Effect of adhesive primer on dentin remineralization by an alkasite compared to a glass hybrid restorative material: an in vitro study

Effect of adhesive primer on dentin remineralization by an alkasite compared to a glass hybrid restorative material: an in vitro study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of adhesive primer on dentin remineralization by an alkasite compared to a glass hybrid restorative material: an in vitro study Yasmin Nasr, Dina Ali, Ahmed Abo El-Ezz This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8450406/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Bioactive restorative materials can promote dentin remineralization, but their efficacy may be influenced by adhesive interfaces. This study aimed to evaluate the effect of an adhesive primer on the remineralization potential of an alkasite material (Cention Forte) compared to a glass hybrid material (Equia Forte HT) on artificially demineralized dentin. Methods Forty-two human molars with standardized Class V cavities were chemically demineralized and randomly divided into three restorative groups (n = 14). Cention Forte without primer (CF − P), Cention Forte with primer (CF + P), and Equia Forte HT (EF). After restoration, all samples underwent 14 days of pH cycling. Remineralization was evaluated using Vickers microhardness and energy-dispersive X-ray spectroscopy (EDX) at baseline (T₀), after demineralization (T₁), and after pH cycling (T₂). Recovery percentages were calculated for microhardness and mineral content (calcium, phosphorus, oxygen and carbon). Statistical analysis was performed using two-way ANOVA and post hoc tests (p < 0.05). Results All groups showed significant increases in microhardness after pH cycling (p < 0.0001). CF − P demonstrated the highest microhardness recovery (74.21 ± 2.48%), followed by EF (72.50 ± 2.10%), while CF + P showed the lowest recovery (61.36 ± 3.22%; p < 0.001). EDX analysis revealed significant gains in calcium and phosphorus in all groups. Calcium recovery was highest in CF − P (76.10 ± 5.58%) and EF (75.44 ± 2.85%), both significantly higher than in CF + P (68.91 ± 3.66%; p < 0.001). Phosphorus recovery followed a similar pattern. Conclusion The use of an adhesive primer significantly reduced the remineralization capacity of the alkasite material. Cention Forte without primer performed comparably to the glass hybrid Equia Forte HT, whereas primer application limited its bioactive efficacy. Alkasite Glass hybrid Adhesive primer Remineralization Dentin Cention Forte Equia Forte HT Figures Figure 1 Figure 2 Introduction Dental caries is recognized as the most prevalent chronic oral disease globally, with secondary caries being the primary cause of restoration failure, despite ongoing advances in materials and adhesive protocols [ 1 , 2 ] . Contemporary restorative dentistry emphasizes minimally invasive techniques, supporting the selective removal of infected dentin while preserving the demineralized, but potentially remineralizable, caries-affected dentin [ 3 ] . Enhancing remineralization of this remaining tooth structure is crucial for improving the seal, strengthening the dentin, and ultimately extending restoration longevity [ 4 ] . To achieve this goal, recent restorative materials have been developed with bioactive properties, enabling the release of ions such as calcium (Ca²⁺) fluoride (F⁻), and phosphate (PO₄³⁻), which favor hydroxyapatite formation at the dentin interface [ 5 ] . Glass ionomer cements (GICs) have historically served this purpose; however, their limited wear resistance and mechanical strength spurred the development of reinforced variants [ 6 ] . Equia Forte HT, a glass hybrid restorative, is one such advanced material, offering both enhanced mechanical properties and sustained ion release, supported by the inclusion of strontium in its glass composition [ 7 , 8 ] . A parallel development in bioactive dentistry is the introduction of alkasite-based materials, such as Cention Forte. which is characterized by its ability to release Ca²⁺, F⁻, and hydroxide (OH⁻) ions. The release of OH⁻ ions is particularly valuable as it raises the local pH, creating an alkaline environment that actively promotes remineralization [ 9 ] . Cention Forte's application method typically involves its dedicated adhesive, Cention Primer [ 10 ] . However, adhesive layers may act as diffusion barriers, potentially limiting the movement of ions from the material to the demineralized substrate [ 11 ] . Whether Cention Primer compromises the remineralization efficacy of the alkasite material remains an unresolved clinical concern. Currently, direct comparative data on the remineralization performance of Cention Forte (with and without its primer) versus Equia Forte HT under clinically relevant acidic challenges are lacking. Therefore, this in vitro study aimed to evaluate and compare the remineralization potential of Cention Forte (with and without Cention Primer) and Equia Forte HT on artificially demineralized dentin lesions. The null hypothesis was that no significant difference in remineralization would exist among the three tested groups. Methods This in-vitro study compared three restorative groups: Equia Forte HT (GC Corporation) and Cention Forte (Ivoclar Vivadent) tested both with and without its dedicated primer. Details concerning the materials, including their descriptions, compositions, manufacturers, and lot numbers, are provided in Table 1 . Table 1: The materials’ trade name, description, composition and manufacturer Material (Trade Name) Description Composition Manufacturer Lot no. Cention® Forte Bioactive powder-liquid restorative material Ca-fluorosilicate glass, Ba–Al silicate glass, Ca–Ba–Al fluorosilicate glass, copolymer, UDMA, aromatic aliphatic UDMA, DCP, PEG-400-DMA, ytterbium trifluoride Ivoclar Vivadent AG, Schaan, Liechtenstein ZL08SR Cention® Primer Self-etching, self-curing primer for tooth structure HEMA, MDP, Bis-GMA, D3MA, ethanol, methacrylate-modified polyacrylic acid, silicon dioxide, potassium hydroxide, camphorquinone Ivoclar Vivadent AG, Schaan, Liechtenstein Z065VK Equia Forte® HT Bulk-fill, fluoride-releasing glass hybrid restorative system Powder: Fluoroaluminosilicate glass, polyacrylic acid, iron oxide Liquid: Polybasic carboxylic acid, water GC Corporation, Tokyo, Japan 2201052 Sample size calculation: This in vitro study was approved by the Ethics Committee of the Faculty of Dentistry, Suez Canal University (Approval No. 623/2023). The requirement for informed consent was waived because the study used anonymized, extracted human molars. To assess microhardness and elemental analysis of the tested materials in chemically induced carious lesion in dentin, a minimum total sample size of 42 samples were sufficient to detect the effect size of 0.50, a power (1-β = 0.80) of 80% at a significance level of p < 0.05. The sample size was calculated according to G*Power software version 3.1.9.6. [ 12 ][ 13 ] . Where, f is the effect size = 0.50; α = 0.05; β = 0.2; Power = 1- β = 0.8. The samples were divided evenly between each tested material (CF-P, CF + P, EF) used in the study, where (n = 14) for each group. Each group was evaluated 3 times according to the time of microhardness and elemental analysis evaluation (T). At baseline directly following cavity preparation (T 0 ), following demineralizing solution application and chemical caries induction (T 1 ), and after restoration and pH cycling (T 2 ). The specimen preparation