Effect of Chlorhexidine-Encapsulated Nanotube-Modified Adhesive System on the Bond Strength to Human Dentin

Abstract

Introduction: The resin-dentin interface undergoes degradation by endogenous matrix metalloproteinases (MMPs) after adhesive procedures. Application of several MMP inhibitors such as chlorhexidine (CHX) to the demineralized collagen dentin matrix after acid-etching has been suggested to be a successful approach to prevent degradation of the hybrid layer. Further, nanotubes (HNT) have been used as a reservoir for encapsulation and controlled delivery for several therapeutic drugs with sustained release. Therefore, HNT can be encapsulated with CHX and incorporated into dentin adhesives for the possibility of enhancing the longevity and durability of the hybrid layer. Objective: To evaluate the effect of a CHX-encapsulated nanotube-modified primer/PR and adhesive/ADH on the microtensile resin bond strength (µTBS) to dentin. Materials and Methods: A commercial adhesive and its respective primer were modified by adding CHX-encapsulated nanotubes at two distinct concentrations (10 and 20 wt.%). The experimental adhesives were evaluated by degree of conversion (DC) and viscosity. Meanwhile, only viscosity was determined for the experimental primers. The prepared HNT-encapsulated with CHX (10 and 20 wt.%) powders were incorporated into the primer and/or adhesive according to the groups: ADH (control); HNT (control); 0.2% CHX; PR+CHX10%; PR+CHX20%; ADH+CHX10%; ADH+CHX20%. Human molars were selected and autoclaved; mid-coronal dentin surfaces were exposed for bonding purposes. Dentin surfaces were etched, followed by primer and adhesive application, and restored with a resin composite. After 24 hours, the teeth were sliced into beams for µTBS testing; beams collected for each tooth were equally assigned into two testing condition groups: 24 hours and 6 months. Microtensile bond strength was tested using a universal testing machine, and the types of failure were classified as adhesive, mixed, and cohesive failure. Data from DC and viscosity tests were analyzed using one-way ANOVA. Bond strength data were analyzed by pair-wise comparisons using the Sidak method to control the overall significance level at 5% for each aging time separately. Weibull-distribution survival analysis was used to compare the differences in the microtensile bond strength results among the groups after 24 hours and 6 months. Results and Conclusion: DC analysis revealed no significant differences among adhesive groups. However, ADH group had a significantly lower viscosity than modified adhesive groups, and a significantly higher viscosity than modified primer groups. Test results of stress value (MPa) by each group for each aging time revealed no significant differences among groups after 24 hours. However, after 6-month storage, modified primer groups (PR+CHX10%, PR+CHX20%) and 0.2%CHX group showed a significant difference in µTBS compared to control groups (ADH, HNT) and modified adhesive groups (ADH+CHX10%, ADH+CHX20%) in the same aging time testing (p < 0.05). When comparing the µTBS after 24 hours and 6 months, there were no significant differences among the groups except for the ADH+CHX20% group, for which MPa values were higher after 24 hours than 6 months (p = 0.0487). In conclusion, this study has demonstrated the great potential of modified dental primers with CHX-encapsulated nanotubes in preservation of the resin-dentin bond strength over a 6-month time period. Additionally, modification of dental primers and adhesives was a successful approach that didn’t compromise the characteristics or the mechanical properties of the materials and has a promising long-term effect on resin-dentin bond strength.