Marginal adaptation of dentin bonded ceramic inlays: effects of bonding systems and luting resin composites

This in vitro study evaluated the marginal adaptation of bonded inlays of lucite-reinforced glass ceramic (Empress) to dentin as influenced by different bonding systems and by luting resin composites (LRCs) with different curing modes. Forty-eight Empress inlays etched with 5% hydrofluoric acid and treated with a silane-coupling agent (Monobond-S) were bonded to two-surface Class II cavities. Two total-etch bonding systems (OptiBond FL, Nexus) and one bonding system with selective enamel etching and a self-conditioning dentin primer (ART Bond) were included in the study. ART Bond was tested with and without the pre-curing of a first layer of adhesive resin selectively applied to the cervical cavity floor (selective double-bond technique). Each bonding system was used in combination with a light-cured resin composite (Prodigy) and a dual-cured LRC (Nexus or Vita Cerec Duo Cement). Marginal integrity was evaluated before and after thermocycling (TC) in a scanning electron microscope (SEM). Dye penetration tests were performed after TC was completed. The median percentages of continuous margin in dentin ranged from 80% to 100% before TC and from 53.5% to 96.1 % after TC. After TC, the influence of the bonding system was more pronounced than that of the LRC. In combination with the LC resin composite, ART Bond with precuring was significantly higher and the Nexus bonding system had significantly lower proportions of continuous margin than all the other bonding systems investigated. Swelling of the adhesive along the gingival margins was frequently found with the Nexus bonding system and with ART Bond without pre-curing. Microleakage was detected with all bonding system/LRC combinations, with somewhat lower rates in specimens completed using the selective double-bond technique. With the exception of the Nexus bonding system, post-TC marginal integrity was not influenced by the curing mode of the LRC (LC vs DC). In conclusion, the marginal quality of dentin bonded ceramic inlays can be improved by proper selection of the bonding sys- tem/LRC combination. The results of this study indicate the use of the Nexus luting system as directed without substitution.