procedure and the study workflow are depicted in Fig. 1 . Sample preparation: Standardized Class V cavities were prepared on both the buccal and lingual surfaces of each tooth using a size #57 straight carbide fissure bur (Meisinger GmbH, Germany) mounted in a high-speed handpiece under copious water cooling. To ensure cavity uniformity and consistent positioning, a metal matrix band with a 4 mm × 3 mm window was secured to each surface using a Tofflemire retainer (ASA Dental GmbH, Germany). The outline of the cavity was marked with a pencil, with the lower edge of the matrix band aligned with the cementoenamel junction (CEJ) and the window's lower margin positioned 1 mm above the CEJ [ 14 ] . The bur was replaced after every fifth preparation to maintain cutting efficiency and standardization. Each cavity was prepared with the following dimensions: 4 mm width (mesiodistally) × 3 mm height (occlusogingivally) × 2 mm depth, and positioned parallel to the CEJ, extending 1 mm above it [ 15 ] . A graduated periodontal probe (Williams 568/1, Medesy, Italy) was used to verify the dimensions of each cavity, ensuring consistency across all specimens [ 16 ] . Baseline microhardness evaluation: Each tooth was longitudinally sectioned in the occluso-gingival direction using a low-speed diamond saw under continuous water cooling, yielding two halves: buccal and lingual. To ensure consistency in baseline mineral composition between both halves of the same tooth, elemental analysis was performed on the pulpal floor of the buccal and lingual sections in a representative sample. This analysis confirmed the absence of significant differences in mineral content between the two halves. Each half was individually labeled to maintain accurate identification and traceability throughout subsequent treatment and testing procedures. The lingual cavity surface of each tooth was further sectioned longitudinally through its center using a slow-speed diamond saw under water cooling, producing two quadrants. In this study design, the lingual half of each tooth functioned as the control, while the buccal half served as the experimental (test) group [ 17 ] One quadrant from each control sample was randomly selected and embedded in self-curing acrylic resin within a plastic ring. The embedded surfaces were then progressively refined and polished using a series of flexible abrasive discs (Sof-Lex™, 3M ESPE) to obtain a smooth and standardized surface suitable for microhardness testing. Baseline cross-sectional microhardness with a Vickers diamond indenter was carried out for all experimental groups. The microhardness assessments were carried out using a Vickers’ Microhardness Tester (Fig. 18), utilizing a Vickers’ diamond indenter and a 20X objective lens. Readings were recorded at three distinct locations on each specimen: on the axial dentin, approximately 0.5 mm from the preparation margin, and spaced 1 mm apart from each other. Each reading was performed using a 100g load for a duration of 15 seconds, with the load-oriented perpendicular to the dentin surface. The diagonal lengths of the resulting indentations were measured using an incorporated scaled micrometer, and these measurements were converted into Vickers numbers. The obtained values were averaged to generate a singular hardness value for each individual specimen. Micro-hardness was calculated using the subsequent equation: HVN = 1.854 P/d2, where HVN is Vickers hardness in g/µm2, P is the load in grams, and d is the average length of the diagonals in micrometers [ 16 ] . Elemental Analysis: The remaining quadrant of each lingual cavity was used for elemental analysis using Energy-Dispersive X-ray Spectroscopy (EDX). The system was operated through Inca Energy software, version 18. Prior to imaging, the dentin surfaces were treated with 17% ethylenediaminetetraacetic acid (EDTA) for 3 minutes, followed by immersion in 2% sodium hypochlorite (NaClO) for an additional 3 minutes, to eliminate the smear layer [ 18 ] . The specimens were mounted on aluminum stubs using carbon double-sided adhesive tape. Imaging and elemental analysis were conducted under low vacuum conditions (100 Pa) using an ESEM/EDX. Operating parameters included an accelerating voltage of 20 kV, a working distance of 8.5 mm, a detection threshold of 0.5 wt%, a resolution of 133 eV, and an amplification time of 100 microseconds. Data acquisition was performed over 600 seconds for elemental mapping and 60 seconds for spectral collection. Analysis was carried out over areas of approximately 50 × 50 µm, allowing for the quantification of the elemental composition specifically calcium (Ca), phosphorus (P), oxygen (O), and carbon (C) expressed in both weight and atomic percentages. The Ca/P ratio was calculated to assess the mineral phase characteristics of the dentin surface [ 19 ] . Chemical caries induction: The prepared buccal cavities and control lingual quadrants were first rinsed with deionized water and gently air-dried. To isolate the experimental area, two coats of acid-resistant nail varnish were applied to all surfaces except for a window that included the cavity and a 2 mm border of sound surrounding tooth structure. The first coat was allowed to air-dry at room temperature for 3–4 hours before the second coat was applied. To induce artificial carious lesions, the exposed window areas of all three groups were immersed in a chemical caries-inducing solution for 7 days, using 50 mL of solution per sample. The demineralizing medium consisted of a 50 mM acetate buffer containing 2.2 mM CaCl₂ and 2.2 mM KH₂PO₄, adjusted to pH 5 [ 20 ] . The solution was freshly prepared each day and replaced every 24 hours to maintain consistent chemical conditions. After 7 days of demineralization, specimens were removed and rinsed thoroughly with deionized water for 3 minutes, followed by ultrasonic cleaning in deionized water for 5 minutes to stop the demineralization process and remove residual solution. Second evaluation following demineralization: Following the induction of artificial caries-like lesions, the control specimens which had previously undergone baseline assessment for Vickers cross-sectional microhardness and elemental composition were re-evaluated using the same testing protocols. This second round of measurements was conducted to obtain the corresponding post-demineralization values, allowing for comparison with baseline data and assessment of mineral loss resulting from the demineralization process. Restorative material application: For each of the three experimental groups, the prepared cavities were thoroughly rinsed with water to remove debris, then dried using sterile cotton and compressed air. Restorative procedures were performed on the buccal surfaces of all teeth (n = 14). The materials were applied in accordance with the manufacturers' instructions, as follows: CF-P: The capsule was activated and inserted into the mixer for 15 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds. CF + P: A drop of cention primer was dispensed into a dish to protect it from light. The corresponding coated Cention Primer single-use applicator was dipped in the liquid and stirred for 5 seconds. The mixing process was complete when the applicator had a uniform yellow color. The cavity surface was scrubbed with the primer for 10 seconds. Air thinning until a shiny, thin, immobile film had formed. The capsule was activated and inserted into the mixer for 15 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds. EF: