Title	MDPB-Containing Bonding Agents Offer Short-Term Inhibition of Bacterial Growth
Clinical Question	For bonded restorations, does an MDPB-containing bonding agent inhibit bacterial growth and secondary caries formation at the tooth/restorative interface when compared to the control?
Clinical Bottom Line	MDPB-containing bonding agents can provide some short-term inhibition of bacterial growth. The positive charge of MDPB attracts the negative charge of bacterial cell walls and leads to lysis and cell death. MDPB-containing bonding agent Clearfil Protect Bond (Kurarey Co. Ltd, Japan) also contains fluoride, which may decrease demineralization at the restorative interface. However, due to a lack of higher evidence at this time and the small difference in the antimicrobial effect that may explain the contradicting published results, recommendations concerning clinical effectiveness regarding the reduction of secondary caries formation cannot be made.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26345999 Cocco/2015 23 studies Systematic review of non-randomized trials Key results 23 studies (20 in vitro, 2 in vivo, 1 in situ) regarding 12-methacryloyloxy dodecypyridinium bromide (MDPB) incorporation into bonding agents showed an antibacterial effect against Streptococcus and Lactobacillus species. 25095833 Vasconcelos/2014 10 patients In situ Comparative Study Key results 10 volunteers wore palatal devices with composite bonded to sterilized human enamel samples. Restorations were bonded using All-Bond SE self-etching control or Clearfil Protect Bond, a fluoride and MDPB self-etching bonding agent. Specimens were worn for 14 days, with sucrose application 8x/day simulating a high caries risk environment. Total streptococci, Mutans streptococci and lactobacilli were recorded. Although Clearfil Protect Bond demonstrated fewer colony-forming units for total streptococci and lactobacilli, no significant difference was found between the different samples. Potential for secondary caries formation was measured using microhardness. No significant difference was noted between samples, suggesting that none of the bonding agents was effective in inhibiting demineralization and secondary caries formation. 26201229 Pinto/2015 17 patients In situ Comparative Study Key results Restorations were bonded using Clearfil Protect Bond or One-up Bond F Plus to sterilized bovine enamel and dentin and mounted on palatal stents. 17 volunteers used palatal stents for 14 days simulating a high caries risk environment. Sucrose was applied to the samples 8x/day. Total streptococci, Mutans streptococci and lactobacilli were recorded. Results showed the Clearfil Protect Bond had less Mutans streptococci and total streptococci, and less depth of penetration of secondary caries when compared to One-up Bond F Plus. Neither bonding agent prevented bacterial colonization or eliminated the loss of mineral content at the tooth restorative interface, although less demineralization was seen with Clearfil Protect Bond.
Evidence Search	MDPB[All Fields]; MDPB[All Fields] AND Clinical Trial[ptyp]
Comments on The Evidence	Validity: Cocco et al. detected moderate to high bias in the mostly in vitro studies reviewed concerning antimicrobial effectiveness for MDPB. The conclusions drawn from these evaluations are only useful for short-term evaluation of antimicrobial activity. The two crossover in situ studies provide a closer approximation to a clinical situation. Both studies were similar in design. Vasconcelos et al. used human enamel under poor oral hygiene conditions. Pinto et al. used bovine enamel and dentin under a similar environment. Both evaluated bacterial biofilm content and demineralization at the restorative margin. Perspective: Although the antimicrobial properties of MDPB-containing Clearfil Protect Bond have been well established in vitro, Vasconcelos et al. found that, under in situ conditions, there was no significant difference between bonding agents in bacterial inhibition of streptococcal species and demineralization at the restorative margin. The results from the double-blinded study by Pinto el al. differed in that Clearfil Protect Bond out-performed One-up Bond F Plus by inhibiting the extent of demineralization insult at the restorative margin and the amount of streptococcal species in plaque. It did not, however, out-perform One-up Bond F Plus in the inhibition of lactobacillus. Overall, the bacterial acidic insult resulting from a high caries risk environment may negate the antibacterial potential of the MDPB bonding agent. A more clinically relevant outcome may be seen in the moderate or high caries risk patient who is motivated to control caries risk factors.
Applicability	Clearfil Protect Bond (Kurarey Co., Ltd Japan) is the only commercially available bonding agent that incorporates MDPB. An antimicrobial effect at the tooth restoration interface has been demonstrated in vitro and in situ. This, along with improved diet and oral hygiene habits, may improve the longevity of bonded restorations and reduce the frequency of replacement and overall cost of dental care for the high caries risk patient. However, clinical trials are needed to test the effectiveness of MDPB-containing bonding agents in reducing secondary caries formation in this population.
Specialty	(General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords	Antimicrobial bonding agent, MDPB, high caries risk
ID#	2928
Date of submission	10/16/2015
E-mail	LEES14@livemail.uthscsa.edu
Author	Spencer Lee, DDS
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kyumin Whang, PhD
Faculty mentor e-mail	WHANG@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available