Effect of three surface treatments on the adhesive properties of indirect composite restorations.

Purpose: To evaluate the effect of different surface treatments of composite resin blocks on the adhesive properties of indirect composite restorations. The null hypothesis tested was that none of the performed surface treatments would produce greater bond strength. Materials and Methods: The crowns of 80 extracted molars were transversally sectioned next to the pulp to expose flat, deep dentin surfaces. Eighty-eight cylindrical composite specimens measuring 3.5 mm in diameter and 10 mm in height were prepared and randomly divided into 4 groups (CG, HFSiG, SaG, SaSiG), which respectively received the following treatments: control (CG): etching with 9.5% HF acid gel and application of a silane (HFSiG); sandblasting (SaG) with 50-mu m Al2O3 from a distance of 10 mm at a pressure of 2.5 bars for 10 s; combination of sandblasting and silanization procedures (SaSiG). Two composite specimens of each group were analyzed with SEM, while the remaining twenty cylindrical specimen were bonded to dentin samples using a two-step adhesive system and a thin layer of composite. After 24 h storage and 5000 thermocycles, all specimens were loaded to failure under tension in a universal testing machine. The mean differences of each group were analyzed with the Kruskal-Wallis test, while multiple comparisons were made using the Ryan-Einot-Gabriel-Welsch Range test. P-values less than 0.05 were considered to be statistically significant in all tests. The fracture pattern of bonded specimens was also evaluated by SEM. Results: SEM analysis showed morphological changes in each group. The mean values (in MPa) of TBS (+/- SD) for groups CG, HFSiG, SaG, and SaSiG were 11.17 +/- 3.48, 10.81 +/- 5.19, 16.51 +/- 3.45 and 16.55 +/- 3.16, respectively. Statistical analysis showed that the bond strength was significantly affected by surface treatment (p < 0.001). Multiple comparison analysis identified statistically significant differences for CG and HFSiG vs SaG and SaSiG (p < 0.05), while no significant differences were found for the comparisons CG vs HFSiG and SaG vs SaSiG (p > 0.05). Only a few adhesive failures were recorded (CG: 0.5%; SaG: 0.4%; HFSiG: 0.5%; SaSiG: 0.7%). The null hypothesis was rejected. Conclusion: Composite surface treatments are important for adhesion of indirect composite restorations. Roughening the composite area of adhesion, sandblasting, or both sandblasting and silanizing can provide statistically significant additional resistance to tensile load. Hydrofluoric acid etching with silane treatment did not reveal significant changes in tensile bond strength. These findings suggest that sandblasting treatment was the main factor responsible in improving the retentive properties of indirect composite restorations.