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Composite-to-Composite Microtensile Bond Strength se nz
in the Repair of a Microfilled Hybrid Resin: Effect of
Surface Treatment and Oxygen Inhibition
Federica Papacchinia/Susanna Dall’Ocaa/Nicoletta Chieffib/Cecilia Goraccic/
Fernanda Tranchesi Sadekd/Byoung I. Suhe/Franklin R. Tayf/Marco Ferrarig

Purpose: To compare the 24-h microtensile bond strength of a microfilled hybrid composite to the same material after
mechanical and/or chemical treatment and assess the effect of oxygen inhibition on the composite-composite bond.

Materials and Methods: Forty composite cylinders of Gradia Direct Anterior (GC) were prepared and stored 24 h prior
to the following surface treatments: 50-μm aluminum oxide air abrasion and 37% phosphoric acid etching (group 1); hy-
drochloric acid and 6.9% hydrofluoric acid etching (group 2); diamond bur roughening and 37% phosphoric acid etching
(group 3); diamond bur roughening (group 4). In all groups, Prime & Bond NT (Dentsply De Trey) was applied and light
cured in air or under a nitrogen atmosphere, prior to layering a buildup of the repairing resin composite. Microtensile
bond strength measurements were performed. Data were statistically analyzed with two-way ANOVA and Tukey’s test
(α = 0.05).

Results: The curing atmosphere did not significantly influence the interfacial strength (p < 0.05). Surface treatment sig-
nificantly affected the composite-composite bond (p > 0.05). Air abrasion, regardless of curing atmosphere, resulted in
the strongest bond (p < 0.05). The other treatments were comparable.

Conclusion: Air abrasion and the application of a bonding agent offer satisfactory bond strengths for composite repair.
The oxygen inhibition layer on a light-cured adhesive is not crucial to the success of the 24-h composite-composite bond.

Keywords: composite repair, surface treatment, oxygen-inhibited layer, microtensile bond strength.

J Adhes Dent 2007; 9: 25-31. Submitted for publication: 28.02.06; accepted for publication: 09.06.06.

a PhD Student, Department of Dental Materials and Restorative Dentistry, Uni-

versity of Siena, Policlinico “Le Scotte” Viale Bracci, Siena, Italy.
b Private Practitioner, Siena, Italy.
c Assistant Professor, Department of Dental Materials and Restorative Den-
tistry, University of Siena, Policlinico “Le Scotte” Viale Bracci, Siena, Italy.
d PhD Student, Department of Dental Materials, University of São Paulo, São
Paulo, Brazil; Department of Dental Materials and Restorative Dentistry, Uni-
versity of Siena, Policlinico “Le Scotte” Viale Bracci, Siena, Italy.
e President, Bisco Inc, Schaumburg, IL, USA.
f Research Scientist, Department of Oral Biology and Maxillofacial Pathology,
School of Dentistry, Medical College of Georgia, Augusta, Georgia, USA; De-
partment of Dental Materials and Restorative Dentistry, University of Siena,
Policlinico “Le Scotte” Viale Bracci, Siena, Italy.
g Dean and Professor, Department of Dental Materials and Restorative Den-
tistry, Policlinico “Le Scotte”, University of Siena, Viale Bracci, Siena, Italy.
Reprint requests: Prof. Marco Ferrari, University of Siena, School of Dental
Medicine, Department of Dental Sciences, Policlinico Le Scotte, Viale Bracci,
Siena, 53100, Italy. Tel: +39-0577-233131, Fax: +39-0577-233117. e-mail:
md3972@mclink.it
T he advent of adhesive techniques and bioactive restora-
tive materials has paved the way for minimally invasive
operative dentistry, aimed at preserving tooth structure as
opposed to cavity preparation for mechanical retention.35 In
light of this operative philosophy, the complete removal and
remaking of a defective composite restoration is frequently
neither necessary nor desirable, as it is time consuming16
and involves the risk of removing sound tooth substance as
well as injuring the pulp tissue. Selective replacement or ve-
neering of the unsatisfactory part, be it worn, discolored or
inadequate in color matching or in outline form, can be con-
sidered the most conservative approach.
A large amount of research data has been collected on
composite repairs. This essentially includes results from
conventional scanning electron microscopy,3,20,27 mi-
croleakage tests,6 and bond strength measurements. In par-
ticular, the composite-to-composite strength has been eval-
uated with flexural,27,28 fatigue,10 shear,2,3,14,19,20,27,32,33
and conventional tensile tests.27 In recent years, although

