Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : ZC14 - ZC19 Full Version

Evaluation of Shear Bond Strength of Incremental Layer of Self-etch Self-adhesive Novel Flowable Composite after Salivary Contamination: An In-vitro Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57959.17071
Divya Makhijani, Sharad Kamat, Santosh Hugar, Girish Nanjannawar, Sonali Kinikar, Tanvi Kadu

1. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. 2. Principal and Head, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. 3. Professor, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. 4. Ex-Professor, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. 5. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India. 6. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Dental College and Hospital, Sangli, Maharashtra, India.

Correspondence Address :
Dr. Divya Makhijani,
Sunder Jivan APTS, Nagpur, Maharashtra, India.
E-mail: makhijani.divya@gmail.com

Abstract

Introduction: Contamination of composite restoration during incremental placement leads to decrease in the incremental bond strength. Adhesive application on freshly contaminated resin surface increases the bond strength but is a complex and time-consuming procedure. Recently composite systems combining etchant, bonding agent and flowable composite into a single component have been introduced to simplify bonding and save time. In this study incremental layer shear bond strength is utilised to assess bond stability at resin-resin interface after salivary contamination.

Aim: To evaluate shear bond strength of incremental layer of self-etch self-adhesive novel flowable composite after salivary contamination.

Materials and Methods: The present in-vitro experimental study included 55 acrylic resin cylinders (2×2.5 cm) with square shaped cavity (5×5 mm, thickness 2 mm) restored with DMGTM Constic flowable composite that were randomly divided into five groups with eleven specimens per group. Group I: No salivary contamination, Group II: Salivary contamination followed by air drying, Group III: Salivary contamination followed by rinsing and air drying. Group II and III were subdivided into subgroup a: application and brushing of 0.5 mm of Constic followed by light curing and filling of rest of mold by Constic, subgroup b: direct application of 2 mm of Constic. Shear bond strength between increments of composite was determined by universal testing machine. Data were analysed using One-way ANOVA test and Independent t-test. Level of significance was kept at 5%.

Results: Incremental shear bond strength (MPa) was highest for group I (12.09±1.99) followed by group IIIa (10.21±3.49), group IIa (10.08±3.21), group IIb (7.59±2.31) and lowest for group IIIb (7.35±3.06).

Conclusion: Active application of self-etch self-adhesive flowable composite successfully restores the incremental shear bond strength after salivary contamination.

Keywords

Adhesive, Bond stability, Resin-resin interface, Saliva

Adhesive restorative dentistry is an area of great significance for research as well as clinical practice. New materials and clinical strategies are continuously evolving to restore the form, function, aesthetics and structural integrity of the damaged teeth (1).

The popularity of dental composites is increasing day by day that has led to the importance of moisture and contamination control, as composites do not ‘pardon’ contamination. Technique sensitivity and the difficulty in achieving contamination and moisture control is a common problem experienced by the clinicians in restorative dentistry (2),(3).

Blood, gingival sulcular fluid, or hand piece lubricant contribute in failure of adhesion and retention of composite resin to enamel and dentin (4). Salivary contamination or contamination with blood has been cited in literature as one of the main issues encountered during direct adhesive restorative procedures (5).

Contamination acts like a barrier and compromises the adhesion of composite to the tooth structure resulting in formation of micro gap between restoration and tooth, postoperative hypersensitivity, discolourations, occurrence of secondary caries all of which will lead to failure of the restoration (4).

In order to warrant complete polymerisation of composite restorations for supreme physical properties, the clinicians are encouraged to place resin composite restorations in increments (3),(6),(7),(8),(9),(10).

Several studies reported that salivary contamination of enamel and dentin results in decreased bond strength between composite restoration and enamel or dentin (3),(4). It has been reported in discrete studies that contamination of composite with biological fluids like saliva reduces the bond strength at the composite-composite interface decreasing the incremental bond strength (4),(11),(12),(13),(14),(15).

