has concluded that 10 000 cycles corresponds
showed bond strength even higher than etch and rinse approximately to 1 year of in vivo functioning.68 More-
adhesive. Therefore, the null hypothesis that prior acid over, specimen geometry also influences the effect of ther-
etching did not affect the enamel bond strengths was mocycling on bond strength, which was confirmed by a
rejected. The most plausible explanation for the increased study in which thermocycling of restored flat surfaces did
SBS is the increase in enamel porosity due to additional not decrease the micro-thermocycling bond strength,
phosphoric acid etching, resulting in increased resin inter- whereas a similar aging protocol applied to restored cavi-
locking and micromechanical retention. In spite of the ties resulted in a significantly decreased micro-thermocy-
weak correlation between enamel etching depth/pattern cling bond strength.69
and bond strength found in the literature,13,23,39,61 the Observation of the fractured surfaces revealed that the
aggressiveness of the enamel treatment may play an failure mode of self-etch adhesives was primarily adhesive
important role. when the adhesives were used according to the manufac-
Various studies have also indicated the potential bene- turers instructions. An increase in the mixed type of frac-
fit of additional enamel etching with phosphoric acid ture occurred when phosphoric acid was applied prior to
prior to the use of self-etch adhesives.2427,34,6264 Trans- application of self-etch adhesives. This may be due to
mission electron microscopy analysis showed that the higher bond strength of self-etch adhesives with prior
enamel surface was more microretentive, and microten- etching of enamel surfaces with phosphoric acid.
sile bond strengths were significantly increased for a This study was performed on healthy extracted teeth
two-step self-etch adhesive after etching with phosphoric that do not take into account the bonding potential of
acid.25 Clinical trials have also demonstrated that there self-etch adhesive systems to caries affected or sclerotic
were fewer defects and superficial discoloration at the dentin, the role of intrapulpal pressure, and the effect of
enamel margins in Class V restoration of noncarious interproximal contacts between teeth. Further research is
lesions after 2 years and enamel margins of Class III res- required to ascertain the durability of these simplified
torations after 3 years when a two-step self-etch adhesive adhesives in clinical conditions.
was used with prior etching of enamel surfaces.62,64
However, there was no significant influence on retention
Conclusions
of the restoration or their clinical performance. Our
findings are contradictory to the study of Watanabe Within the limitations of this in vitro study it can be
et al.,27 who stated that improvement in bond strengths concluded that the gold standard etch and rinse adhesive
after prior etching of enamel surfaces using phosphoric system shows better bonding potential to tooth surface
acid depends on the brand of the self-etch adhesive used, as compared to the one-step self-etch adhesives. With
and so this may be due to other factors that might have additional etching of enamel surfaces, there is significant
had an important effect on enamel bond strengths, increase in the bond strength values for all three self-etch
including the cohesive strengths of adhesives and resin adhesives tested. Morphological evaluation also revealed
composites. that phosphoric acid etching produces a more retentive

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C. Batra et al. Shear bond strength of self-etch adhesives

enamel surface than self-etch adhesive alone. However, recommended solely on the basis of bond strength and
introduction of an extra step defies the principle of user- SEM study. Further clinical evaluation is required to vali-
friendliness and technique simplification. An additional date the incorporation of this step in routine clinical
acid etching step with self-etch adhesives cannot be protocol.

pairs of adhesives from the same materials into enamel surfaces with
References
manufacturers. Oper Dent 2005; reference to bonding. Arch Oral
1 Buonocore MG. A simple method 30:4929. Microbio 1968; 13:6170.
of increasing the adhesion of 12 Hanning M, Reinhardt KJ, Bott B. 22 Hayakawa T, Kikutake K, Nemoto K.
acrylic filling materials to enamel Self-etching primer vs phosphoric Influence of self-etching primer treat-
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