Vol 9, No 1, 2007 25

Papacchini et al
Table 1 Composition, batch numbers, and manufacturers of the materials used in this study
Materials Composition
Gradia Direct Anterior UDMA, dimethacrylate co-monomers, silica, prepolymerized
Batch #: filler, pigments, catalysts
A3-0305231
B3-0305221
Total Etch 37% H3PO4
Batch #: E25773
Prime&Bond NT Di- and trimethacrylate resins; PENTA, nanofillers, amorphous Dentsply DeTrey; Konstanz, Germany
Batch #: 0311002148 silicon dioxide, photoinitiators, stabilizers, cetylamine
hydrofluoride, acetone
Chelagess 6.9% hydrofluoric acid, > 10% hydrochloric acid
Batch #: 00328
Abbreviations: H3PO4: phosphoric acid; UDMA: urethane dimethacrylate; PENTA: dipentaerythritol penta acrylate monophosphate.
an increasing number of researchers have adopted the mi-
crotensile technique as a more accurate method for the as-
sessment of the interfacial strength,22 only a few studies
have evaluated the composite-to-composite microtensile
bond strength.21,29,30
The bond strength necessary for a clinically satisfactory
composite repair in vivo has never been assessed. On the
other hand, many in vitro studies have investigated the po-
tential variables affecting the composite-composite bond
strength: surface roughness,2-4,17,27 intermediary material
applied,4,17,27,32,33 repairing material used,12,21,27 and time
after repair.21,27 Divergent results were reported considering
the contribution of surface roughness to the interfacial bond
strength. Some investigators, by conducting SEM observa-
tions27 and bond strength measurements,17,27 concluded
that mechanical interlocking is the most significant factor
improving the repair strength. However, other studies re-
ported that grinding of the composite surface decreased the
tensile bond strength as a consequence of filler exposure.3,4
For this reason, the use of an intermediary layer, whether an
adhesive agent alone or in combination with a previous ap-
plication of a silane primer, has been proposed on a me-
chanically-treated composite to improve surface wetting and
chemical bonding, irrespective of the texture created by the
previous surface treatment.4,14,20,21,32 As the operator is
sometimes unable to identify the material to be repaired, the
compatibility between the repaired and repairing materials
is also of interest. It has been reported that repairs of com-
posite resins with identical resin matrix chemistry did not
produce bond strengths significantly greater than those of
different matrix chemistry.12,21 A tendency for composite-
composite bond strength to decrease after aging and stor-
age of the substrate material in water or saliva has also been
reported.21,27
26
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Manufacturer e ss e n z
GC; Tokyo, Japan
Ivoclar Vivadent; Schaan, Liechtenstein
Techim, Arese, Milano, Italy
Clinically, bonding between two composite layers is
achieved in the presence of an oxygen-inhibited zone of un-
reacted monomers and oligomers11,25 that would act as an
adhesive medium binding the overlying applied material via
a chemical bond. The influence of the oxygen-inhibited lay-
er on bond strength has already received some attention, al-
though there is no consensus in the literature on how this in-
completely polymerized surface can affect the layer-layer in-
teraction. Divergent reports on the existence of a positive
correlation between the oxygen-inhibited layer and the ad-
hesive strength,34 and other studies that reported no sig-
nificant differences9,17,30 or even a detrimental correla-
tion8,24,37 further contributed to the controversy of this is-
sue.
Based on these premises, the objectives of this study
were: (1) to compare the 24-h microtensile bond strength of
a composite to the same material after mechanical and/or
chemical treatment; (2) to assess the influence of oxygen in-
hibition on the 24-h composite-to-composite bond.
The null hypotheses to be tested were: (a) surface treat-
ment has no effect on the 24-h bond strength of a resin com-
posite repaired with the same type of material; (b) there is
no difference in the 24-h repair strength of a composite re-
gardless of the presence or absence of an oxygen-inhibited
layer.
MATERIALS AND METHODS
Specimen Preparation
The materials used in this study are listed in Table 1. Forty
cylinder-shaped composite substrates, 4 mm in height and
8 mm in diameter, were made by layering 2-mm-thick incre-
ments of Gradia Direct Anterior (GC; Tokyo, Japan, shade A3)
The Journal of Adhesive Dentistry