Previous study has reported that reapplication of self-etching primer after salivary contamination restores the bond strength between self-etch primer and dentinal surface (16). Application of adhesive on recently contaminated surface has also demonstrated good results (6).

Using etchant and adhesive between each increment is a complex and time-consuming procedure. In recent years self-etching self-adhesive flowable composite systems have been introduced to simplify bonding. These composite systems combine an etchant, bonding agent and flowable composite into a single component example DMGTM Constic, VertiseTM- flow (17),(18).

Instead of using separate etchant and bonding agent after contamination of composite with saliva, this novel self-etching self-adhesive flowable composite can be used to restore bond strength at resin-resin interface. None of the studies have been conducted to study the shear bond strength of incremental layer of saliva contaminated composite after application of novel self-etching self-adhesive flowable composite. Thus, the purpose of this study was to evaluate shear bond strength of incremental layer of self-etch self-adhesive novel flowable composite after salivary contamination.

The null hypothesis tested was that salivary contamination causes no detrimental effect on shear bond strength of incremental layer of self-etch self-adhesive novel flowable composite.

Material and Methods

This in-vitro experimental study was conducted in the Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Deemed to be University, Dental College and Hospital, Sangli, Maharashtra, India. The duration of study was about six months in the calendar year September 2021- February 2022. The study was approved by the Institutional Ethical Committee on 13th December 2019 (Letter number-BVDUMC&H/IEC/Dissertation 2019-20/D-29). Informed consent was collected from volunteer prior to collection of saliva. Procedure was carried in accordance with the ethical standards of the Institute.

Sample size calculation: The sample size was determined by GPower software. Effect size was calculated from the data obtained from a previous study conducted by Furuse AY et al., (11).

Input: Tail(s) = Two
Effect size d = 1.2674108
α err prob = 0.05
Power (1- β err prob) = 0.80
Allocation ratio N2/N1 = 1

Output: Non centrality parameter δ = 2.9723418
Critical t = 2.0859634
Df = 20
Sample size per group = 11
Actual power = 0.8070629
Total Sample size = (11×5) 55

Preparation of Specimens

Fifty-five acrylic resin cylinders (2 cm diameter, 2.5 cm height) with a square shaped modelling wax (5×5 mm, thickness 2 mm) embedded on the surface were prepared (Table/Fig 1), wax was eliminated using boiling water to obtain a square shaped standardised cavity (Table/Fig 2). DMGTM Constic flowable composite resin indicated for direct restorations was used as per the manufacturer’s instructions for the study.

Constic was inserted into the prepared cavities using composite packing instruments in single increment, glass cover slip was placed on top of the mold and gently pressed to produce a flat surface and remove excess. Constic was cured using LED curing unit for 20 seconds (Table/Fig 3). Oxygen inhibition layer was retained to replicate clinical circumstances of incremental filling technique. Any sample that shows adhesive failure than cohesive was replaced by new one.

Samples were randomly categorised into five equal study groups- eleven samples per group.

Group I (Control group): No salivary contamination was carried; second increment was directly placed and light cured for 20 seconds using LED curing unit.

Group II: Samples were contaminated with saliva, dried with oil free compressed air for 20 seconds from a distance of 10 cm.

It was further divided into two subgroups: -

Group IIa: 0.5 mm of Constic was applied, brushed for 25 seconds (19) and was cured for 20 seconds using LED curing unit. Rest of the Teflon mold was filled with Constic and light cured using LED curing unit for 20 seconds.

Group IIb: 2 mm of second increment of constic was applied directly without brushing and was cured for 20 seconds using LED curing unit.

Group III: Samples were contaminated with saliva, rinsed with water for 20 seconds and dried with oil free compressed air for 20 seconds from a distance of 10 cm.

