Impact of Casein Phosphopeptide Amorphous Calcium Phosphate and Proanthocyanidin on Bond Strength of Universal Adhesives to Caries-Affected Dentin in Primary Teeth: An In Vitro Study

Abstract

Objectives: This study aimed to assess the impact of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and proanthocyanidin (PA) on the microshear bond strength (μSBS) of universal adhesives to caries-affected dentin (CAD) in primary teeth. Materials and Methods: 160 human primary second molars with occlusal caries were utilized, with CAD-exposed dentin surfaces. The teeth were categorized into four groups based on CAD pretreatment: no pretreatment, CPP-ACP for 3 min, PA for 1 min, and PA for 1 min followed by CPP-ACP for 3 min. Each group subdivided into four based on adhesive system (Gluma Bond Universal or All-Bond Universal) and application mode (etch and rinse; E&R or self-etch; SE). Following composite resin restoration, μSBS measurements were taken after 24 h of water storage. Results: PA pretreatment showed the highest μSBS compared to controls and other methods (p < 0.001). Conversely, CAD pretreatment with CPP-ACP + PA led to lower μSBS than the control (p = 0.009). Universal adhesive choice significantly influenced μSBS (p < 0.001), with Gluma Bond Universal outperforming All-Bond Universal (p < 0.001). The E&R method demonstrated superior bond strength over SE (p < 0.001). Conclusion: CAD pretreatment, particularly with PA, significantly impacted bond strength, with Gluma Bond Universal and the E&R method proving optimal for enhancing μSBS to CAD. These findings offer valuable insights for refining adhesive protocols in pediatric dentistry, potentially improving clinical outcomes in restorative procedures.