in a split aluminum mold. Each increment was carefully con-
densed with a clean plastic filling instrument in order to
avoid contamination and/or incorporation of voids, then
cured for 20 s with the tip of the light-polymerizing unit (VIP,
Bisco; Schaumburg, IL, USA, output: 500 mW/cm2) placed
in contact with the surface of the mold. The last increment
was covered with a Mylar strip and compressed with a glass
slide in order to obtain a flat surface of the specimen after
light curing. After the top surface had been cured, the spec-
imen was removed from the mold and irradiation was per-
formed for a further 20 s on the portions of the specimens
that were in contact with the metallic parts of the mold, in
order to ensure uniform and complete polymerization.
All composite cylinders were stored in a saline solution at
37°C for 24 h before the repair procedures were performed,
then randomly assigned to 4 groups of 10 specimens each.
Each group differed in the chemical and/or mechanical sur-
face treatment that preceded the repairing procedure, as de-
scribed below.
• Group 1: An air spray of 50-μm aluminum oxide particles
(Microetcher II, Danville Engineering; San Ramon, CA,
USA) was used for 10 s from a distance of approximately
5 mm perpendicular to the specimen surface at a pres-
sure of 60 to 100 psi. 37% phosphoric acid (Total Etch,
Ivoclar-Vivadent; Schaan, Liechtenstein) was applied to
the treated surfaces for 30 s, then washed off with water
for 30 s to remove debris, and dried using an air syringe
for 10 s from a distance of 5 mm.
• Group 2: A mix of hydrochloric acid (HCl, >10%) and hy-
drofluoric acid (HF, 6.9%) (Chelagess, Techim; Arese, Mi-
lano, Italy) was applied to the experimental surface for 60
s, then rinsed with a water spray for 20 s, and dried with
compressed air for 10 s from a distance of 5 mm.
• Groups 3 and 4: A 770-8P fine-grit diamond bur was used
for 10 s to roughen the specimens surface. In group 3,
37% phosphoric acid (Total Etch, Ivoclar-Vivadent;
Schaan, Liechtenstein) was also applied to the treated
surfaces for 30 s, then washed off with water for 30 s to
remove debris, and dried using an air syringe for 10 s
from a distance of 5 mm.
In all groups, the self-priming etch-and-rinse adhesive
Prime&Bond NT (Dentsply DeTrey; Konstanz, Germany) was
then applied with a microbrush on the treated composite
substrate, lightly air dried, and light cured for 20 s with the
above mentioned light-curing device in an air atmosphere
(subgroup A, n = 5) or under a nitrogen atmosphere (sub-
group N, n = 5). In the nitrogen chamber, oxygen was com-
pletely removed through 6 to 8 purge cycles prior to intro-
ducing nitrogen by opening an inlet valve.
Each specimen was then replaced into the mold and
fresh Gradia Direct Anterior shade B3 was packed against
the treated side of the substrate specimen in 2-mm-thick in-
crements, which were incrementally cured for 20 s each, cre-
ating a repaired composite-composite specimen 8 mm in
height and 8 mm in diameter with (A) or without (N) a pre-ex-
isting oxygen-inhibited interface. Different shades were in-
tentionally chosen for the substrate and for the repairing ma-
terial, in order to facilitate the visual identification of the
Vol 9, No 1, 2007
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composite-composite interface and an accurate and easierhalt
n interface en
mounting of the repaired specimens at the repair t
i
in the testing machine. e ss e n z
After a 24-h storage in a 37°C saline solution, each bond-
ed specimen was secured with sticky wax (Micerium, Aveg-
no; Genova, Italy) on an acrylic resin cylinder, which was
mounted on a cutting machine (Isomet, Buehler; Lake Bluff,
IL, USA). By means of a water-cooled diamond blade, each
repaired specimen was serially sectioned to obtain multiple
beam-shaped sticks, according to the nontrimming tech-
nique.22 The cross-sectional area ranged between 0.78 and
0.81 mm2. For about one-half of its length, each stick was
composed of the treated substrate composite material, and
for the remaining half, the repairing material. The two halves
were joined together at their interface by the bonding agent
Prime & Bond NT with or without a pre-existing oxygen-in-
hibited interface, depending on the subgroup.
For microtensile testing, each beam was secured at the
ends with cyanoacrylate adhesive (Zapit, Dental Ventures of
America; Corona, CA, USA) to a Gerardeli’s jig,23 designed to
transmit purely tensile forces to the specimen when mount-
ed on a universal loading machine (Controls; Milano, Italy).
The test was conducted at a cross-head speed of 0.5
mm/min until failure. The load at failure was recorded in N,
and the specimen’s fragments were carefully removed from
the fixtures with a scalpel blade. The cross-sectional area at
the site of fracture was measured to the nearest 0.01 mm
with a digital caliper, in order to calculate the bond strength
at failure in MPa.
For each specimen, the failure mode was classified as co-
hesive within the substrate or the repairing composite, ad-
hesive, or mixed, by examining the fractured stick with an op-
tical microscope (Nikon SMZ645; Tokyo, Japan) at 50X mag-
nification. All the sticks that failed prematurely while being
cut or glued were included and considered in the statistical
calculations as null bond strength values.
SEM Evaluation
Three additional composite substrates were prepared and
surface treated similarly to those in groups 1 to 4. The spec-
imens were mounted on aluminum stubs, sputter coated
with gold (SC7620 Sputter Coater, Polaron Range, Quorum
Technologies; Newhaven, UK), and observed using a scan-
ning electron microscope (JEOL, JSM-6060LV; Tokyo, Japan).
Micrographs were taken at standardized magnifications
(150X, 500X, 2000X) in order to document the surface tex-
ture created by the different mechanical and/or chemical
treatments performed in each study group.
Statistical Analysis
The bond strength data were first analyzed for normality with
the Kolmogorov-Smirnov test and the Levene’s test for ho-
mogeneity of variances. As data were normally distributed,
a two-way ANOVA was applied with “bond strength” as the
dependent variable, and “surface treatment” and “atmos-
phere” as factors. Tukey’s test was then used for multiple
comparisons among surface treatments. All analyses were
processed using SPSS 11.0 software (SPSS; Chicago, IL,
USA), with significance set at the 95% probability level.
27
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Table 2 Means and standard deviations of the microtensile bond strengths (μTBS) measured in each experimental group
a lte
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Groups Atmosphere μTBS (MPa) Failure mode Number ofess e n z
of curing (stereomicroscopy) premature failures
cohesive adhesive mixed