It was further divided into two subgroups:-

Group IIIa: 0.5 mm increment of Constic was applied, brushed for 25 seconds and was cured for 20 seconds using LED curing unit. Rest of the Teflon mold was filled with Constic and light cured using LED curing unit for 20 seconds.

Group IIIb: 2 mm of second increment of Constic was applied directly without brushing and was cured for 20 seconds using LED curing unit.

Study Procedure

Unstimulated whole saliva was collected from a single healthy individual donor in a sterile test tube and was used within one hour (20),(21). Fresh saliva is considered as an acceptable material to be used in saliva contamination testing (3).

Donor saliva was actively spread on the surface of specimen for 10 seconds using a microbrush on all samples except group I (Table/Fig 4).

After contamination and treatments according to the respective groups, a Teflon mold (diameter 4 mm, thickness 2 mm) was placed on first increment and second increment was applied according to the respective groups (Table/Fig 5).

Bond strength measurement is essential for studying the bonding stability (22). Hence to assess the bonding between resin-resin increment, shear bond strength was assessed.

All the samples were stored in distilled water at 37°C for 24 hours. After 24 hours, shear bond strength between increments of composite was determined by Universal Testing Machine.

Shear bond strength assessment: Samples were mounted and stressed in shear at a rate of 0.5 mm/min using Universal Testing Machine (ACME, India) using chisel knife edge until failure of the bonding occurred (Table/Fig 6).

The maximum load at failure was recorded in Newtons (N) and converted to MegaPascals (MPa) (6).

Shear Bond Strength (MPa)=F(N)/A=F(N)/πr2

Where π=3.1416, r=radius of composite build-up, N=Load.

Samples which show failure at any other interface apart from composite-composite were replaced by new samples and tested again.

Statistical Analysis

Descriptive statistics were employed to measure mean and Standard Deviation (SD) for shear bond strength. One-way ANOVA test was applied to compare the overall difference among five groups. Pairwise comparisons between different subgroups were performed using Independent t-test. Statistical significance was fixed at ≤0.05. Analysis was done using Statistical Package for Social Sciences (SPSS) software version 23.0.

Results

Incremental shear bond strength (MPa) was highest for group I (12.09±1.99) followed by group IIIa (10.21±3.49), group IIa (10.08±3.21), group IIb (7.59±2.31) and lowest for group IIIb (7.35±3.06). The difference between the groups were statistically significant (p=0.001) (Table/Fig 7). The difference between mean incremental layer shear bond strength of control group from mean result of group IIa (p=0.092) and group IIIa (p=0.136) was non significant (Table/Fig 8).

The difference between mean incremental layer shear bond strength of control group had a significant difference from mean result of group IIb (p=0.001) and group IIIb (p=0.001).

The mean difference between the incremental layer shear bond strength of group IIa and group IIb was 2.49 MPa. The incremental layer shear bond strength of group IIa was significantly more than that of group IIb (p≤0.05) (Table/Fig 9). The mean difference between the incremental layer shear bond strength of group IIIa and group IIIb was 2.86. The incremental layer shear bond strength of group IIIa was significantly greater than that of group IIIb (p≤0.05).

Non significant difference was found between mean incremental layer shear bond strength of group IIa and group IIIa, also between group IIb and group IIIb (Table/Fig 10). Significant difference (p≤0.05) was found between mean incremental layer shear bond strength of group IIa and group IIIb, also between group IIb and group IIIa.

Thus, subgroup a had an overall improved bond strength as compared to subgroup b. The treatments carried out in groups IIa and IIIa successfully restored the bond strength comparable to that of the control group.

Discussion

Dental composites have unquestionably acquired a prominent place among the filling materials employed in direct techniques (23). Evolution of self-adhesive composites over the past years has led to establishment of novel self-adhesive composites that are composed of monomers that have self-etching and/or self-adhesive properties. They etch the tooth surfaces and chemically bond to the hydroxyapatite crystals (24).

