Testing adhesion of direct restoratives to dental hard tissue - a review

This articles concerns itself with the testing of adhesion between direct restoratives and dental hard tissue, ie, enamel and dentin. The aim is to survey available methods for adhesion testing and influential parameters affecting experimental outcome. The testing of adhesion to indirect restorative materials, eg, ceramics and metals, is beyond the scope of this article and shall be discussed elsewhere. The longevity and success of modern dental restorations very often relies on potent dental adhesives to provide durable bonds between the dental hard substance and the restorative composite. To predict the clinical outcome of such restorative treatment, a large variety of in vitro laboratory tests and clinical in vivo experiments have been devised, analyzed, and published. The purpose of this review is to provide a current overview of bond strength testing methods and their applicability to the characterization of dental adhesives. Regardless of the method employed, subtle variations in sample preparation may already severely impact test results, usually necessitating at least co-testing of a well-known internal reference to allow conclusive interpretation. This article attempts to list and discuss the most influential parameters, such as substrate nature, age, health status, storage, clinically relevant pre-treatment, and sample preparation. Special attention is devoted to the last aspect, as numerous publications have stressed the tremendous influence of preparatory parameters on the validity and scope of obtained data. Added to the large variety of such factors, an equally large diversity of load-applying procedures exists to actually quantify adhesion between composites and dental hard substance. This article summarizes the basics of macro and micro approaches to shear and tensile bond strength testing, as well as push- and pull-out tests. The strengths and weaknesses inherent to each method and influential test parameters are reviewed and methods for accelerated sample aging and simulation of clinical conditions presented. Alternatively to shear or tensile bond strength tests, fracture toughness is introduced together with its application to dental adhesives and an overview of its physical background.