The Effect of Bonding Strategy and Aging on Adhesion to Primary Enamel: An In-Vitro Study.

PURPOSE: Resin composites are commonly used in pediatric dentistry, but there is limited evidence on adhesion to primary teeth, especially primary enamel. In this study, three bonding strategies were assessed - one-step self-etch (1-SE), two-step self-etch (2-SE), and three-step etch-and-rinse (3-ER) - by measuring the immediate and aged microshear bond strength (microSBS) to sound primary enamel. MATERIALS AND METHODS: 120 extracted human primary molars with sound buccal surfaces were used for microSBS testing. Six adhesive protocols (two per bonding strategy) were selected and microSBS was measured either after 24 h or 10,000 thermal cycles (n = 10). Confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) were used to determine failure modes. Furthermore, 18 primary molars were etched using the different adhesive protocols (n = 3) for the measurement of surface roughness (Sa) using CLSM and morphological analysis using SEM. RESULTS: After 24 h, there was no significant difference in microSBS between 1-SE and 2-SE strategies (p = 0.96), but the 2-SE strategy yielded significantly higher microSBS after thermocycling (p < 0.001). The highest microSBS was obtained using the 3-ER strategy regardless of aging (p < 0.001). The 3-ER strategy clearly exposed enamel prisms and resulted in the highest Sa (p < 0.001). In contrast, if SE strategies were used, enamel prisms were barely recognizable, and Sa was not significantly different from baseline (p > 0.95). CONCLUSION: The 3-ER strategy is optimal for bonding to primary enamel. The etching effect of SE strategies is weaker, resulting in lower microSBS. Thermocycling revealed that the bonding durability of the 1-SE strategy is inferior to that of to multi-step strategies.