Comparative evaluations of shear bond strength of mineral trioxide aggregate, Biodentine, and calcium-enriched mixture to bulk-fill flowable composite using three different adhesive systems: An in vitro study

Abstract

The objective of the study was to assess the shear bond strength of bulk-fill flowable composite resin smart dentin replacement plus when bonded to mineral trioxide aggregate (MTA)-angelus, biodentine, and calcium-enriched mixture (CEM) at two different aging periods (15 min and 72 h) using three distinct adhesive systems. In addition, the study identified the specific modes of failure (adhesive, cohesive, or mixed) using a stereomicroscope and scanning electron microscope. One hundred and twenty-six cylindrical acrylic blocks used in the study were sorted into three groups based on the bioactive substance used to fill the 3-mm diameter and 3-mm high hole in the center of each block. The groups were MTA, Biodentine, and CEM. The specimens were then divided into subgroups based on the aging interval (15 min and 72 h) of the bioactive material and the adhesive system used (two-step total-etch, two-step self-etch [SE], and one-step SE) while bonding to the restorative bulk-fill flowable composite. The shear bond strength values were measured with a universal testing machine, and the data were analyzed using two-way and one-way analysis of variance, followed by a post hoc test. The specimens were assessed under stereomicroscope and scanning electron microscope to characterize the mode of bond failure (cohesive, adhesive, or mixed). The study showed that the type of adhesive system and the time of bonding affected the shear bond strength of bulk-fill composite to the pulp capping agents (P < 0.05). For MTA, the highest bond strength was observed with two-step SE group at 15 min (18.16 ± 2.97 MPa) (P < 0.05). CEM exhibited the highest bond strength with two-step SE group at 72 h intervals (8.77 ± 1.76) (P < 0.05). The highest bond strength for biodentine group was observed with total-etch group (8.54 ± 1.35 Mpa) and two-step SE (8.19 ± 1.94 Mpa) bonded at 72 h interval (P < 0.05). The majority of the samples in the MTA group (29/42) and CEM group (20/42) showed a cohesive fracture, whereas Biodentine group (22/42) had an adhesive fracture in most of its samples. MTA demonstrated the highest bond strength with two-step SE group at 15 min, and CEM exhibited the highest bond strength with two-step SE groups at 72 h interval. For biodentine group, the type of adhesive used did not impact the bond strength values.