The effect of remineralization pretreatments on the enamel bond strength of demineralized and sound enamel: An in vitro study

Abstract

BACKGROUND: During tooth preparation, the clinician may face a hard remineralized enamel surrounding the cavity with unknown effects on the enamel bond strength. This study aims to assess the effect of remineralizing pretreatments with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) or CPP-amorphous calcium fluoride phosphate (CPP-ACFP) on the bond strength of composite resin and sound or demineralized enamel. MATERIALS AND METHODS: This study employed an in vitro experimental factorial design. A total of 144 enamel surfaces were prepared and randomly divided into 12 groups (G1-G12). The surfaces of G7-12 were demineralized to create a lesion (L), while G1-6 were assigned to the sound (S) enamel group. The three pretreatment protocols were CPP-ACFP, CPP-ACP, or no pretreatment for a 10-day pH-cycling period. A composite rod was bonded to the surfaces using a self-etch or total-etch bonding system. Shear force was applied, and the bond strengths of the specimens were measured. The data were analyzed using the Kruskal-Wallis test, followed by pairwise comparisons using Dunn's test. The significance level for all tests was set at 0.05. RESULTS: The sound (S) groups (33.81 +/- 8.48) showed a significantly higher bond strength than the lesion (L) groups (25.77 +/- 6.69). Among the pretreatments, CPP-ACFP-pretreated groups had the highest bond strength (33.86 +/- 8.87). Pairwise comparisons showed significant differences between CPP-ACFP-treated demineralized enamel and control demineralized enamel in both bonding systems (P = 0.019 and P = 0.025 for Clearfil SE and Optibond FL, respectively). CONCLUSION: Pretreatment of demineralized enamel with CPP-ACFP before using total-etch and self-etch systems results in a bond strength comparable to that of sound enamel, making it clinically acceptable.