The Influence of a Hemostatic Agent on Adhesion Strength and Microleakage of Composite Resin Restorations

Timur V. Melkumyan, Anjela D. Dadamova, Khaidar P. Kamilov

International Journal of Biomedicine. 2018;8(4):355-357.   
DOI: 10.21103/Article8(4)_OA18
Originally published December 15, 2018  


The aim of the present study was to assess the side effect of an aluminum chloride hemostatic agent on adhesion strength and microleakage of composite resin restorations bonded with the one-bottle total-etch adhesive system.
Methods: We prepared 10 human tooth samples (extracted premolars for orthodontic purposes) in accordance with the Ultratest technique for the assessment of shear bond strength (SBS), and another 10 human tooth samples for microleakage assessment. The SBS tooth samples (n=10) were subjected to the two following tests: In Test 1, before traditional adhesive protocol, the aluminum chloride hemostatic agent was rubbed into a surface dentin for 60 sec with the help of a metal dento-infusor tip and washed with distilled water. In Test 2, just traditional wet bonding was performed. In the group of teeth (n=10) for microleakage assessment, we prepared two round artificial cavities of similar size (3 mm in diameter, 1 mm deep) in each tooth sample on the proximal surfaces with half in enamel and another half in root dentin. All created cavities (n=20) were divided into two subgroups. In cavities of Subgroup 1 (n=10), the adhesive protocol and filling with composite resin were performed after preliminary rubbing-in of the hemostatic agent. In Subgroup 2 (n=10), cavities were merely restored according to the rules for applying the one-bottle total-etch adhesive system. Assessment of microleakage was performed at the enamel margin and dentin margin. Scanning electron microscopy was used to evaluate the microstructure morphology of a hybrid layer, formed without the side effect of a hemostatic agent and after application of it.
Results: The average score of SBS was 7.42±3.5 kg in Test 2 and 3.87±2.45 kg in Test 1. Therefore, the side effect of the aluminum chloride hemostatic agent was detrimental to the bond strength of the composite resin to human dentin and significantly decreased the quality of adhesion by 1.92 times (P<0.05). The average scores of dye penetration through the enamel-composite microgap in both subgroups were low (0.5±0.52 CU in Subgroup 1 and 0.3±0.48 CU in Subgroup 2) and had no significant difference (P>0.05).  However, the visual analysis of the dentin-composite junction of sectioned tooth samples demonstrated 2.1 times more microleakage in Subgroup 1 (1.7±0.95 CU) than in Subgroup 2 (0.8±0.79 CU), but the difference was not significant (P>0.05). In view of clinical situations with no possibility to escape the application of a hemostatic agent in cases of possible capillary hemorrhage and crevicular fluid leakage, it could be wise before running an adhesive protocol to cut off the portion of surface dentin that was exposed to an aluminum chloride hemostatic agent side effect.

shear bond strength • microleakage • hemostatic agent • side effect

1. Strassler HE, Boksman L. Tissue management, gingival retraction and hemostasis. Oral Health Journal. 2011;101:35-42. 
2. Thomas MS, Joseph RM, Parolia A. Nonsurgical gingival displacement in restorative dentistry. Compend Contin Educ Dent. 2011 Jun;32(5):26-34; quiz 36, 38. PubMed
3. Kumbuloglu O, User A, Toksavul S, Boyacioglu H. Clinical evaluation of different gingival retraction cords. Quintessence Int. 2007;38(2):e92–8. PubMed
4. Koppolu M, Gogala D, Mathew VB, Thangala V, Deepthi M, Sasidhar N. Effect of saliva and blood contamination on the bond strength of self-etching adhesive system- An in vitro study. J Conserv Dent. 2012;15(3):270-3. doi: 10.4103/0972-0707.97956. PubMed
5. Tarighi P, Khoroushi M. A review on common chemical hemostatic agents in restorative dentistry. Dent Res J (Isfahan). 2014;11(4):423-8. PubMed
6. Gupta G, Kumar S, Rao H, Garg P, Kumar R, Sharma A, et al. Astringents in dentistry: a review. Asian J Pharm Health Sci. 2012; 2: 428–432.
7. Bailey JH, Fischer DE. Procedural hemostasis and sulcular fluid control: a prerequisite in modern dentistry. Pract Periodontics Aesthet Dent. 1995;7(4):65-75; quiz 76. PubMed
8. de Carvalho Mendonça EC, Vieira SN, Kawaguchi FA, Powers J, Matos AB. Influence of blood contamination on bond strength of a self-etching system. Eur J Dent. 2010;4(3): 280–6. PubMed
9. Sharafeddin F, Farhadpour H. Evaluation of Shear Bond Strength of Total- and Self-etching Adhesive Systems after Application of Chlorhexidine to Dentin Contaminated with a Hemostatic Agent. J Dent (Shiraz). 2015;16(3):175-81. PubMed
10. Kuphasuk W, Harnirattisai C, Senawongse P, Tagami J. Bond strengths of two adhesive systems to dentin contaminated with a hemostatic agent. Oper Dent. 2007;32(4):399-405. PubMed
11 Kimmes NS, Olson TL, Shaddy RS, Latta MA. Effect of ViscoStat and ViscoStat Plus on composite shear bond strength in the presence and absence of blood. J Adhes Dent. 2006;8(6):363–6. PubMed
12 O'Keefe KL, Pinzon LM, Rivera B, Powers JM. Bond strength of composite to astringent-contaminated dentin using self-etching adhesives. Am J Dent. 2005;18(3):168–72. PubMed
13 Mohammadi N, Kimyai S, Bahari M, Pournaghi-Azar F, Mozafari A. Effect of aluminum chloride hemostatic agent on microleakage of class V composite resin restorations bonded with all-in-one adhesive. Med Oral Patol Oral Cir Bucal. 2012;17(5):e841–4. PubMed
14. Melkumyan TV, Kakhkharova DJ, Dadamova AD, Kamilov NKh, Siddikova SSh, Rakhmatullaeva ShI, Masouleh SM. Comparative Analysis of in vitro Performance of Total-Etch and Self-Etch Adhesives. International Journal of Biomedicine. 2016;6(4):283-6. doi: 10.21103/Article6(4)_OA7. Google Scholar
15.Terry DA. An essential component to adhesive dentistry: the rubber dam. Pract Proced Aesthet Dent. 2005;17(2):106, 108. PubMed

Download Article
Received November 14, 2018.
Accepted December 5, 2018.
©2018 International Medical Research and Development Corporation.