1 A 43.2 (13.5) [65]a 15 45 5 0

2 35.2 (12.0) [73]b 3 63 1 6
3 37.8 (9.9) [60]b 8 48 3 1
4 37.3 (14.4) [72]b 12 53 4 3

1 N 42.4 (14.0) [64]a 18 43 3 0

2 33.5 (11.4) [64]b 4 60 0 0
3 36.3 (11.7) [67]b 10 53 4 0
4 36.2 (10.9) [66]b 7 58 1 0

The failure modes and the number of specimens that failed prematurely during cutting or gluing are reported. Numbers in square brackets represent the
number of tested sticks. Subgroups (A, N) labelled with the same superscript letter are not statistically different (p > 0.05). A: air; N: nitrogen.

RESULTS Chemical treatment with a mix of HCl and 6.9% HF (Fig

Microtensile Bond Strengths
The means and standard deviations of the microtensile bond
strengths measured for all the tested subgroups are presen-
ted in Table 2. The failure modes are also reported.The statis-
tical analysis showed that the atmosphere under which the
adhesive was cured did not have a significant influence on
the interfacial strength (p > 0.05), whereas the surface treat-
ment significantly affected composite-composite strength (p
< 0.05). Tukey’s post-hoc test revealed that aluminum oxide
abrasion (group 1) produced significantly higher bond
strengths (p < 0.05) than all the other surface treatments.
Irrespective of the presence (A: 43.2 ± 13.5 MPa) or ab-
sence (N: 42.4 ± 14.0 MPa) of a pre-existing oxygen-inhibit-
ed layer at the composite-composite interface, aluminum ox-
ide abrasion achieved the statistically significantly (p < 0.05)
highest bond strength of all the subgroups. All other surface
treatments in the tested subgroups showed comparable
bond strength results.
The interaction between surface treatment and atmos-
phere was statistically significant (p < 0.05). According to the
Tukey’s test, the bond strength values achieved following air
abrasion in either atmosphere were significantly higher than
those measured in any other subgroup.
As regards the failure modes, in the majority of loaded
specimens, fractures developed at the composite-compos-
ite interface; however, the highest number of cohesive and
mixed failures was recorded for air-abraded subgroups and
the lowest for HF/HCl-acid treated subgroups.
SEM Observations
SEM examination of the mechanically and/or chemically
treated composite substrates revealed different surface tex-
tures. Air abrasion with 50-μm aluminum oxide particles
and etching with 37% phosphoric acid (Fig 1A) produced a
roughened, highly irregular surface topography, with resin
composite block asperities created among numerous mi-
croretentive fissures.
1B) resulted in an extensive dissolution of the upper layer of
the composite substrate, exposing both the glass fillers and
the resin matrix. In addition, numerous irregular and ran-
domly distributed gaps and pores could be identified.
Scratches and grooves covered with streaks of smeared
matrix can be observed on the composite substrate after
roughening with a fine-grit diamond bur (Fig 1C). Etching with
37% phosphoric acid did not cause any morphological change
in the retentive pattern of the similarly-treated composite sur-
face, apart from producing a cleaning effect (Fig 1D).
DISCUSSION
In all groups, the treated surface was coated with a thin lay-
er of a bonding agent, as it has been well documented that
the repairing material does not wet the etched composite
surface at all locations.28 The poor wettability could be ex-
plained by the high viscosity of the uncured repairing com-
posite or by the polymerization shrinkage that pulls the ma-
terial away from the treated surface during the curing
process.
The use of an intermediate low viscosity resin can be con-
sidered a necessary step in composite repair in order to en-
hance the composite-composite bond by promoting chemi-
cal coupling to the resin matrix, chemical bonds to the ex-
posed filler particles, or micromechanical retention through
monomer penetration into the matrix microcracks.20 Differ-
ent composite surface treatments are likely to generate dif-
ferences in smearing and matrix cracking,28 and thus influ-
ence the repair bond strength.
The results of our investigation, in agreement with other
studies,4,17,27 confirm that surface abrasion with 50-μm alu-
minum oxide particles significantly improves the composite-
to-composite repair bond strength. It has been reported that
this surface pretreatment, followed by the application of a
bonding agent, can result in an intraoral repair strength that
is nearly identical to the cohesive strength of the original

28 The Journal of Adhesive Dentistry

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B D

Fig 1A Scanning electron micrograph of the composite surface air abraded with 50-μm aluminum oxide
particles and etched with 37% phosphoric acid. A roughened, highly irregular topography was produced,
with resin composites asperities appearing besides areas of numerous microretentive fissures (bar = 50
μm).
Fig 1B Scanning electron micrograph of the composite substrate etched with a mix of hydrochloric and
6.9% hydrofluoric acid. Extensive dissolution of the upper layer of the composite substrate could be iden-
tified, involving both the glass fillers and the resin matrix. Gaps and pores were extensively distributed on
the chemically-treated surface (bar = 50 μm).
Fig 1C Scanning electron micrograph of the composite surface roughened with a fine-grit diamond bur.
Scratches and grooves covered with streaks of smeared matrix could be observed (bar = 50 μm).
Fig 1D Scanning electron micrograph of the composite substrate roughened with a fine-grit diamond bur
and etched with 37% phosphoric acid. The etching procedure did not produce morphological changes in
the retentive pattern of the composite surface, but only a cleaning effect (bar = 50 μm).

