Optimization of the etch-and-rinse technique: New perspectives to improve resin-dentin bonding and hybrid layer integrity by reducing residual water using dimethyl sulfoxide pretreatments.

OBJECTIVE: To determine whether bonding effectiveness and hybrid layer integrity on acid-etched dehydrated dentin would be comparable to the conventional wet-bonding technique through new dentin biomodification approaches using dimethyl sulfoxide (DMSO).

METHODS: Etched dentin surfaces from extracted sound molars were randomly bonded in wet or dry conditions (30s air drying) with DMSO/ethanol or DMSO/H2 O as pretreatments using a simplified (Scotchbond Universal Adhesive, 3M ESPE: SU) and a multi-step (Adper Scotchbond Multi-Purpose, 3M ESPE: SBMP) etch-and-rinse adhesives. Untreated dentin surfaces served as control. Bonded teeth (n=8) were stored in distilled water for 24h and sectioned into resin-dentin beams (0.8mm2 ) for microtensile bond strength test and quantitative interfacial nanoleakage analysis (n=8) under SEM. Additional teeth (n=2) were prepared for micropermeability assessment by CFLSM under simulated pulpar pressure (20cm H2 O) using 5mM fluorescein as a tracer. Microtensile data was analyzed by 3-way ANOVA followed by Tukey Test and nanoleakage by Kruskal-Wallis and Dunn-Bonferroni multiple comparison test (α=0.05).

RESULTS: While dry-bonding of SBMP produced significantly lower bond strengths than wet-bonding (p<0.05), DMSO/H2 O and DMSO/ethanol produced significantly higher bond strengths for SBMP irrespective of dentin condition (p<0.05). SU presented significantly higher nanoleakage levels (p<0.05) and micropermeability than SBMP. Improvement in hybrid layer integrity occurred for SBMP and SU for both pretreatments, albeit most pronouncedly for DMSO/ethanol regardless of dentin moisture.

CONCLUSION: DMSO pretreatments may be used as a new suitable strategy to improve bonding of water-based adhesives to demineralized air-dried dentin beyond conventional wet-bonding. Less porous resin-dentin interfaces with higher bond strengths on air-dried etched dentin were achieved; nonetheless, overall efficiency varied according to DMSO's co-solvent and adhesive type.

CLINICAL SIGNIFICANCE: DMSO pretreatments permit etched dentin to be air-dried before hybridization facilitating residual water removal and thus improving bonding effectiveness. This challenges the current paradigm of wet-bonding requirement for the etch-and-rinse approach creating new possibilities to enhance the clinical longevity of resin-dentin interfaces.