Effects of Chlorhexidine in Application to Hybrid Layers
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Effects of Chlorhexidine in Application to Hybrid Layers

Authors: Ilma Robo, Saimir Heta, Edona Hasanaj, Vera Ostreni


The hybrid layer (HL), the way it is created and how it is protected against degradation over time, is the key to the clinical success of a composite restoration. The composite supports the dentinal structure exactly with the realized surface of micro-retention. Thus, this surface is in direct proportion to its size versus the duration of clinical use of composite dental restoration. Micro-retention occurs between dentin or acidified enamel and adhesive resin extensions versus pre-prepared spaces, such as hollow dentinal tubules. The way the adhesive resin binds to the acidified dentinal structure depends on the physical or chemical factors of this interrelationship between two structures with very different characteristics. During the acidification process, a precursor to the placement of the adhesive resin layer, activation of metalloproteinases of dental origin occurs, enzymes which are responsible for the degradation of the HL. These enzymes have expressed activity depending on the presence of Zn2+ or Ca2+ ions. There are several ways to inhibit these enzymes, and consequently, there are several ways to inhibit the degradation process of the HL. The study aim is to evaluate chlorhexidine (CHX) as a solution element, inhibitor of dentin activated metalloproteinases, as a result of the application of acidification. This study aims to look at this solution in advantage or contraindication theories, already published in the literature.

Keywords: Hybrid layer, chlorhexidine, degradation, smear layer.

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[1] Theodore M.R, Herald O.H, Edward J.S, Jr., editors. Art Science Operative Dentistry, 5th Edition New York, USA, Mosby Inc.2006, 35-58p.
[2] Stephen Cohen Kenneth, M. Hargreaves, pathways of the pulp, ninth edition, New York, USA, Elsevier Inc.2005, 58-109p.
[3] Michael G.N, Henry H.T, Ferman A.C, editors. Clinical Periodontology, ninth edition, New York USA, Mosby inc.2004, 5-25p.
[4] John I.I, Leif K.B, editors. Endodontics fourth edition, New York USA, Elsevier Inc. 2002, 35-67p.
[5] Venigalla BS, Jyothi P, Kamishetty S, Reddy S, Cherukupalli RC, Reddy DA. Resin bond strength to water versus ethanol-saturated human dentin pretreated with three different cross-linking agents. J Conserv Dent. 2016 Nov-Dec;19(6):555-559.
[6] Zecin-Deren A, Sokolowski J, Szczesio-Wlodarczyk A, Piwonski I, Lukomska-Szymanska M, Lapinska B. Multi-Layer Application of Self-Etch and Universal Adhesives and the Effect on Dentin Bond Strength. Molecules. 2019 Jan 18;24(2):345.
[7] Flury S, Lussi A, Peutzfeldt A. Long-Term Bond Strength of Two Benzalkonium Chloride-Modified Adhesive Systems to Eroded Dentin. Biomed Res Int. 2017;2017:1207208.
[8] Robo, Ilma & Heta, Saimir & Gjumsi, Enxhi & Ostreni, Vera. (2021). Oral Microflora, in Cases with Gingival Hypertrophy Caused by Fixed Orthodontic Appliances. SN Comprehensive Clinical Medicine. 3. 1-9. 10.1007/s42399-021-01045-5.
[9] Sinhoreti, Mário & Soares, Eveline & Abuna, Gabriel &Sobrinho, Lourenço&Roulet, J-F &Geraldeli, Saulo. (2017). Microtensile Bond Strength of Adhesive Systems in Different Dentin Regions on a Class II Cavity Configuration. Brazilian Dental Journal. 28.
[10] Frassetto A, Breschi L, Turco G, Marchesi G, Di Lenarda R, Tay FR, Pashley DH, Cadenaro M. Mechanisms of degradation of the hybrid layer in adhesive dentistry and therapeutic agents to improve bond durability--A literature review. Dent Mater. 2016 Feb;32(2):e41-53.
[11] Abuhaimed TS, Abou Neel EA. Sodium Hypochlorite Irrigation and Its Effect on Bond Strength to Dentin. Biomed Res Int. 2017; Epub 2017 Aug 20.
[12] Li Y, Hu X, Xia Y, Ji Y, Ruan J, Weir MD, et al. Novel magnetic nanoparticle-containing adhesive with greater dentin bond strength and antibacterial and remineralizing capabilities. Dent Mater. 2018 Sep;34(9):1310-1322.
