Cuspal deflection and cervical microleakage scores to determine the adhesive potential of universal bonding systems.

Objectives: To assess the adhesive performance of three universal bonding systems (self-etch and total-etch protocols) with cuspal deflection and cervical microleakage score.

Methods: Fifty-six standardised sound maxillary premolar teeth with uniform mesio-occlusal-distal (MOD) cavities were randomly allocated to six groups. Restoration with resin-based composite (RBC) was performed in conjunction with a universal bonding system facilitated by a quartz-tungsten-halogen light-curing-unit. The dependent variable was the universal bonding protocol (self-etch or total-etch). Buccal and palatal cuspal deflections were recorded at 0, 30, 60 and 180s post-irradiation using a twin channel deflection measuring gauge. Following restoration, the teeth subjected to 500 thermocycles, immersed in a 0.2% basic fuchsin dye for 24h, sectioned and examined for cervical microleakage.

Results: Comparing between bonding protocol (self-etch or total-etch), a decrease in total cuspal deflection and a concomitant increase in cervical microleakage were evident when employing the total-etch compared with the self-etch protocol for two of the three universal dental adhesives.

Conclusions: The 'Adhesion-Decalcification concept' suggests a trend towards 'mild self-etch' adhesives. Differences in adhesive performance (cuspal deflection and cervical microleakage) between the teeth restored using the self-etch or total-etch protocols is suggested to be a result of the pH of the self-etch solutions. 'Mild self-etch' (pH∼2.0) adhesives out-performed ultra-mild (pH>2.5) or strong (pH<1.5) self-etch solutions.

Clinical Significance: Poorly performing adhesives could be identified using the cuspal deflection and cervical microleakage protocol reported which could save the complications encountered clinically with Class II RBC restorations.