Rola of collagen cross-linkers on the stability of bonded interface

Restorative adhesive dentistry is based on the infiltration of dental adhesive resin within the dentin collagen network creating the hybrid layer. The stability and integrity of collagen fibrils within the hybrid layer are crucial for the maintenance of bond effectiveness over time. The matrix metallo-proteinases enzymes (MMPs), which are endogenous enzymes present in dentin tissue, are claimed to play a key role in affecting the integrity of the hybrid layer causing the hydrolysis and degradation of dentin collagen. The aim of this research project was to evaluate the efficacy of different cross-linking agent in preserving the adhesive/dentin layer. Two water soluble collagen cross-linking agents riboflavin, and the carbodiimide hydrochloride, 1-ethyl-3-[3-dimethylaminopropyl] (EDC) were initially tested, then additional cross-linking agents were included in the study: acrolein, (water soluble), and the N,N'-dicyclohexylcarbodiimide (DCC) (soluble in acetone and ethanol). The concentration of each solution was chosen according to the previous studies: 0.1% riboflavin/wt, 0.3M EDC/wt, 0,01% acrolein/wt, 0.5M DCC/ethanol, 0.5M/acetone. Cross-linkers were associated to different adhesive systems available on the market and different tests were performed to evaluate the ability of cross-linkers in preserving the hybrid layer: mechanical test (microtensile bond strength), qualitative test (nanoleakage analysis), and biochemical assays (zymographic analysis and in situ zymographic analysis). For the microtensile bond strength recently extracted third molars (N=5 for each group) were selected and restorative treatments were performed: in the experimental groups teeth were pretreated with the tested cross-linkers before the application of the adhesive systems (XP Bond, Scotch Bond 1XT, Optibond FL, Clearfil SE), while in the control groups the adhesives were applied according to the manufacturers' instructions. The experimental groups were divided as follow: 1) 0.1% riboflavin/XP Bond; 0.3M EDC/Scotch Bond 1XT; 2) 0.3M EDC+XP Bond 3) 0.3M EDC+Scotch Bond 1XT; 4) 0.3M EDC+Optibond FL; 5) 0.01% acrolein+Scotch Bond 1XT; 6) 0.3M EDC+Clearfil SE. The bonded specimens were serially sectioned to obtain approximately 1-mm-thick beams in accordance with the microtensile non-trimming technique. Beams were stored at 37°C in artificial saliva to reproduce the oral cavity environment and then were stressed to failure after 24hours (T0), 6 months (T6) or 1 year (T12) using a simplified universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed using Two-Way (variables: cross-linker pretreatment and storage time) analysis of variance (ANOVA) and post hoc Tukey test (p values < 0.05 were considered as statistically significant). The results of microtensile bond strength showed that the use of the tested cross-linkers tested does not affect the immediate bond strength, while at T12 bond strength values of the experimental groups are significantly higher compared to the control groups. For the qualitative interfacial nanoleakage analysis, additional molars (4 per group) were selected to evaluate the integrity of the tooth/resin interfaces. The experimental groups were divided as follow: 1) 0.1% riboflavin-XP Bond; 2) 0.3M EDC-Scotch Bond 1XT; 3) 0.3M EDC-Optibond FL. The specimens were prepared and stored as described for the microtensile test; after storage the beams were immersed for 24h in AgNO3, then rinsed in distilled water and immersed in photo-developing solution to reduce silver ions into metallic silver grain. Nanoleakage analysis was performed under light microscopy and the interfacial nanoleakage degree was scored on a scale of 0†"4 based on the percentage of the adhesive surface showing silver nitrate deposition: 0: no nanoleakage; 1: <25% nanoleakage; 2: 25 to ?50% nanoleakage; 3: 50 to ?75% nanoleakage; and 4: >75% nanoleakage. Statistical differences among nanoleakage group scores were analyzed using the ?2 test. The results did not reveal differences in the interfacial nanoleakage expression between the experimental groups 2 (0.3M EDC-Scotch Bond 1XT) and 3 (0.3M EDC-Optibond FL) and their respective control group. After 12-month storage the treatment with the riboflavin significantly reduce the infiltration of AgNO3 within the hybrid layer created with XP Bond. For the biochemical assay of the enzymatic activity, zymographic analysis and in situ zymography were performed. The following groups were added to the previously described treatments and submitted to these tests: 0.5M DCC/ethanol, 0.5M DCC/acetone, 0.5M DCC/ethanol- Scotchbond 1XT, 0.5M DCC/acetone Scotchbond 1XT. For the zymographic analysis dentin powder was obtained from thirty human sound molars; the powder was treated with the cross-linking agents in association or not with the different adhesive systems. The extract proteins were submitted to electrophoresis on SDS-polyacrylamide gels copolymerized with gelatin as MMPs substrate. Zymograms showed that the use of cross-linkers before the adhesive application was able to reduce or totally inhibit the activity of MMPs (especially MMP-2 and MMP-9). The specimens submitted to in situ zymography were prepared as previous described for the microtensile test. Bonded specimens were cut in order to expose the adhesive/dentin interfaces and in situ zymography was performed applying a self-quenched fluorescein-conjugated gelatin on adhesive/dentin interface. The specimens were light-protected and incubated in humidified chambers at 37°C for 24 h, then the hydrolysis of quenched fluorescein-conjugated gelatin substrate (related to endogenous gelatinolytic enzyme activity) was assessed by examination with a confocal laser scanning microscope. Images revealed reduced green fluorescence in the hybrid layer of experimental groups (pretreated with the cross-linking agents) compared to the control group fluorescence. The results of all these studies suggest that the use of cross-linking agents before the bonding procedures improves the stability of the resin/dentin interface. We can speculated that cross-linkers are able to reinforced the dentin collagen network increasing the mechanical properties of the hybrid layer, as confirmed by the microtensile test. Furthermore the results showed that these agents are able to inhibit the MMP gelatinolytic activity, preserving the dentin collagen fibrils from the hydrolysis and avoiding the failure of the hybrid layer.