[13] Baldion, Paula. Mathematical models of polymer-dentin physicochemical interactions and their biological effects. Scientific Journal of Review. (2016). 5. 319-330.
[14] Cecchin D, Farina AP, Vidal C, Bedran-Russo AK. A Novel Enamel and Dentin Etching Protocol Using α-hydroxy Glycolic Acid: Surface Property, Etching Pattern, and Bond Strength Studies. Oper Dent. 2018 Jan/Feb;43(1):101-110.
[15] Vasconcelos E Cruz J, Polido M, Brito J, Gonçalves LL. Dentin Bonding and SEM Analysis of a New Experimental Universal Adhesive System Containing a Dendrimer. Polymers (Basel). 2020 Feb 17;12(2):461.
[16] Botelho MPJ, Isolan CP, Schwantz JK, Lopes MB, Moraes RR. Rubbing time and bonding performance of one-step adhesives to primary enamel and dentin. J Appl Oral Sci. 2017 Sep-Oct;25(5):523-532.
[17] Prati C, Nucci C, Toledano M, García-Godoy F, Breschi L, Chersoni S. Microleakage and marginal hybrid layer formation of compomer restorations. Oper Dent. 2004 Jan-Feb;29(1):35-41.
[18] Perdigão J. Dentin bonding-variables related to the clinical situation and the substrate treatment. Dent Mater. 2010 Feb;26(2):e24-37.
[19] Gibby SG, Wong Y, Kulild JC, Williams KB, Yao X, Walker MP. Novel methodology to evaluate the effect of residual moisture on epoxy resin sealer/dentine interface: a pilot study. Int Endod J. 2011 Mar;44(3):236-44.
[20] Prati C, Chersoni S, Acquaviva GL, Breschi L, Suppa P, Tay FR, Pashley DH. Permeability of marginal hybrid layers in composite restorations. Clin Oral Investig. 2005 Mar;9(1):1-7.
[21] Onay EO, Orucoglu H, Kiremitci A, Korkmaz Y, Berk G. Effect of Er,Cr:YSGG laser irradiation on the apical sealing ability of AH Plus/gutta-percha and Hybrid Root Seal/Resilon Combinations. Oral Surg Oral Med Oral Pathol Oral RadiolEndod. 2010 Nov;110(5):657-64.
[22] Hossain M, Yamada Y, Nakamura Y, Murakami Y, Tamaki Y, Matsumoto K. A study on surface roughness and microleakage test in cavities prepared by Er:YAG laser irradiation and etched bur cavities. Lasers Med Sci. 2003;18(1):25-31.
[23] Rontani RM, Ducatti CH, Garcia-Godoy F, De Goes MF. Effect of etching agent on dentinal adhesive interface in primary teeth. J Clin Pediatr Dent. 2000 Spring;24(3):205-9.
[24] Sauro S, Mannocci F, Toledano M, Osorio R, Pashley DH, Watson TF. EDTA or H3PO4/NaOCl dentine treatments may increase hybrid layers' resistance to degradation: a microtensile bond strength and confocal-micropermeability study. J Dent. 2009 Apr;37(4):279-88.
[25] Wang JH, Yang K, Zhang BZ, Zhou ZF, Wang ZR, Ge X, Wang LL, Chen YJ, Wang XJ. Effects of Er:YAG laser pre-treatment on dentin structure and bonding strength of primary teeth: an in vitro study. BMC Oral Health. 2020 Nov 10;20(1):316.
[26] Hirabayashi S, Yoshida E, Hayakawa T. SEM analysis of microstructure of adhesive interface between resin cement and dentin treated with self-etching primer. Dent Mater J. 2011;30(4):528-36.
[27] Baseggio W, Consolmagno EC, de Carvalho FL, Ueda JK, Schmitt VL, Formighieri LA, Naufel FS. Effect of deproteinization and tubular occlusion on microtensile bond strength and marginal microleakage of resin composite restorations. J Appl Oral Sci. 2009 Sep-Oct;17(5):462-6.
[28] Zhang Y, Wang Y. Distinct photopolymerization efficacy on dentin of self-etch adhesives. J Dent Res. 2012 Aug;91(8):795-9.
[29] Saikaew P, Chowdhury AF, Fukuyama M, Kakuda S, Carvalho RM, Sano H. The effect of dentine surface preparation and reduced application time of adhesive on bonding strength. J Dent. 2016 Apr;47:63-70.