The capsule was activated and inserted in the mixer for 10 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds. All specimens were polymerized using a LED light-curing unit (Elipar™, 3M ESPE, St. Paul, MN, USA) operating in standard mode with a light intensity of 1200 mW/cm². To ensure standardized curing, the tip of the curing light was held in direct contact with the buccal surface of each specimen during polymerization. pH cycling: To simulate the dynamic process of demineralization and remineralization that occurs in the oral environment, a 14-day pH cycling regimen was applied to all restored specimens. The samples were alternately immersed in two solutions: Demineralizing solution: 2.2 mM calcium chloride, 2.2 mM sodium phosphate, and 50 mM acetic acid, adjusted to pH 4.8, for a period of 8 hours daily. Remineralizing solution: 1.5 mM calcium chloride, 0.9 mM sodium phosphate, and 0.15 mM potassium chloride, adjusted to pH 7.0, for the remaining 16 hours of the day [ 21 ] . All specimens were maintained in an incubator at 37°C under constant circulation throughout the cycling period. To ensure the chemical stability and efficacy of the solutions, freshly prepared demineralization and remineralization media were replaced every 24 hours [ 22 ] . Final evaluation following pH cycling: Following pH cycling, the restored buccal cavities from all experimental groups were sectioned in a buccolingual direction using a low-speed diamond saw under water cooling. The resulting specimens were then subjected to the final evaluation of Vickers cross-sectional microhardness and elemental analysis, using the same protocols previously described for baseline and post-demineralization assessments. Statistical analysis: Data was analyzed using Medcalc software, version 22 for windows (MedCalc Software Ltd, Ostend, Belgium). Continuous data was explored for normality using Kolmogrov Smirnov test and Shapiro Wilk test. The data showed normal distribution and was described using mean and standard deviation. Two-way ANOVA was used to assess interaction of variables. Statistical power of the study was set at 80% with 95% confidence level and all tests were two tailed. Intergroup comparison was performed using one-way ANOVA followed by Tukey Kramer post hoc test with statistical significance set at (p ≤ 0.016) after Bonferroni correction. Intragroup comparison was performed using paired t test with statistical significance set at (p ≤ 0.05). For each group the recovery percentage for both cross-sectional microhardness and mineral content was calculated as follows: [(Remineralization − Demineralization)/ (Baseline − Demineralization)] *100 [ 23 ] . Results Artificial demineralization resulted in a reduction in dentin microhardness across all experimental groups. After 14 days of pH cycling, microhardness values increased relative to the demineralized condition for all tested materials, with within-group comparisons showing statistically significant differences (p < 0.0001; Table 2 ). Analysis of the microhardness recovery percentage calculated relative to baseline mineral loss revealed statistically significant differences among the groups (p < 0.001, Table 3 ). Cention Forte applied without its primer (CF − P) demonstrated the highest recovery (74.21% ± 2.48), which was statistically comparable to Equia Forte HT (EF) (72.50% ± 2.10). In contrast, the application of Cention Primer (CF + P) resulted in a significantly lower recovery percentage (61.36% ± 3.22). Two-way ANOVA confirmed a significant main effect of the remineralization process (time) on microhardness (F = 92.843, p < 0.001), but no significant main effect of material type or material-time interaction (Table 4 ). Energy-dispersive X-ray spectroscopy (EDX) quantified mineral ion reprecipitation. Two-way ANOVA showed significant main effects of material and time, as well as a significant material-time interaction, on both calcium (Ca) and phosphorus (P) weight percentages (all p < 0.01, Table 4 ). This interaction signifies that the amount of mineral gain was dependent on the restorative material used. Post-demineralization, the CF + P group presented with the highest residual Ca content (22.90 ± 3.64 wt%). However, this group exhibited the lowest Ca recovery percentage (68.91% ± 3.66), which was significantly less than both CF − P (76.10% ± 5.58) and EF (75.44% ± 2.85) (Table 3 ). A similar pattern was observed for phosphorus, where CF − P achieved the highest recovery (73.15% ± 1.52), followed by EF (68.61% ± 2.57), with CF + P showing the lowest (61.38% ± 1.99); all pairwise differences were significant (Table 3 ). The Ca/P ratio, indicative of the formed mineral phase, was significantly affected by material, time, and their interaction (Table 4 ). After pH cycling, both CF − P and EF showed significant increases in their Ca/P ratios (p = 0.0005 and p < 0.0001, respectively), whereas the CF + P group showed no significant change (p = 0.114) (Table 2 ). Consequently, the recovery of the Ca/P ratio was significantly higher for CF − P (79.98% ± 11.42) and EF (78.74% ± 2.90) than for CF + P (60.44% ± 23.63) (Table 3 ). Remineralization involves the displacement of the demineralized organic matrix by mineral. Significant reductions in carbon (C) and oxygen (O) weight percentages from T₁ to T₂ were observed across all groups (p < 0.05, Table 2 ). The recovery percentages for reducing C and O content reflecting the efficacy of this mineral-for-organic substitution were significantly higher for CF − P and EF than for CF + P (p < 0.001, Table 3 ). Representative EDX spectra of demineralized dentin restored with (a) CF − P, (b) CF + P, and (c) EF at baseline (T⁰), post-demineralization (T¹), and post-pH cycling (T²), illustrating relative changes in calcium and phosphorus peak intensities. ( Fig. 2 ). Table 2 Mean ± standard deviation of microhardness (VHN) and elemental composition (weight %) of dentin after demineralization (T₁) and after pH cycling (T₂) for each restorative group. *Paired t-test. CF − P: Cention Forte without primer; CF + P: Cention Forte with primer; EF: Equia Forte HT. Group Post-Demineralization (T₁) Post-pH Cycling (T₂) p-value (T₁ vs T₂)* VHN CF − P 47.74 ± 2.36 52.11 ± 1.69 < 0.0001 CF + P 47.69 ± 2.68 51.51 ± 1.95 < 0.0001 EF 47.72 ± 1.70 52.36 ± 1.56 < 0.0001 Ca (wt%) CF − P 15.11 ± 4.12 25.99 ± 1.22 < 0.0001 CF + P 22.90 ± 3.64 28.79 ± 2.11 < 0.0001 EF 18.49 ± 3.57 27.75 ± 1.59 < 0.0001 P (wt%) CF − P 7.93 ± 1.72 11.54 ± 0.48 < 0.0001 CF + P 10.84 ± 1.55 13.01 ± 0.66 < 0.0001 EF 11.84 ± 1.64 13.24 ± 0.70 < 0.0001 Ca/P Ratio CF − P 1.89 ± 0.19 2.25 ± 0.12 0.0005 CF + P 2.11 ± 0.26 2.21 ± 0.14 0.1142 EF 1.59 ± 0.40 2.10 ± 0.20 < 0.0001 Table 3 Mean ± standard deviation recovery percentages of microhardness and elemental composition for dentin restored with Cention Forte without primer (CF − P), Cention Forte with primer (CF + P), and Equia Forte HT (EF) following pH cycling. *One-way ANOVA followed by Tukey’s post-hoc test. Values within the same row sharing a common superscript letter (A, B, C) are not significantly different (p > 0.05). Different superscript letters indicate statistically significant differences (p < 0.05). For all parameters except Phosphorus (P), groups CF − P and EF (both labeled 'A') are not significantly different, but both are significantly higher than CF + P (labeled 'B'). For Phosphorus, all three groups are significantly different from each other (CF − P > EF > CF + P). CF − P CF + P EF p-value* VHN 74.21 ± 2.48 A 61.36 ± 3.22 B 72.50 ± 2.10 A < 0.001 Calcium (Ca) 76.10 ± 5.58 A 68.91 ± 3.66 B 75.44 ± 2.85 A < 0.001 Phosphorus (P) 73.15 ± 1.52 A 61.38 ± 1.99 C 68.61 ± 2.57 B < 0.001 Carbon (C) 73.31 ± 5.34 A 66.78 ± 4.60 B 74.08 ± 4.98 A < 0.001 Oxygen (O) 77.37 ± 7.09 A 65.85 ± 7.47 B 74.28 ± 6.29 A < 0.001 Ca/P Ratio 79.98 ± 11.42 A 60.44 ± 23.63 B 78.74 ± 2.90 A 0.009 Table 4 Two-way ANOVA results (F-values and p-values) for the effects of restorative material, time (mineralization state), and their interaction on dentin microhardness and elemental composition. Dependent Variable Source F-value p-value Vickers Hardness Material 0.351 0.705 Time 92.843 < 0.001 Material × Time 0.292 0.748 Calcium (Ca) Material 22.890 < 0.001 Time 184.360 < 0.001 Material × Time 5.270 0.007 Phosphorus (P) Material 39.770 < 0.001 Time 78.381 < 0.001 Material × Time 5.737 0.005 Ca/P Ratio Material 11.894 < 0.001 Time 34.833 < 0.001 Material × Time 4.863 0.010 * Time refers to the mineralization state (demineralization T₁ vs. remineralization T₂). Bold p-values indicate statistical significance (p < 0.05).