Nakamura et al.

Asian Pac J Dent 2013; 13: 37-39.

Ten-year clinical performance of a composite repair restoration
bonded with a tri-n-butylborane initiated adhesive resin: a casereportMitsuo Nakamura, DDS, PhD,a,b Hideo Matsumura, DDS, PhDb,c Kota Okamura, DDS,dand Yusuke Oba, DDSdabc

Private Practice, Ichikawa, Department of Fixed Prosthodontics, Division of Advanced Dental
dTreatment, Dental Research Center, Nihon University School of Dentistry, and Nihon University
Graduate School of Dentistry, Tokyo, Japan
This article describes the clinical course of a composite restoration applied to secondary dental caries adjacent toa single restoration. After cavity preparation, the dentin surface was treated with citric acid and ferric chloride
aqueous solution. A thione primer (V-Primer) and a silane primer (Porcelain Liner M) were separately applied
to the metal and porcelain surfaces. An adhesive opaque resin (Super-Bond Opaque Ivory) and two layers ofcomposite resins (Metafil Flo Opaque and Metafil C) were placed into the cavity. After an observation period of
11 years and 1 month, the restoration is functioning. The materials and bonding technique reported here areapplicable as an option for a single-visit repair treatment. (Asian Pac J Dent 2013; 13: 37-39.)
Key Words: adhesive, alloy, composite, porcelain, primer, repair

Introduction
Single-visit repair treatment is sometimes requested from patients in particular as an urgent restoration offractured anterior dentition. Composite restorative materials are frequently used for repair as well as restorations.
This is due to the fact that bonding to dentin of light-polymerized composite materials has improved
considerably through the development of self-etching adhesives containing acidic monomers. Also, a number ofmetal and porcelain priming systems have been introduced for use with adhesives and composite restorativematerials. This report describes the clinical course of a direct composite repair restoration bonded with aself-polymerizing adhesive system.

Clinical Report
A 61-year-old female patient presented with a chief complaint of esthetic disturbance associated with gingival
recession and discoloration of her left maxillary central incisor (Fig. 1). The incisor had undergone treatment
with a porcelain-fused-to-metal (PFM) restoration, which was functioning for more than 5 years. Examination
revealed that the abutment tooth was not vital, and fracture of the root was not detected. The cervical area,
however, had been considerably discolored.

Two treatment options were proposed: 1) dislodgment andreplacement of the restoration; and 2) direct restoration with an adhesive system. The patient chose the latteroption. The restorative procedure was then explained in detail and consent obtained from the patient. A
summary of the restorative procedure for this case was previously reported.1
A direct restorative treatment with a microfilled composite resin was planned. Although cavity preparation
could be completed with diamond rotary cutting instruments with water coolant, the incisal wall of the cavity
was extended to the cervical porcelain of the PFM restoration, whereas pulpal wall of the cavity consisted ofmetallic structure, i.e., an axial wall of the dowel core. The remaining surfaces to be restored were dentin (Fig.
2).
The dentin surface was treated with 10% citric acid and 3% ferric chloride aqueous solution (Green37Nakamura et al.

Asian Pac J Dent 2013; 13: 37-39.

Conditioner, Sun Medical Co., Ltd., Moriyama, Japan) for 5 s, washed with water, and air-dried (Fig. 3). A
single liquid thione primer (V-Primer, Sun Medical Co., Ltd.) was applied to the metal surface, and a two-liquidsilane primer (Porcelain Liner M, Sun Medical Co., Ltd.) was applied to the porcelain surface (Fig. 4). These
two primers were applied separately with an applicator before air-drying. A self-curable adhesive opaque resin(Super-Bond Opaque Ivory, Sun Medical Co., Ltd.) was applied to the cavity floor to hide the metallic color (Fig.
5). The opaque resin is capable of bonding intraorally all of the shown adherends and composite resin. Before
setting the adhesive resin, layers of composite resins, Metafil Flo Opaque and Metafil C (Sun Medical Co., Ltd.)
were filled into the cavity and exposed to light for 20 s and 60 s, respectively (Figs. 6 and 7). The restored
surface was ground and polished with a series of diamond and silicone rotary instruments. The patient thenentered a maintenance program (Fig. 8). Figure 9 shows a photograph taken 11 years and 1 month after
restorative treatment. Although brownish discoloration of interface between the porcelain and the composite
resin can be seen, both the PFM and composite restorations are functioning.