[30] Lin J, Zheng WY, Liu PR, Zhang N, Lin HP, Fan YJ, Gu XH, Vollrath O, Mehl C. Influence of casein phosphopeptide-amorphous calcium phosphate application, smear layer removal, and storage time on resin-dentin bonding. J Zhejiang Univ Sci B. 2014 Jul;15(7):649-60.
[31] Sundfeld RH, Valentino TA, de Alexandre RS, Briso AL, Sundefeld ML. Hybrid layer thickness and resin tag length of a self-etching adhesive bonded to sound dentin. J Dent. 2005 Sep;33(8):675-81.
[32] Mazzoni A, Carrilho M, Papa V, Tjäderhane L, Gobbi P, Nucci C, Di Lenarda R, Mazzotti G, Tay FR, Pashley DH, Breschi L. MMP-2 assay within the hybrid layer created by a two-step etch-and-rinse adhesive: biochemical and immunohistochemical analysis. J Dent. 2011 Jul;39(7):470-7.
[33] Leme AA, Vidal CM, Hassan LS, Bedran-Russo AK. Potential role of surface wettability on the long-term stability of dentin bonds after surface biomodification. J Biomech. 2015 Jul 16;48(10):2067-71.
[34] Boruziniat A, Gharaei S. Bond strength between composite resin and resin modified glass ionomer using different adhesive systems and curing techniques. J Conserv Dent. 2014 Mar;17(2):150-4.
[35] Cai J, Palamara JEA, Burrow MF. Effects of Collagen Crosslinkers on Dentine: A Literature Review. Calcif Tissue Int. 2018 Mar;102(3):265-279.
[36] Arrais CA, Miyake K, Rueggeberg FA, Pashley DH, Giannini M. Micromorphology of resin/dentin interfaces using 4th and 5th generation dual-curing adhesive/cement systems: a confocal laser scanning microscope analysis. J Adhes Dent. 2009 Feb;11(1):15-26.
[37] Wagner A, Wendler M, Petschelt A, Belli R, Lohbauer U. Bonding performance of universal adhesives in different etching modes. J Dent. 2014 Jul;42(7):800-7. doi: 10.1016/j.jdent.2014.04.012. Epub 2014 May 6.
[38] Dos Santos PH, Karol S, Bedran-Russo AK. Long-term nano-mechanical properties of biomodified dentin-resin interface components. J Biomech. 2011 Jun 3;44(9):1691-4.
[39] Leme-Kraus AA, Phansalkar RS, Dos Reis MC, Aydin B, Sousa ABS, Alania Y, McAlpine J, Chen SN, Pauli GF, Bedran-Russo AK. Dimeric Proanthocyanidins on the Stability of Dentin and Adhesive Biointerfaces. J Dent Res. 2020 Feb;99(2):175-181.
[40] Bedran-Russo AK, Pauli GF, Chen SN, McAlpine J, Castellan CS, Phansalkar RS, Aguiar TR, Vidal CM, Napotilano JG, Nam JW, Leme AA. Dentin biomodification: strategies, renewable resources, and clinical applications. Dent Mater. 2014 Jan;30(1):62-76.
[41] Bedran-Russo AK, Zamperini CA. New Preventive Approaches Part II: Role of Dentin Biomodifiers in Caries Progression. Monogr Oral Sci. 2017;26:97-105. doi: 10.1159/000479351. Epub 2017 Oct 19.
[42] Moreira MA, Souza NO, Sousa RS, Freitas DQ, Lemos MV, De Paula DM, Maia FJN, Lomonaco D, Mazzetto SE, Feitosa VP. Efficacy of new natural biomodification agents from Anacardiaceae extracts on dentin collagen cross-linking. Dent Mater. 2017 Oct;33(10):1103-1109.
[43] Anshida VP, Kumari RA, Murthy CS, Samuel A. Extracellular matrix degradation by host matrix metalloproteinases in restorative dentistry and endodontics: An overview. J Oral MaxillofacPathol. 2020 May-Aug;24(2):352-360.
[44] Castellan CS, Bedran-Russo AK. Biomimetic strategy to stabilize the mechanical properties of caries-affected dentin matrix: A 12-month in vitro study. Am J Dent. 2020 Apr;33(2):64-68.
[45] Liu RR, Fang M, Zhang L, Tang CF, Dou Q, Chen JH. Anti-proteolytic capacity and bonding durability of proanthocyanidin-biomodified demineralized dentin matrix. Int J Oral Sci. 2014 Sep;6(3):168-74.
