Do collagen cross-linkers improve dentin's bonding receptiveness?

Objective. Dentin biomodification using collagen cross-linkers has been proposed as one of the strategies to improve bond durability of adhesives to dentin. However, literature is not very consistent regarding their benefit, in particular when cross-linkers are applied in clinically realistic application times. This study investigated the effect of three cross-linkers on the mini-interfacial fracture toughness (mini-iFT) of four adhesives bonded to dentin following either etch&rinse (E&R) or self-etch (SE) modes. Methods. 60 molars were randomly divided in accordance with the three variables: crosslinker, adhesive and bonding mode (n = 5). The cross-linkers glutaraldehyde (5 wt%; GA), proanthocyanidin (6.5 wt%; PA), or UVA-activated riboflavin (0.5 wt%; RB), and distilled water(control) were applied on dentin for 60 s after acid-etching (E&R) or before self-etching (SE). The 3-step E&R adhesive (3E&Ra) OptiBond FL (Kerr), the 2-step SE adhesive (2SEa) Clearfil SE Bond 2 (Kuraray Noritake) and the universal adhesives G-Premio Bond (GC) and Prime&Bond Active (Dentsply), the latter two employed in both E&R and SE modes, were applied following the respective manufacturer's instructions. Composite buildups (8 x 8 x 8 mm) were made using Filtek Supreme XTE (3M) prior to 1-week storage in artificial saliva. After the teeth were sectioned into mini-specimens (1.5 x 2.0 x 18 mm), a single notch was prepared at the adhesive-dentin interface. Half of the specimens were immediately loaded until failure by 4-point bending to determine the mini-iFT, while the remaining specimen set was tested upon 6-month aging. Data were statistically analyzed with a linear model (p < 0.05). Results. No significant decrease in mini-iFT was noted only for PA (p < 0.05), while the mini-iFT decreased for both other cross-linkers and in quite a similar way as when solely water (Wa) was applied. Significance. The cross-linker proanthocyanidin (PA) applied in clinically relevant conditions was able to maintain a stable mini-iFT after 6-month aging. The incorporation of UVA-activated riboflavin (RB) and glutaraldehyde (GA) in the dentin-bonding protocol appeared not effective to improve the stability of adhesive-dentin interfaces. (C) 2018 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.