* Discussion The high global prevalence of dental caries underscores a clinical requirement for restorative materials that provide therapeutic ion exchange in addition to structural replacement [ 24 ] . While conventional resin composites demonstrate adequate mechanical and esthetic properties, their bio-inert nature limits their efficacy in high-caries-risk environments. This study evaluated the remineralization potential of two distinct bioactive systems: an alkasite material (Cention Forte) and a high-viscosity glass hybrid (Equia Forte HT), focusing on their ability to facilitate dentin mineral recovery. Cention Forte was selected based on its alkaline glass filler technology, which is engineered to release Ca²⁺, F⁻, OH⁻ ions in response to acidic challenges [ 25 ] . In the context of a dentin substrate, the release of OH⁻ ions is critical, as the resulting localized pH elevation may stabilize the demineralized collagen matrix and create an environment conducive to calcium phosphate precipitation [ 20 , 26 ] . While the earlier powder-liquid formulation (Cention N) has shown promising remineralization outcomes [ 27 , 28 ] , evaluating the updated capsulated system allows for a more standardized assessment of these ion-release kinetics. The inclusion of the proprietary primer with Cention Forte represents a clinically relevant modification intended to enhance adhesion. However, adhesive systems are known to alter the physicochemical environment at the dentin interface. Acidic functional monomers may partially infiltrate the dentin surface and form resin-rich interfacial layers that restrict ion diffusion [ 11 , 29 , 30 ] . Therefore, Cention Forte was tested with and without primer to determine how the adhesive interface affects remineralization. Conversely, Equia Forte HT served as a validated comparator due to its fluoroaluminosilicate glass composition. The ion-release profile of glass hybrids is characterized by an initial burst of F⁻ followed by sustained, long-term diffusion of both F⁻ and Ca²⁺ ions [ 31 , 32 ] . Dentin was selected as the substrate to reflect the clinical complexity of remineralizing a partially demineralized collagen matrix. Unlike enamel, which is predominantly inorganic, dentin repair requires mechanisms that both stabilize the collagen scaffold and facilitate intrafibrillar mineral nucleation [ 20 , 26 ] . To evaluate this process comprehensively, Vickers microhardness and EDX elemental analysis were combined. Microhardness measured functional recovery of tissue resistance, while EDX provided direct compositional quantification. Monitoring the Ca/P ratio allowed assessment of not only mineral quantity but also stoichiometric quality, an indicator of hydroxyapatite-like mineral maturity [ 33 , 34 ] . Given the clinical importance of bioactive materials in caries management, the findings of this study demonstrate that remineralization efficacy is critically dependent on material composition and interfacial conditions. The superior performance of unprimed Cention Forte, the comparable yet mechanistically distinct recovery by Equia Forte HT, and the significant inhibition caused by the adhesive primer collectively indicate that not all restorative systems promote dentin mineral recovery equally, leading to the rejection of the null hypothesis. In the current study, results revealed significant microhardness recovery for the CF-P which is consistent with previous literature evaluating the bioactive potential of alkasite materials. Theerarath & Sriari, reported that Cention N enhanced enamel surface hardness recovery more effectively than Equia Forte and conventional composites following pH cycling [ 28 ] . Similarly, Kim et al., observed that the acid-neutralizing capacity and calcium release of Cention N promoted effective surface recovery and enamel resistance to demineralization [ 35 ] . While these studies focused on enamel where remineralization is largely driven by fluoride-mediated surface redeposition [ 36 ] . The present findings extend this bioactive efficacy to dentin, a more complex substrate requiring mineral deposition within a collagenous matrix. This suggests that the alkasite mechanism, which involves alkaline buffering and multi-ion release, may be versatile across different dental tissues, supporting collagen stabilization and intrafibrillar mineralization in dentin [ 20 , 26 , 37 ] . The consistency of bioactive performance may be influenced by the material’s delivery system. Earlier studies predominantly evaluated the powder–liquid formulation of Cention N, which can introduce variability in powder-to-liquid ratios during manual mixing, potentially affecting ion-release behavior [ 38 , 39 ] . In contrast, the capsulated Cention Forte used here ensures standardized mixing and improved reproducibility, enabling a clearer assessment of functional recovery under dynamic pH-cycling conditions. The observed microhardness recovery aligns with the acid-neutralizing capacity of alkasite materials, a mechanism that supports sustained mineral deposition under acidic challenge [ 40 ] . However, the literature presents variable findings regarding the comparative remineralization performance of alkasite and glass hybrid restorative materials. Khurana et al., reported that Equia Forte exhibited the highest nanohardness values in both normal and fluorosed enamel, outperforming Cention N, Fuji VIII, and a resin composite [ 41 ] . Similarly, Salinović et al., observed that after 28 days, Equia Forte HT and Fuji TRIAGE achieved the highest dentin microhardness values, while Cention Forte demonstrated comparable but not superior performance relative to Riva SC [ 42 ] . Dhumal et al. further demonstrated significantly higher microhardness values for Equia Forte at depths ranging from 100 to 300 µm from the restoration interface compared with several fluoride-releasing materials, including Cention N [ 43 ] . These findings may be explained by differences in ion diffusion patterns and evaluation depth. The sustained fluoride release characteristic of glass hybrid materials may promote mineral recovery over a broader subsurface region, particularly at greater distances from the restoration interface. In contrast, the present study focused on dentin immediately adjacent to the restorative material, where localized alkaline buffering and rapid calcium ion availability associated with alkasite