[46] Sun Q, Gu L, Wu S, Huang Z, Mai S. Biomodifying effect of epigallocatechin-3-gallate on dentine substrate splicing surface. Zhonghua Kou Qiang Yi Xue Za Zhi. 2016 Mar;51(3):148-53. Chinese.
[47] Hiraishi N, Sono R, Sofiqul I, Yiu C, Nakamura H, Otsuki M, Takatsuka T, Tagami J. In vitro evaluation of plant-derived agents to preserve dentin collagen. Dent Mater. 2013 Oct;29(10):1048-54.
[48] Vidal CM, Aguiar TR, Phansalkar R, McAlpine JB, Napolitano JG, Chen SN, Araújo LS, Pauli GF, Bedran-Russo A. Galloyl moieties enhance the dentin biomodification potential of plant-derived catechins. Acta Biomater. 2014 Jul;10(7):3288-94.
[49] Prakki A, Xiong Y, Bortolatto J, Gonçalves LL, Bafail A, Anderson G, Stavroullakis AT. Functionalized epigallocatechin gallate copolymer inhibit dentin matrices degradation: Mechanical, solubilized telopeptide and proteomic assays. Dent Mater. 2018 Nov;34(11):1625-1633.
[50] Nam JW, Phansalkar RS, Lankin DC, McAlpine JB, Leme-Kraus AA, Vidal CM, Gan LS, Bedran-Russo A, Chen SN, Pauli GF. Absolute Configuration of Native Oligomeric Proanthocyanidins with Dentin Biomodification Potency. J Org Chem. 2017 Feb 3;82(3):1316-1329.
[51] Venigalla BS, Jyothi P, Kamishetty S, Reddy S, Cherukupalli RC, Reddy DA. Resin bond strength to water versus ethanol-saturated human dentin pretreated with three different cross-linking agents. J Conserv Dent. 2016 Nov-Dec;19(6):555-559.
[52] Moraes IQS, Nascimento TG, Silva AT, Lira LMSS, Parolia A, Porto ICCM; Inhibition of matrix metalloproteinases: a troubleshooting for dentin adhesion Restorative Dentistry & Endodontics 2020; 45(3): e31.; Published online: 22 May 2020.
[53] Mazzoni A, Tjäderhane L, Checchi V, Di Lenarda R, Salo T, Tay FR, Pashley DH, Breschi L. Role of dentin MMPs in caries progression and bond stability. J Dent Res. 2015 Feb;94(2):241-51.
[54] Göstemeyer G, Schwendicke F. Inhibition of hybrid layer degradation by cavity pretreatment: Meta- and trial sequential analysis. J Dent. 2016 Jun;49:14-21.
[55] Breschi L, Maravic T, Comba A, Cunha SR, Loguercio AD, Reis A, Hass V, Cadenaro M, Mancuso E, Mayer-Santos E, Niu L, Pashley DH, Tay FR, Mazzoni A. Chlorhexidine preserves the hybrid layer in vitro after 10-years aging. Dent Mater. 2020 May;36(5):672-680. doi: 10.1016/j.dental.2020.03.009. Epub 2020 Apr 10.
[56] Tjäderhane L, Nascimento FD, Breschi L, Mazzoni A, Tersariol IL, Geraldeli S, Tezvergil-Mutluay A, Carrilho M, Carvalho RM, Tay FR, Pashley DH. Strategies to prevent hydrolytic degradation of the hybrid layer-A review. Dent Mater. 2013 Oct;29(10):999-1011.
[57] Vallabhdas AK, Kumar CNV, Kabbinale P, Nayak R, Rajakumari M, Shilpa T. Evaluation of Hybrid Layer and Bonding Interface after Water Storage with and without the Usage of 2% Chlorhexidine: A Scanning Electron Microscope Study. J Contemp Dent Pract. 2018 Jan 1;19(1):52-59.
[58] Moon PC, Weaver J, Brooks CN. Review of matrix metalloproteinases' effect on the hybrid dentin bond layer stability and chlorhexidine clinical use to prevent bond failure. Open Dent J. 2010 Jul 20;4:147-52.
[59] Strobel S, Hellwig E. The effects of matrix-metallo- proteinases and chlorhexidine on the adhesive bond. Swiss Dent J. 2015;125(2):134-45. English, German.
[60] Hebling J, Pashley DH, Tjäderhane L, Tay FR. Chlorhexidine arrests subclinical degradation of dentin hybrid layers in vivo. J Dent Res. 2005 Aug;84(8):741-6.
