Self-etching primer vs phosphoric acid: an alternative concept for composite-to-enamel bonding

The purpose of this in vitro study was (1) to investigate the composite-to-enamel bond strength and (2) to analyze the marginal adaptation of resin composite restorations in class 2 cavities using three self-etching priming agents in comparison to conventional phosphoric acid etching and bonding application. In the first part of the study 24 extracted bovine incisors were embedded in acrylic resin and ground flat with 800-grit paper. The following three self-etching priming agents/composite resins were applied to the enamel surfaces of six teeth each: Clearfil Liner Bond 2/Clearfil AP-X (Group I), Etch & Prime 3.0/Degufill mineral (Group II), Resulcin AquaPrime + MonoBond/Ecusit (Group III). In Group IV Ecusit-Mono/Ecusit was used after enamel etching with phosphoric acid (37%). Shear bond strength values measured on a T22 K testing machine at a crosshead speed of 1 mm/min were: 24.2 +/- 3.0 MPa (Group I), 21.9 +/- 1.4 MPa (II), 34.0 +/- 3.6 MPa (III), and 26.3 +/- 1.8 MPa (IV). ANOVA revealed significant (P < 0.05) differences in shear bond strength between groups, except comparison of Group I and II, and Group I and IV. In the second part of the study 24 standardized class 2 cavity preparations with the approximal box extending 1 mm above the CEJ were prepared in extracted human molars. Enamel margins were beveled and the teeth were divided into four groups of six teeth each. Cavities were restored using the self-etching priming agents Clearfil Liner Bond 2 (Group I), Etch & Prime 3.0 (Group II), and Resulcin AquaPrime + MonoBond (Group III). In Group IV composite resin restorations were placed after 37% phosphoric acid etching and bonding application (Ecusit-Mono). Quantitative SEM analysis of the marginal adaptation of the restorations after thermocycling (5-55 degrees C, 2500 cycles) and mechanical loading (100 N, 500,000 cycles) revealed excellent, gap-free margins in 91.2% (Group I), 93.0% (Group II), 92.0% (Group III), and 92.5% (Group IV) of the restorations' approximal area. There were no statistically significant differences between the four groups (P < 0.05). In conclusion, results of the present in vitro study indicate that use of self-etching primers may be an alternative to conventional phosphoric acid pre-treatment in composite-to-enamel bonding restorative techniques.