Constic is composed of 10-Methacryloyloxydecyl Dihydrogen Phosphate (MDP) monomer which holds longer and greater number of hydrophobic spacer chains. MDP forms stable 10-MDP-Calcium salts without leading to major decalcification, resulting in formation of a sturdy chemical bonding with hydroxyapatite crystals of tooth structure (25),(26). Constic etches enamel and dentin, bonds with tooth structure similar to glass ionomer, and it has ability to co-polymerise with the composite resin (19).

Composite resins being a multi-step procedure routinely require discrete conditioning steps with the aid of an adhesive system to enable bonding of composite resin on tooth structure. Contamination by saliva, blood, gingival sulcular fluid, and handpiece oil leads to decrease in the bond strength between the restoration and the tooth substrate, hence they are important determinants that influence adhesion of composite resin (27). Saliva possess a great risk of contaminating the surface to be restored (27),(28).

The clinical performance and longevity of dental restorations can be determined by adhesive bond strength (29). Adhesion tests measure either tensile bond strength or shear bond strength. Furuse AY et al., (11) assessed the shear bond strength at resin-resin interface using a universal testing machine, similar method was adapted in the present study.

According to the results of this study, the mean incremental shear bond strength value of all groups contaminated with saliva was found to be less than that of control group. This is in accordance with the results published by Eiriksson SO et al., (3), Furuse AY et al., (11) and Jaberi AZ and Mohammadpour A (4). Thus, salivary contamination lowers the adhesive strength between resin increments and the most anticipated reason behind it is the formation of a film of glycoprotein sugars on the surface of composite resin coming in contact with saliva (3).

Yazici AR et al., (27) studied the effect of saliva contamination on microleakage of an etch-and-rinse and a self-etching adhesive. They attributed the detrimental effects of saliva contamination on the cured adhesive layer to the adsorption of glycoproteins onto the poorly polymerised adhesive surface, similar results were observed in the present study.

In 2004 Eiriksson SO et al., (3) assessed the saliva contaminated resin surface of specimen under a scanning electron microscope, it displayed a flat surface on the specimens. They concluded that this might be the probable reason behind decrease in the incremental layer shear bond strength as it leads to lack of contact of composite resin increment with the contaminated surface.

Comparison of present study with previous studies on effect of salivary contamination on bond strength and various methods employed to regain the bond strength is summarised in (Table/Fig 11) (3),(4),(11),(27),(28),(30).

Furuse AY et al., (11) concluded that if salivary contamination of resin surface occurs during the procedure of composite layering it decreases the bond strength and hence, requires a plausible decontamination method to restore the bond strength. This is in agreement with the results obtained from the present study.

Group IIb and Group IIIb resulted in significantly lower incremental bond strength than control group. The mean incremental shear bond strength value of group IIb was more than mean incremental layer shear bond strength value of group IIIb. However, the difference was statistically insignificant (p≤0.05) suggesting that neither of the above methods are reliable to decontaminate the surface of resin after salivary contact. This is in accordance with the study conducted by Jaberi AZ and Mohammadpour A (4) where they assessed the microshear bond strength of composite-composite after salivary contamination. They concluded that air drying of resin surface contaminated with saliva decreases the bond strength considerably.

Eiriksson SO et al., (3) published that bond strength between resin increments after salivary contamination decreases even if saliva is in contact with resin for a short time or is rinsed away with water. They also assessed the saliva contaminated resin surface of specimen that was rinsed and air dried under a scanning electron microscope, it displayed few craters or blisters suggesting that water, air or saliva might still be trapped on the surface of the specimens and might have led to decreased bond strength. Same reason might have resulted in significantly lower bond strength values of group IIb and group IIIb to that of control, group IIa and group IIIa. Furuse AY et al., (11) reported that the lowest incremental shear bond strength was found when the rinsing and drying of the contaminated surface was performed, which is in accordance with the present study.