composite.17,27 SEM observations in previous studies20,27
showed that aluminum oxide sandblasting is able to pro-
duce microretentive features, increasing the surface area
available for wetting and bonding by the adhesive resin. This
may account for the strong interfacial bond achieved in this
experiment following air abrasion.
The composite-to-composite bond achieved after grinding
the substrate surface with a diamond bur was significantly
weaker, regardless of the use of 37% phosphoric acid to
clean the composite surface. These differences in bond
strength as compared with the air-abraded specimens are
probably related to the different microscopic pattern pro-
duced by the rotating instrument, which results in scratches
and a tenacious smear layer that can decrease the strength
of the composite-to-composite bond.27
The acid etching procedure, also performed in similar re-
search protocols,2,20,27 was unable to produce any signifi-
cant morphological changes in the retentive pattern of the
resin matrix, as confirmed by the similar bond strengths in
comparison to the unetched groups. Lucena-Martín et al20
found clinically unacceptable repair bond strengths in sec-
ondarily cured microhybrid and microfilled composites after
treating an unground resin surface with 37% phosphoric
acid and an adhesive agent. Their study agrees with our re-
sults, confirming both that mechanical retention plays the
most important role in repair bond strength and that 37%
phosphoric acid probably exercises a superficial cleaning ef-
fect on the composite surface.
The lowest bond strength was obtained by chemically
treating the composite surface with a mix of HCl and 6.9%