[61] Carrilho MR, Geraldeli S, Tay F, de Goes MF, Carvalho RM, Tjäderhane L, Reis AF, Hebling J, Mazzoni A, Breschi L, Pashley D. In vivo preservation of the hybrid layer by chlorhexidine. J Dent Res. 2007 Jun;86(6):529-33.
[62] Collares FM, Rodrigues SB, Leitune VC, Celeste RK, Borba de Araújo F, Samuel SM. Chlorhexidine application in adhesive procedures: a meta-regression analysis. J Adhes Dent. 2013 Feb;15(1):11-8.
[63] Lingling J, Qianbing W. Progress on matrix metalloproteinase inhibitors. Hua Xi Kou Qiang Yi Xue Za Zhi. 2017 Apr 1;35(2):208-214. Chinese.
[64] Ou Q, Hu Y, Yao S, Wang Y, Lin X. Effect of matrix metalloproteinase 8 inhibitor on resin-dentin bonds. Dent Mater. 2018 May;34(5):756-763.
[65] Gou YP, Li JY, Meghil MM, Cutler CW, Xu HHK, Tay FR, Niu LN. Quaternary ammonium silane-based antibacterial and anti-proteolytic cavity cleanser. Dent Mater. 2018 Dec;34(12):1814-1827.
[66] Kiuru O, Sinervo J, Vähänikkilä H, Anttonen V, Tjäderhane L. MMP Inhibitors and Dentin Bonding: Systematic Review and Meta-Analysis. Int J Dent. 2021 May 27;2021:9949699.
[67] Zhang SC, Kern M. The role of host-derived dentinal matrix metalloproteinases in reducing dentin bonding of resin adhesives. Int J Oral Sci. 2009 Dec;1(4):163-76.
[68] Baldion PA, Betancourt DE. Dataset on the effect of flavonoids on the stabilization of the resin-dentin interface. Data Brief. 2021 Mar 19;35:106984.
[69] Li H, Li T, Li X, Zhang Z, Li P, Li Z. Morphological effects of MMPs inhibitors on the dentin bonding. Int J Clin Exp Med. 2015 Jul 15;8(7):10793-803.
[70] Li F, Majd H, Weir MD, Arola DD, Xu HH. Inhibition of matrix metalloproteinase activity in human dentin via novel antibacterial monomer. Dent Mater. 2015 Mar;31(3):284-92.
[71] Fialho MPN, Hass V, Nogueira RP, França FMG, Turssi CP, Basting RT, Amaral FLB. Effect of epigallocatechin-3- gallate solutions on bond durability at the adhesive interface in caries-affected dentin. J Mech Behav Biomed Mater. 2019 Mar;91:398-405.
[72] Breschi L, Martin P, Mazzoni A, Nato F, Carrilho M, Tjäderhane L, Visintini E, Cadenaro M, Tay FR, De Stefano Dorigo E, Pashley DH. Use of a specific MMP-inhibitor (galardin) for preservation of hybrid layer. Dent Mater. 2010 Jun;26(6):571-8.
[73] Brackett MG, Tay FR, Brackett WW, Dib A, Dipp FA, Mai S, Pashley DH. In vivo chlorhexidine stabilization of hybrid layers of an acetone-based dentin adhesive. Oper Dent. 2009 Jul-Aug;34(4):379-83.
[74] de Menezes LR, da Silva EO, Maurat da Rocha LV, Ferreira Barbosa I, Rodrigues Tavares M. The use of clays for chlorhexidine controlled release as a new perspective for longer durability of dentin adhesion. J Mater Sci Mater Med. 2019 Nov 30;30(12):132.
[75] Sadek FT, Braga RR, Muench A, Liu Y, Pashley DH, Tay FR. Ethanol wet-bonding challenges current anti-degradation strategy. J Dent Res. 2010 Dec;89(12):1499-504.
[76] Pinheiro SL, Pereira DR, De Milito F, Villalpando KT. Influence of metalloproteinases on dentin hybridization of one-bottle or self-etch dental bonding systems. J Contemp Dent Pract. 2014 Nov 1;15(6):705-11.
[77] Silva MDS, Neto NL, da Costa SA, da Costa SM, Oliveira TM, Oliveira RC, Machado MAAM. Biophysical and biological characterization of intraoral multilayer membranes as potential carriers: A new drug delivery system for dentistry. Mater Sci Eng C Mater Biol Appl. 2017 Feb 1;71:498-503.