materials may exert a more pronounced effect [ 29 , 40 ] . Apparent discrepancies across studies are therefore likely attributable to methodological variables that influence remineralization kinetics, including substrate type, evaluation depth, and duration of assessment. The time-dependent nature of mineral precipitation further complicates direct comparisons. Ghilotti et al. demonstrated that carbonated hydroxyapatite formation induced by glass ionomer-based materials may only become detectable after a 14-day threshold, with outcomes additionally modulated by residual dentin thickness [ 44 ] . Accordingly, the 14-day evaluation period employed in the present investigation likely represents an intermediate stage of mineralization rather than a definitive endpoint. This interpretation is supported by longitudinal investigations, such as that of Ubolsa-Ard et al., which showed that material performance rankings may shift over extended durations as ion-release kinetics and mineral maturation evolve [ 45 ] . The elemental analysis via EDX provided quantitative evidence of mineral re-deposition across all experimental groups, though distinct recovery patterns were observed between materials. The CF − P group demonstrated the highest calcium recovery, followed closely by EF. The observed functional recovery is consistent with previous investigations into the ion-release kinetics of the Cention N formulation. Ruengrungsom et al. and Kim et al., characterized the high calcium ion-release capacity of alkasite materials as a primary driver of their remineralization efficacy [29, 35] . Eriwati et al. further confirmed the strong ion-release potential of bioactive materials, though they noted significant differences in acid buffer capacity among different formulations [ 46 ] . However, Di Lauro et al. presented contradictory data, showing that Equia Forte HT consistently released higher levels of calcium than Cention N across various pH and temperature conditions [ 31 ] . This discrepancy likely originates from fundamental methodological differences between static and dynamic experimental designs. Di Lauro et al. quantified cumulative ion release into static solutions, a metric that reflects a material’s theoretical ion-release potential. In contrast, the present study evaluated functional mineral incorporation into a demineralized dentin matrix under dynamic pH-cycling conditions. Elemental analysis indicated robust phosphate recovery across the experimental groups, with EF performing comparably CF-P. This finding is consistent with previously reported ion-release behavior of glass hybrid restorative materials. Ruengrungsom et al., reported that Equia Forte Fil demonstrated notable phosphate-related behavior among ion-releasing restorative materials, which has been attributed to the fluoroaluminosilicate glass composition of these materials [ 29 ] . In contrast, Kasraei et al., reported higher phosphate ion release from Cention N compared with a resin-modified glass ionomer (Fuji II LC) over a six-month evaluation period [ 25 ] . The difference between those findings and the present results can be attributed to differences in study design and outcome measures. Kasraei et al. quantified cumulative phosphate ion release into solution over an extended period, whereas the present study evaluated phosphorus incorporation into dentin after a 14-day pH-cycling protocol. The time-dependent nature of ion release and mineral deposition has been documented in previous studies. Ghilotti et al. reported that mineral deposition associated with glass ionomer-based materials continues beyond 14 days, with more evident changes observed at later evaluation periods [ 44 ] . Accordingly, the present findings reflect phosphorus recovery under short-term, dynamic pH-cycling conditions and do not represent long-term mineral exchange behavior. Differences in evaluation duration should therefore be considered when comparing phosphate-related outcomes across studies. Both CF-P and EF demonstrated an increase in the Ca/P ratio following pH cycling, an increase in the Ca/P ratio is commonly interpreted as an indicator of improved mineral composition and structural maturity of the deposited phase [ 34 ] . Similar findings were reported by Puttipanampai et al., who observed a significant increase in the Ca/P ratio for both Cention N and Equia Forte adjacent to Class II restorations in demineralized enamel after 14 days of pH cycling [ 47 ] . In contrast, CF + P exhibited a markedly lower Ca/P ratio following pH cycling. A reduced Ca/P ratio suggests altered mineral stoichiometry and may indicate incomplete maturation of calcium phosphate phases rather than the formation of crystalline hydroxyapatite. This observation is consistent with the findings of Par et al., who demonstrated that adhesive coatings substantially reduced ion release from bioactive materials and inhibited the formation of apatite-like precipitates on material surfaces [ 11 ] . These results suggest that the presence of an adhesive interface may interfere with the local conditions required for effective ion supersaturation and crystal nucleation, thereby affecting not only the extent but also the compositional quality of remineralization at the dentin interface [ 29 , 30 ] . The most significant clinical observation in this study is the consistent inhibitory effect of the proprietary primer on the remineralization potential of the alkasite material across all evaluated parameters. This inhibitory effect can be explained by well-established physicochemical mechanisms. Following polymerization, resin-based primers form a hybrid layer that significantly reduces dentin permeability, restricting the diffusion of calcium, phosphate, and fluoride ions from the restorative material into the demineralized dentin substrate [ 48 ] . Additionally, acidic functional monomers present in adhesive systems such as 10-MDP can chelate calcium ions [ 49 ] , reducing local ion availability and disrupting the supersaturation conditions necessary for hydroxyapatite nucleation. Beyond acting as a diffusion barrier, adhesive layers physically separate the bioactive material from the dentin surface, which may impede the formation of a stable nucleation interface required for the maturation of calcium phosphate phases into crystalline hydroxyapatite [ 50 ] . This finding aligns with established literature characterizing the physical and chemical barriers imposed by adhesive resins. Abdallah reported negligible calcium gain at the restorative interface when Cention N was used with a bonding agent, corroborating the inhibited mineral incorporation observed in our CF + P group [ 51 ] . Additionally, Sauro & Pashley noted that resin-rich hybrid layers can significantly reduce dentin permeability, limiting the transport of remineralizing ions to the underlying substrate [ 30 ] . However, the impact of adhesive systems on bioactivity appears to be subject to temporal and formulation-specific variables. Obaees et al. reported that although Cention Forte with primer initially exhibited restricted ion diffusion, fluoride release surpassed that of the unprimed material by day 28 [ 52 ] . Similarly, Kelić et al. observed that while adhesive application reduced cumulative fluoride release, the capacity for fluoride recharging remained intact [ 53 ] . These data suggest that while standard resin primers act as a kinetic barrier that delays ion mobilization, they may not entirely eliminate long-term bioactivity in