Prime-and-rinse approach for improving the enamel micro-tensile bond strengths of self-etch adhesives

The study investigated the effects of prime-and-rinse approach using 15% MDP (10-methacryloyloxydecyl dihydrogen phosphate)-containing primer on the enamel micro-tensile bond strengths (MTBS) of (ultra-) mild self-etch adhesives, enamel surfaces and enamel-resin interfaces. The buccal enamel surfaces of 69 human third molars were polished and randomly assigned to three groups: Group A (control, self-etch approach): Polished enamel surfaces were not further pre-treated. The enamel surfaces were acid-etched (Group B, (selective) enamel etching) or primed with 15% MDP-containing primer (Group C, prime-and-rinse approach) for 15 s and thoroughly water-sprayed. The enamel surfaces were applied with self-etch adhesives and placed with composite resins (Adper Easy One + Filtek Z350 (3 M ESPE); Clearfil S3 Bond + Clearfil Majesty (Kuraray-Noritake Co.); G Bond + Gradia Direct (GC); iBond + Charisma (Heraeus-Kulzer)), respectively. The specimens were prepared for MTBS test and scanning/transmission electron microscopy observations. Compared with group A, groups B and C produced significantly higher enamel MTBS (p < .01), regardless of the adhesives used. Groups B and C possessed similar enamel MTBS (p > .05). The SEM findings showed that smear layer remained on the polished enamel surface was completely removed by acid etching and almost completely removed by prime-and-rinse approach. The TEM microphotographs reveal that smear layer was detectable at the resin-enamel interface in group A, not in groups B and C. The novel prime-and-rinse approach using MDP-containing primer before the application of (ultra-) mild self-etch adhesives could greatly increase the enamel MTBS. That might be an alternative to selective enamel etching.