Effects of dentine surface cleaning on bonding of a self-etch adhesive to root canal sealer-contaminated dentine

Objectives: To compare the effectiveness of different sealer cleaning methods on bonding of a self-etch adhesive to root canal sealer-contaminated dentine. Methods: Forty-nine extracted molars were divided into seven groups. Dentine surfaces were exposed and cotaminated with a thin layer of epoxy resin-based sealer (AH Plus (AHP)) or zinc oxide eugenol-based sealer (Pulp Canal Sealer (PCS)). Three cleaning protocols were examined: dry cotton pellet, 70% ethanol-saturated cotton pellet or a surfactant-based cleaner (KatanaTM Cleaner (KC), Kuraray Noritake Dental Inc.). Uncontaminated dentine served as control. The dentine surfaces were bonded with a two-step self-etch adhesive and restored with resin composite. Bond strength testing was performed using a microtensile approach. Two teeth from each group were used for scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDX). The pulpal floor of the teeth was covered with sealer and cleaned. The percentage of zinc/zirconium on the dentine surface was detected to indicate the amount of remnant sealer. Results: Tensile bond strength for uncontaminated dentine control was 46.4 +/- 7.3 MPa; bond strength decreased significantly for the dry cotton group (29.6 +/- 4.2 MPa for AHP, 24.7 +/- 4.7 MPa for PCS, p<0.05). Both ethanol and KC restored bonding performance after cleaning, with no significant difference from the control. Significantly lower MTBS was observed for the ZOE/ethanol subgroup (38.9 +/- 5.1 MPa). Cleaner surfaces and less zinc/zirconium elements were identified by SEM/EDX after cleaning with ethanol or KC. Conclusions: KatanaTM Cleaner decontaminates root canal sealer-smeared dentine surfaces effectively and restores the bonding performance of a self-etch adhesive to dentine. Clinical significance: The surfactant-based KatanaTM Cleaner, originally designed for cleaning zirconia surfaces prior to adhesive bonding, may be used as for cleaning dentine that has been contaminated with unset root canal sealers after root canal treatment to restore the bonding strength of a self-etch adhesive to sealer-contaminated dentine.