Fig. 1. Pre-operative viewFig. 2. Cavity preparation

Fig. 3. Etching dentin with
Green Conditioner

Fig. 4. Application of V-Primerand Porcelain Liner M

Fig. 5. Super-Bond Opaque Ivory
as an adhesiveFig. 6. Metafil Flo OpaqueFig. 7. Metafil C as a
restorative material

Fig. 8. Repair restoration

Fig. 9. 11 years and 1 monthafter repair

Discussion
The Super-Bond Opaque Ivory resin consists of three components; monomer liquid, powder, and initiator.
The monomer liquid contains 5% 4-methacryloyloxyethyl trimellitate anhydride (4-META) in methyl
methacrylate (MMA). The powder is a mixture of pulverized poly-MMA and surface-coated titanium dioxide.

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Nakamura et al.

Asian Pac J Dent 2013; 13: 37-39.

The initiator is a partially oxidized tri-n-butylborane (TBB).
4-META/MMA-TBB opaque resin.

The material therefore is abbreviated as

Combined application of the 4-META/MMA-TBB opaque resin andlight-cured composite resin was originally introduced as a bonding technique for metal frameworks of castrestorations and composite facing materials.2,3 According to their report, the 4-META/MMA-TBB opaque resinand composite facing materials can be bonded if a light curable opaque resin or a tooth-colored composite resin
was placed before setting the TBB initiated resin. The technique is also applicable for intraoral bonding between
dentin, alloys, porcelain, and composite resins. The current case used 4-META/MMA-TBB opaque resin as anadhesive for intraoral bonding of dentin, noble metal alloy, porcelain, and a light-polymerized composite
restorative material.
Studies have shown the possibility of inducing reciprocal effect of several primers on bonding to dentin of
TBB initiated resin. Kajihara et al.4 reported double-priming on bonding to dentin of TBB initiated resin. Theirresults showed that bonding to dentin of TBB initiated resin was not negatively affected by double-priming as
long as the Green Conditioner was employed. However, bond strength to Ag-Pd-Cu-Au alloy was considerably
reduced when the Green Conditioner was applied to the alloy before application of TBB initiated resin. Caremust be taken when the adherend surface consists of both dentin and Ag-Pd-Cu-Au alloy.
Brownish discoloration is sometimes detected along the bonded interface of TBB initiated resin. Superficial
discoloration can be eliminated for most of cases by polishing the surface with rotary instruments.

The5

remaining issues to be solved are; 1) enhancement of bonding between porcelain and TBB initiated resin, andimprovement in wear resistance of the TBB initiated resin.6,7
Acknowledgments
This clinical report associated with adhesive bonding of dental casting alloys is supported in part by Grant-in-Aid for
Scientific Research C 24592934 (2013) from the Japan Society for the Promotion of Science (JSPS).

References
1. Nakamura N. Application of flowable resins. In Adhesive Restorative Techniques, Nagasueshoten, Kyoto, 36-41, 2006, ISBN
4-8160-1170-6 C3047.
2. Matsumura H, Kawahara M, Tanaka T, Atsuta M. Surface preparations for metal frameworks of composite resin veneered
prostheses made with an adhesive opaque resin. J Prosthet Dent 1991; 66: 10-15.
3. Atsuta M, Matsumura H, Tanaka T. Bonding fixed prosthodontic composite resin and precious metal alloys with the use of avinyl-thiol primer and an adhesive opaque resin. J Prosthet Dent 1992; 67: 296-300.
4. Kajihara H, Suzuki S, Kurashige H, Minesaki Y, Tanaka T. Bonding abutments to cast metal post/cores: comparison ofpre-treatment effects. J Oral Rehabil 2003; 30: 119-24.
5. Matsumura H, Nakamura M, Nakabayashi N, Tanaka T, Atsuta M. Effect of a silane coupling agent and ferric chloride on thebonding of porcelain, quartz and alumina with 4-META/MMA-TBB resin. Dent Mater J 1987; 6: 135-9.
6. Nakamura M, Koizumi H, Nishimaki M, Matsumura H. Clinical application of a tri-n-butylborane initiated adhesive resin filledwith pre-polymerized composite particles. Asian Pac J Dent 2011; 11: 61-5.
7. Naito K. Bonding and wear characteristics of a tri-n-butylborane initiated adhesive resin filled with pre-polymerized compositeparticles. J Oral Sci 2011; 53: 109-16.

Correspondence to:Dr. Mitsuo Nakamura
Department of Fixed Prosthodontics, Nihon University School of Dentistry
1-8-13 Kanda-Surugadai, Chiyoda-ku, Tokyo 101-8310, Japan
Fax: +81-3-3219-8351 E-mail: ndent@sea.plala.or.jp
Copyright ©2013 by the Asian Pacific Journal of Dentistry.

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Accepted October 21, 2013.
Online ISSN 2185-3487, Print ISSN 2185-3479