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The Effect of Remineralization Pretreatments on the Enamel Bond Strength of Demineralized and Sound Enamel: An in Vitro Study Publisher



Shirani F1 ; Malekipour MR2 ; Azary M3 ; Manesh VS4 ; Gilani A3 ; Mazdak A3
Authors
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Authors Affiliations
  1. 1. Department of Operative Dentistry, Dental Materials Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
  2. 2. Department of Operative Dentistry, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
  3. 3. Dental Students' Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. College of Medicine and Dentistry, School of Medicine and Dentistry, James Cook University (Cairns Campus), QLD, Australia

Source: Dental Research Journal Published:2025


Abstract

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. © 2025 Wolters Kluwer Medknow Publications. All rights reserved.
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