[78] Brackett WW, Tay FR, Brackett MG, Dib A, Sword RJ, Pashley DH. The effect of chlorhexidine on dentin hybrid layers in vivo. Oper Dent. 2007 Mar-Apr;32(2):107-11.
[79] Brackett MG, Li N, Brackett WW, Sword RJ, Qi YP, Niu LN, Pucci CR, Dib A, Pashley DH, Tay FR. The critical barrier to progress in dentine bonding with the etch-and-rinse technique. J Dent. 2011 Mar;39(3):238-48.
[80] Sabatini C, Ortiz PA, Pashley DH. Preservation of resin-dentin interfaces treated with benzalkonium chloride adhesive blends. Eur J Oral Sci. 2015 Apr;123(2):108-15.
[81] Epasinghe DJ, Yiu CK, Burrow MF, Hiraishi N, Tay FR. The inhibitory effect of proanthocyanidin on soluble and collagen-bound proteases. J Dent. 2013 Sep;41(9):832-9.
[82] Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011 Sep;32(7):60-4, 66.
[83] Gou Y, Jin W, He Y, Luo Y, Si R, He Y, Wang Z, Li J, Liu B. Effect of Cavity Cleanser with Long-Term Antibacterial and Anti-Proteolytic Activities on Resin-Dentin Bond Stability. Front Cell Infect Microbiol. 2021 Nov 19;11:784153.
[84] De Munck J, Mine A, Van den Steen PE, Van Landuyt KL, Poitevin A, Opdenakker G, Van Meerbeek B. Enzymatic degradation of adhesive-dentin interfaces produced by mild self-etch adhesives. Eur J Oral Sci. 2010 Oct;118(5):494-501.
[85] Favetti M, Schroeder T, Montagner AF, Correa MB, Pereira-Cenci T, Cenci MS. Effectiveness of pre-treatment with chlorhexidine in restoration retention: A 36-month follow-up randomized clinical trial. J Dent. 2017 May;60:44-49.
[86] Porto ICCM, Nascimento TG, Oliveira JMS, Freitas PH, Haimeur A, França R. Use of polyphenols as a strategy to prevent bond degradation in the dentin-resin interface. Eur J Oral Sci. 2018 Apr;126(2):146-158.
[87] Thompson JM, Agee K, Sidow SJ, McNally K, Lindsey K, Borke J, Elsalanty M, Tay FR, Pashley DH. Inhibition of endogenous dentin matrix metalloproteinases by ethylenediaminetetraacetic acid. J Endod. 2012 Jan;38(1):62-5.
[88] Scheffel DL, Hebling J, Scheffel RH, Agee K, Turco G, de Souza Costa CA, Pashley D. Inactivation of matrix-bound matrix metalloproteinases by cross-linking agents in acid-etched dentin. Oper Dent. 2014 Mar-Apr;39(2):152-8.
[89] Tay FR, Pashley DH, Loushine RJ, Weller RN, Monticelli F, Osorio R. Self-etching adhesives increase collagenolytic activity in radicular dentin. J Endod. 2006 Sep;32(9):862-8.
[90] Leitune VC, Portella FF, Bohn PV, Collares FM, Samuel SM. Influence of chlorhexidine application on longitudinal adhesive bond strength in deciduous teeth. Braz Oral Res. 2011 Sep-Oct;25(5):388-92.
[91] Stanislawczuk R, Reis A, Loguercio AD. A 2-year in vitro evaluation of a chlorhexidine-containing acid on the durability of resin-dentin interfaces. J Dent. 2011 Jan;39(1):40-7.
[92] Liu N, Li F, Chen YJ, Dou Q, Shen LJ, Chen JH. Effect of quaternary ammonium methacrylates incorporation into a dental adhesive on the resistance of enzymatic degradation of resin-dentine interfaces. Zhonghua Kou Qiang Yi Xue Za Zhi. 2013 Jul;48(7):414-8. Chinese.
[93] Tezvergil-Mutluay A, Agee KA, Uchiyama T, Imazato S, Mutluay MM, Cadenaro M, Breschi L, Nishitani Y, Tay FR, Pashley DH. The inhibitory effects of quaternary ammonium methacrylates on soluble and matrix-bound MMPs. J Dent Res. 2011 Apr;90(4):535-40.
[94] Tezvergil-Mutluay A, Agee KA, Hoshika T, Tay FR, Pashley DH. The inhibitory effect of polyvinylphosphonic acid on functional matrix metalloproteinase activities in human demineralized dentin. Acta Biomater. 2010 Oct;6(10):4136-42.