Vol 9, No 1, 2007 29

Papacchini et al
HF for 60 s. This product has a different aggressiveness de-
pending on the concentration. When diluted to 50%, it is
able to clean investments from cast restorations. When
used undiluted, the solution is effective in dissolving glass
and porcelain by corrosion, and cleaning titanium or resin
composites. In this study we applied the acid solution for 60
s only for etching, taking care to completely wash and dry the
treated surface before performing the bonding procedure. In
contrast to 37% phosphoric acid, this solution appears to
have a more aggressive effect on a direct composite restora-
tion. When hydrofluoric acid is applied on resin composites,
it has been reported that this etching agent, traditionally
used to etch porcelain, would act by lightly dissolving the
glass particles of the composite filling, leaving gaps or pores
and allowing micromechanical retention by the bonding
agent.31 Nevertheless, some studies20,32 reported that a
30- to 120-s application of hydrofluoric acid not only result-
ed in complete dissolution of exposed glass particles, but al-
so produced softening and porosity of the composite resin
matrix. This may have accounted for the lower bond
strengths, depending on the chemical composition of the
material being repaired. For this reason, the routine use of
hydrofluoric acid in a repair procedure is not recommended
by Brosh et al,4 especially when the exact composition of the
old composite is unknown. A similar combined action either
on the glass fillers or in the resin matrix can be assumed to
have occurred for the 6.9% HF used in the present study, as
confirmed by the SEM evaluation. The combined action of
two strong acids, such as hydrofluoric and hydrochloric acid,
had a great impact on the structure of the resin composite,
possibly including a cleavage of the filler particles from the
resin matrix. Clinically, rubber-dam isolation and suction of
vapors will be effective at preventing hazardous effects ei-
ther using intraoral air abrasion or strong acids such as
those applied in this study.
Another topic of interest of the present research is the
bonding ability of the oxygen-inhibited layer on the compos-
ite surface. Oxygen from the ambient atmosphere can inhibit
any free-radical-initiated, addition polymerization reaction.11
It has been reported that oxygen inhibition results from
quenching the free radicals generated via light activation of
the photoinitiator in its excited triplet states, thus limiting the
initiation stage of the polymerization reaction.1 The peroxy
radicals that form in the presence of oxygen are more stable
and less reactive towards carbon-carbon double bonds than
the propagating radical. As a consequence, polymerization
is strongly compromised, and the surface of the polymerized
layer may remain undercured and tacky.25 The degree of oxy-
gen inhibition during polymerization can potentially be af-
fected by several factors such as monomer functionality and
structure,9,18 bis-GMA:HEMA ratio,9 the type and concen-
tration of photoinitiators, polymerization conditions,11,13,15
and the surface-to-volume ratio of the resin coating.9,25
An interesting and controversial aspect that remains un-
resolved is whether this sticky surface is really necessary for
bonding of composite resins. Some studies have shown that
the presence of an oxygen-inhibited layer is crucial for im-
proving the adhesive strength between two composite layers
by means of remaining unreacted acrylate groups, forming
chemical covalent bonds within an interpenetrating net-
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work.19,34,36 ha
Based on these findings, the oxygen-inhibited
n lte
layer has traditionally been assumed to be necessary before n
t
i
e ss e n
adding more layers of bonded composite. Conversely, z
a neg-
ative correlation has also been reported in the litera-
ture,8,24,37 indicating37 that the oxygen-inhibited layer cor-
responds to a soft and undercured interface; local con-
sumption of the photoinitiator on the substrate surface
would be responsible for imperfect bonding with the overly-