Shear bond strength values within both the groups that is group II and group III significantly improved by active application of ~ 0.5 mm layer of Constic for 25 seconds on saliva contaminated surface of composite as compared to not brushing and directly applying composite. Thus, suggesting that active application of Constic by brushing aids in restoring the bond strength comparable to that of control group. Probable reason being that active application of Constic leads to better surface wetting and improved penetration of functional monomers (MDP) producing more stable bond. This is in accordance with a systematic review published by Carrilho E et al., (31), where they published that in order to get the best of the adhesive solutions containing 10-MDP, a scrubbing technique must be employed to apply the adhesive system on dental substrates. This results in better infiltration of monomers at the same time leads to formation of a much stable bond. Eiriksson SO et al., (3) published that application of an adhesive on saliva contaminated surface increases the bond strength similar to control group. The adhesive used in their study was composed of MDP, which is the functional monomer found in Constic, it might have played a vital role in increasing the bond strength. Carrilho E et al., (31) reported that use of MDP containing bonding agents successfully improved the immediate resin repair bond strength. Furuse AY et al., (11) concluded from their study that application of adhesive on contaminated resin surface increases the shear bond strength similar to that of control group.

Jaberi AZ and Mohammadpour A (4) evaluated the micro-shear bond strength of composite-composite after salivary contamination, and investigated which decontamination method best re-establishes the original resin-resin bond strength. They found that shear bond strength after rinsing, air drying followed by acid etching as well as rinsing, air drying followed by acid etching and application of bonding agent on contaminated surface were almost similar and had no significant difference with that of control group.

Nair P and Ilie N (28) conducted a study to evaluate the long-term consequence of salivary contamination at various stages of adhesive application and clinically feasible remedies to decontaminate, they concluded that the acidity of self-etch adhesives modifies and penetrates the smear layer and also breaks through the mucopolysaccharides in the saliva and develops bond strengths comparable with those obtained on noncontaminated dentine surfaces. Constic has the ability to etch enamel (19), this might have contributed in modification of smear layer and mucopolysaccharides in saliva thus, restoring the bond strength of saliva contaminated surface.

The method adapted in the present study maintained the oxygen inhibited layer to mimic in-vivo incremental filling technique, also the manufacturer’s instructions for Constic recommends retaining oxygen inhibition layer (19).

From the results obtained in the study the incremental layer shear bond strength value was highest with control group, followed by subgroups IIIa, IIa, IIIb and minimum bond strength was observed with in IIb. The present study suggests that immediate active application of Constic (self-etch self-adhesive flowable composite) seems to play a vital role in restoring the incremental layer bond strength after salivary contamination, hence rejecting the null hypothesis.

Salivary contamination of resin surface during incremental placement of composite resin is observed frequently in clinical situations and restoring bond strength in such clinical scenario with ease of application and less time consumption enhances the quality and life of treatment and improves public health in a community (4).

Limitation(s)

The specimens made for in-vitro studies are relatively flat, uniform and untextured as compared to intraoral restorations impacting the results considerably. Secondly, in the oral cavity, the additive effects of temperature, area or location, accessibility, distance from tip of light curing unit may influence the results, they were not accounted in this in-vitro study.

Conclusion

Within the limitations of the study, it can be concluded that salivary contamination of composite during incremental placement decreases the shear bond strength at resin-resin interface. Air drying or rinsing followed by air drying the contaminated surface did not increase the incremental shear bond strength and thus, are not reliable methods to restore the bond strength. Air drying alone or rinsing followed by air drying the contaminated surface along with active application of Constic by brushing it resulted in shear bond strength values comparable to that of control group. Active application of self-etch self-adhesive flowable composite successfully restores the incremental shear bond strength after salivary contamination.

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DOI and Others

DOI: 10.7860/JCDR/2022/57959.17071

Date of Submission: Jun 03, 2022
Date of Peer Review: Jul 04, 2022
Date of Acceptance: Aug 10, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

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