static environments. Crucially, the degree of interference is highly dependent on the chemical composition of the adhesive system. Samy et al. emphasized that interfacial interactions are critically influenced by specific primer formulations [ 54 ] , while Chou et al. demonstrated that biomimetic primers containing polyacrylic acid and sodium tripolyphosphate can actively enhance remineralization [ 55 ] . This highlights a fundamental distinction between the passive delay of ion release in static solution studies and the functional failure of mineral recovery in dynamic models. Despite the methodological rigor of the present study, certain limitations should be acknowledged. The artificial caries model, while ensuring standardization, does not replicate the structural heterogeneity or microbial ecology of natural carious lesions. Moron et al. demonstrated that variations in demineralization protocols influence lesion characteristics and subsequent remineralization outcomes [ 56 ] . Additionally, the influence of the adhesive primer may evolve over longer durations, as suggested by studies observing time-dependent changes in ion diffusion through resin interfaces [ 52 ] . Future studies should incorporate microbiological caries models and extended evaluation periods to better simulate clinical conditions and assess the long-term stability of the remineralized interface. Conclusion Within the limitations of this in vitro study, both Cention Forte and Equia Forte HT promoted remineralization of demineralized dentin under pH-cycling conditions. Cention Forte applied without primer showed greater microhardness and mineral recovery than the primed alkasite. The use of the adhesive primer significantly reduced the remineralization potential of the alkasite material. Declarations The study was approved by the Ethical Committee of the Faculty of Dentistry, Suez Canal University (Approval No. 623/2023). All methods were carried out in accordance with relevant guidelines and regulations. The need for informed consent was waived by the Ethics Committee as the study used anonymized extracted human teeth. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Funding Self-financed. Author Contribution - **Yasmin Labib Nasr:** Conceptualization, methodology, investigation, data curation, formal analysis, writing – original draft.- **Ahmed Fawzy Abo El-Ezz:** Supervision, methodology, validation, writing – review & editing.- **Dina Mohamed Ali:** Supervision, methodology, validation, writing – review & editing.All authors read and approved of the final manuscript. 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Caries Res. 2013;47(2):162–70. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 16 May, 2026 Reviewers agreed at journal 16 May, 2026 Reviews received at journal 07 Feb, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers agreed at journal 28 Jan, 2026 Reviewers agreed at journal 23 Jan, 2026 Reviews received at journal 21 Jan, 2026 Reviewers agreed at journal 20 Jan, 2026 Reviewers invited by journal 20 Jan, 2026 Editor invited by journal 29 Dec, 2025 Editor assigned by journal 29 Dec, 2025 Submission checks completed at journal 29 Dec, 2025 First submitted to journal 25 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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2","display":"","copyAsset":false,"role":"figure","size":631599,"visible":true,"origin":"","legend":"\u003cp\u003eRepresentative energy-dispersive X-ray (EDX) spectra of dentin adjacent to (a) Cention Forte without primer (CF−P), (b) Cention Forte with primer (CF+P), and (c) Equia Forte HT (EF) at baseline (T⁰), after demineralization (T¹), and after remineralization following pH cycling (T²).\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8450406/v1/ccfdf07bb192799d32c2e000.jpeg"},{"id":101202590,"identity":"87133620-0bad-46a7-9c50-4ef53acd0904","added_by":"auto","created_at":"2026-01-27 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Contemporary restorative dentistry emphasizes minimally invasive techniques, supporting the selective removal of infected dentin while preserving the demineralized, but potentially remineralizable, caries-affected dentin \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Enhancing remineralization of this remaining tooth structure is crucial for improving the seal, strengthening the dentin, and ultimately extending restoration longevity \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTo achieve this goal, recent restorative materials have been developed with bioactive properties, enabling the release of ions such as calcium (Ca\u0026sup2;⁺) fluoride (F⁻), and phosphate (PO₄\u0026sup3;⁻), which favor hydroxyapatite formation at the dentin interface \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Glass ionomer cements (GICs) have historically served this purpose; however, their limited wear resistance and mechanical strength spurred the development of reinforced variants \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Equia Forte HT, a glass hybrid restorative, is one such advanced material, offering both enhanced mechanical properties and sustained ion release, supported by the inclusion of strontium in its glass composition \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA parallel development in bioactive dentistry is the introduction of alkasite-based materials, such as Cention Forte. which is characterized by its ability to release Ca\u0026sup2;⁺, F⁻, and hydroxide (OH⁻) ions. The release of OH⁻ ions is particularly valuable as it raises the local pH, creating an alkaline environment that actively promotes remineralization \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Cention Forte's application method typically involves its dedicated adhesive, Cention Primer \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. However, adhesive layers may act as diffusion barriers, potentially limiting the movement of ions from the material to the demineralized substrate \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Whether Cention Primer compromises the remineralization efficacy of the alkasite material remains an unresolved clinical concern.\u003c/p\u003e \u003cp\u003eCurrently, direct comparative data on the remineralization performance of Cention Forte (with and without its primer) versus Equia Forte HT under clinically relevant acidic challenges are lacking. Therefore, this in vitro study aimed to evaluate and compare the remineralization potential of Cention Forte (with and without Cention Primer) and Equia Forte HT on artificially demineralized dentin lesions. The null hypothesis was that no significant difference in remineralization would exist among the three tested groups.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis in-vitro study compared three restorative groups: Equia Forte HT (GC Corporation) and Cention Forte (Ivoclar Vivadent) tested both with and without its dedicated primer. Details concerning the materials, including their descriptions, compositions, manufacturers, and lot numbers, are provided in \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;1: The materials\u0026rsquo; trade name, description, composition and manufacturer\u003c/b\u003e \u003c/p\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003cp\u003e(Trade Name)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eComposition\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eManufacturer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLot no.