ing resin composite after polymerization. Moreover, the pres-
ence of an oxygen-inhibited layer in acidic, self-etching ad-
hesives resulted in their incompatibility with self-cured com-
posites.26,29
In the present study, bond strength data obtained from
specimens cured in nitrogen atmosphere, in which the con-
tact of the adhesive layer with oxygen was completely avoid-
ed, and those from specimens cured in the air were statisti-
cally comparable. These results confirmed that, contrary to
the common perception, the oxygen-inhibition layer is not
necessary for bonding additional layers of resin composites,
at least for the initial 24-h period in which incomplete decay
of the existing free radicals within the polymerized dentin ad-
hesive enables its chemical coupling to the repair compos-
ite. Similarly, in recent studies,17,30 comparable results were
found in the composite-to-composite bond strength, with or
without an oxygen-inhibited layer on the composite surface
requiring repair. It can be speculated that the amount of re-
maining active free radicals available for reacting with resin
composite monomers, even in absence of oxygen, is the
most important factor for the coupling of a 24-h direct com-
posite veneering or repair.
As free radicals have half-lives and slowly decay with
time,5 we can assume that for an adhesive layer that is light
cured and bonded with the repairing material after 24 h,
such as those that were examined in this study, a maximum
amount of remaining active free radicals is still available for
bonding with the overlying composite increment. Thus, the
longevity of free radicals appears to be an important factor
affecting the outcome of bonding to a light-cured composite
surface or a light-cured adhesive layer even several days af-
ter photopolymerization, without using a resin activator. Fur-
ther studies should be performed to evaluate how long these
existing free radicals can remain available for bonding with-
out adversely affecting bond strength. Clinically, this will pro-
vide important information, for example, on how long the op-
erator can leave a direct composite restoration before cor-
recting defects or a provisional restoration on adhesive-de-
sensitized dentin,7 without compromising bond strength of
the final restoration.
CONCLUSION
In conclusion, within the limits of this study, the first null hy-
pothesis that surface treatment has no effect on the 24-h
bond strength of a resin composite repaired with the same
type of material has to be rejected. Regardless of the pres-
ence or absence of an oxygen inhibited layer, air abrasion of
a cured composite surface with 50-μm aluminum oxide pro-
duces statistically higher bond strengths than those ob-
tained by treating the same material with a diamond bur or
The Journal of Adhesive Dentistry

a mixture of hydrochloric (> 10%) and hydrofluoric acid
(6.9%). 37% phosphoric acid does not improve composite-to-
composite bond strength when the composite surface is
roughened with a diamond bur, and has only a cleaning ef-
fect. The second null hypothesis that there is no difference
in the 24-h repair strength of a composite regardless of the
presence or absence of an oxygen inhibited layer must be ac-
cepted. The presence of an oxygen-inhibition layer on a light-
cured resin composite or adhesive layer is not necessary for
additional resin coupling, at least up to 24 h after polymer-
ization, due to the presence of incompletely decayed, active,
remnant free radicals within the cured composite or adhe-
sive.
ACKNOWLEDGMENTS
This study was based on a dissertation to be submitted by Dr. Federica
Papacchini for partial fulfilment of the requirements of the degree of
Doctor of Philosophy at the University of Siena, Italy. The materials em-
ployed in this study were generously donated by Bisco, Dentsply Detrey,
GC and Ivoclar-Vivadent.
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Clinical relevance: Air abrasion with aluminum oxide rep-
resents a useful technique for improving composite repair
bond strength. The oxygen inhibition layer on a light-cured
adhesive is not crucial to the 24-h composite-composite
bond.
31