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCention\u0026reg; Forte\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBioactive powder-liquid restorative material\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCa-fluorosilicate glass, Ba\u0026ndash;Al silicate glass, Ca\u0026ndash;Ba\u0026ndash;Al fluorosilicate glass, copolymer, UDMA, aromatic aliphatic UDMA, DCP, PEG-400-DMA, ytterbium trifluoride\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIvoclar Vivadent AG, Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZL08SR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCention\u0026reg; Primer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-etching, self-curing primer for tooth structure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHEMA, MDP, Bis-GMA, D3MA, ethanol, methacrylate-modified polyacrylic acid, silicon dioxide, potassium hydroxide, camphorquinone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIvoclar Vivadent AG, Schaan, Liechtenstein\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ065VK\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEquia Forte\u0026reg; HT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBulk-fill, fluoride-releasing glass hybrid restorative system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePowder: Fluoroaluminosilicate glass, polyacrylic acid, iron oxide\u003c/p\u003e \u003cp\u003eLiquid:\u003c/p\u003e \u003cp\u003ePolybasic carboxylic acid, water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eGC Corporation, Tokyo, Japan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2201052\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample size calculation:\u003c/h2\u003e \u003cp\u003eThis in vitro study was approved by the Ethics Committee of the Faculty of Dentistry, Suez Canal University (Approval No. 623/2023). The requirement for informed consent was waived because the study used anonymized, extracted human molars. To assess microhardness and elemental analysis of the tested materials in chemically induced carious lesion in dentin, a minimum total sample size of 42 samples were sufficient to detect the effect size of 0.50, a power (1-β\u0026thinsp;=\u0026thinsp;0.80) of 80% at a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. The sample size was calculated according to G*Power software version 3.1.9.6. \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Where, f is the effect size\u0026thinsp;=\u0026thinsp;0.50; α\u0026thinsp;=\u0026thinsp;0.05; β\u0026thinsp;=\u0026thinsp;0.2; Power\u0026thinsp;=\u0026thinsp;1- β\u0026thinsp;=\u0026thinsp;0.8.\u003c/p\u003e \u003cp\u003eThe samples were divided evenly between each tested material (CF-P, CF\u0026thinsp;+\u0026thinsp;P, EF) used in the study, where (n\u0026thinsp;=\u0026thinsp;14) for each group. Each group was evaluated 3 times according to the time of microhardness and elemental analysis evaluation (T). At baseline directly following cavity preparation (T\u003csub\u003e0\u003c/sub\u003e), following demineralizing solution application and chemical caries induction (T\u003csub\u003e1\u003c/sub\u003e), and after restoration and pH cycling (T\u003csub\u003e2\u003c/sub\u003e). The specimen preparation procedure and the study workflow are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSample preparation:\u003c/h3\u003e\n\u003cp\u003eStandardized Class V cavities were prepared on both the buccal and lingual surfaces of each tooth using a size #57 straight carbide fissure bur (Meisinger GmbH, Germany) mounted in a high-speed handpiece under copious water cooling. To ensure cavity uniformity and consistent positioning, a metal matrix band with a 4 mm \u0026times; 3 mm window was secured to each surface using a Tofflemire retainer (ASA Dental GmbH, Germany). The outline of the cavity was marked with a pencil, with the lower edge of the matrix band aligned with the cementoenamel junction (CEJ) and the window's lower margin positioned 1 mm above the CEJ \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe bur was replaced after every fifth preparation to maintain cutting efficiency and standardization. Each cavity was prepared with the following dimensions: 4 mm width (mesiodistally) \u0026times; 3 mm height (occlusogingivally) \u0026times; 2 mm depth, and positioned parallel to the CEJ, extending 1 mm above it \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. A graduated periodontal probe (Williams 568/1, Medesy, Italy) was used to verify the dimensions of each cavity, ensuring consistency across all specimens \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eBaseline microhardness evaluation:\u003c/h3\u003e\n\u003cp\u003eEach tooth was longitudinally sectioned in the occluso-gingival direction using a low-speed diamond saw under continuous water cooling, yielding two halves: buccal and lingual. To ensure consistency in baseline mineral composition between both halves of the same tooth, elemental analysis was performed on the pulpal floor of the buccal and lingual sections in a representative sample. This analysis confirmed the absence of significant differences in mineral content between the two halves. Each half was individually labeled to maintain accurate identification and traceability throughout subsequent treatment and testing procedures.\u003c/p\u003e \u003cp\u003eThe lingual cavity surface of each tooth was further sectioned longitudinally through its center using a slow-speed diamond saw under water cooling, producing two quadrants. In this study design, the lingual half of each tooth functioned as the control, while the buccal half served as the experimental (test) group \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOne quadrant from each control sample was randomly selected and embedded in self-curing acrylic resin within a plastic ring. The embedded surfaces were then progressively refined and polished using a series of flexible abrasive discs (Sof-Lex\u0026trade;, 3M ESPE) to obtain a smooth and standardized surface suitable for microhardness testing.\u003c/p\u003e \u003cp\u003eBaseline cross-sectional microhardness with a Vickers diamond indenter was carried out for all experimental groups. The microhardness assessments were carried out using a Vickers\u0026rsquo; Microhardness Tester (Fig.\u0026nbsp;18), utilizing a Vickers\u0026rsquo; diamond indenter and a 20X objective lens. Readings were recorded at three distinct locations on each specimen: on the axial dentin, approximately 0.5 mm from the preparation margin, and spaced 1 mm apart from each other. Each reading was performed using a 100g load for a duration of 15 seconds, with the load-oriented perpendicular to the dentin surface. The diagonal lengths of the resulting indentations were measured using an incorporated scaled micrometer, and these measurements were converted into Vickers numbers. The obtained values were averaged to generate a singular hardness value for each individual specimen. Micro-hardness was calculated using the subsequent equation: HVN\u0026thinsp;=\u0026thinsp;1.854 P/d2, where HVN is Vickers hardness in g/\u0026micro;m2, P is the load in grams, and d is the average length of the diagonals in micrometers \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eElemental Analysis:\u003c/h3\u003e\n\u003cp\u003eThe remaining quadrant of each lingual cavity was used for elemental analysis using Energy-Dispersive X-ray Spectroscopy (EDX). The system was operated through Inca Energy software, version 18. Prior to imaging, the dentin surfaces were treated with 17% ethylenediaminetetraacetic acid (EDTA) for 3 minutes, followed by immersion in 2% sodium hypochlorite (NaClO) for an additional 3 minutes, to eliminate the smear layer \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe specimens were mounted on aluminum stubs using carbon double-sided adhesive tape. Imaging and elemental analysis were conducted under low vacuum conditions (100 Pa) using an ESEM/EDX. Operating parameters included an accelerating voltage of 20 kV, a working distance of 8.5 mm, a detection threshold of 0.5 wt%, a resolution of 133 eV, and an amplification time of 100 microseconds. Data acquisition was performed over 600 seconds for elemental mapping and 60 seconds for spectral collection. Analysis was carried out over areas of approximately 50 \u0026times; 50 \u0026micro;m, allowing for the quantification of the elemental composition specifically calcium (Ca), phosphorus (P), oxygen (O), and carbon (C) expressed in both weight and atomic percentages. The Ca/P ratio was calculated to assess the mineral phase characteristics of the dentin surface \u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003ch3\u003eChemical caries induction:\u003c/h3\u003e\n\u003cp\u003eThe prepared buccal cavities and control lingual quadrants were first rinsed with deionized water and gently air-dried. To isolate the experimental area, two coats of acid-resistant nail varnish were applied to all surfaces except for a window that included the cavity and a 2 mm border of sound surrounding tooth structure. The first coat was allowed to air-dry at room temperature for 3\u0026ndash;4 hours before the second coat was applied. To induce artificial carious lesions, the exposed window areas of all three groups were immersed in a chemical caries-inducing solution for 7 days, using 50 mL of solution per sample. The demineralizing medium consisted of a 50 mM acetate buffer containing 2.2 mM CaCl₂ and 2.2 mM KH₂PO₄, adjusted to pH 5 \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe solution was freshly prepared each day and replaced every 24 hours to maintain consistent chemical conditions. After 7 days of demineralization, specimens were removed and rinsed thoroughly with deionized water for 3 minutes, followed by ultrasonic cleaning in deionized water for 5 minutes to stop the demineralization process and remove residual solution.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSecond evaluation following demineralization:\u003c/h2\u003e \u003cp\u003eFollowing the induction of artificial caries-like lesions, the control specimens which had previously undergone baseline assessment for Vickers cross-sectional microhardness and elemental composition were re-evaluated using the same testing protocols. This second round of measurements was conducted to obtain the corresponding post-demineralization values, allowing for comparison with baseline data and assessment of mineral loss resulting from the demineralization process.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRestorative material application:\u003c/h3\u003e\n\u003cp\u003eFor each of the three experimental groups, the prepared cavities were thoroughly rinsed with water to remove debris, then dried using sterile cotton and compressed air. Restorative procedures were performed on the buccal surfaces of all teeth (n\u0026thinsp;=\u0026thinsp;14).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe materials were applied in accordance with the manufacturers' instructions, as follows:\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eCF-P: The capsule was activated and inserted into the mixer for 15 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P: A drop of cention primer was dispensed into a dish to protect it from light. The corresponding coated Cention Primer single-use applicator was dipped in the liquid and stirred for 5 seconds. The mixing process was complete when the applicator had a uniform yellow color. The cavity surface was scrubbed with the primer for 10 seconds. Air thinning until a shiny, thin, immobile film had formed. The capsule was activated and inserted into the mixer for 15 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEF: The capsule was activated and inserted in the mixer for 10 seconds. After mixing, the material was placed in the applicator and dispensed in the cavity. Light curing was performed for 20 seconds.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eAll specimens were polymerized using a LED light-curing unit (Elipar\u0026trade;, 3M ESPE, St. Paul, MN, USA) operating in standard mode with a light intensity of 1200 mW/cm\u0026sup2;. To ensure standardized curing, the tip of the curing light was held in direct contact with the buccal surface of each specimen during polymerization.\u003c/p\u003e\n\u003ch3\u003epH cycling:\u003c/h3\u003e\n\u003cp\u003eTo simulate the dynamic process of demineralization and remineralization that occurs in the oral environment, a 14-day pH cycling regimen was applied to all restored specimens. The samples were alternately immersed in two solutions: Demineralizing solution: 2.2 mM calcium chloride, 2.2 mM sodium phosphate, and 50 mM acetic acid, adjusted to pH 4.8, for a period of 8 hours daily. Remineralizing solution: 1.5 mM calcium chloride, 0.9 mM sodium phosphate, and 0.15 mM potassium chloride, adjusted to pH 7.0, for the remaining 16 hours of the day \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. All specimens were maintained in an incubator at 37\u0026deg;C under constant circulation throughout the cycling period. To ensure the chemical stability and efficacy of the solutions, freshly prepared demineralization and remineralization media were replaced every 24 hours \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eFinal evaluation following pH cycling:\u003c/h2\u003e \u003cp\u003eFollowing pH cycling, the restored buccal cavities from all experimental groups were sectioned in a buccolingual direction using a low-speed diamond saw under water cooling. The resulting specimens were then subjected to the final evaluation of Vickers cross-sectional microhardness and elemental analysis, using the same protocols previously described for baseline and post-demineralization assessments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eData was analyzed using Medcalc software, version 22 for windows (MedCalc Software Ltd, Ostend, Belgium). Continuous data was explored for normality using Kolmogrov Smirnov test and Shapiro Wilk test. The data showed normal distribution and was described using mean and standard deviation. Two-way ANOVA was used to assess interaction of variables. Statistical power of the study was set at 80% with 95% confidence level and all tests were two tailed.\u003c/p\u003e \u003cp\u003eIntergroup comparison was performed using one-way ANOVA followed by Tukey Kramer post hoc test with statistical significance set at (p\u0026thinsp;\u0026le;\u0026thinsp;0.016) after Bonferroni correction. Intragroup comparison was performed using paired t test with statistical significance set at (p\u0026thinsp;\u0026le;\u0026thinsp;0.05). For each group the recovery percentage for both cross-sectional microhardness and mineral content was calculated as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003e[(Remineralization\u0026thinsp;\u0026minus;\u0026thinsp;Demineralization)/ (Baseline\u0026thinsp;\u0026minus;\u0026thinsp;Demineralization)] *100\u003c/em\u003e \u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eArtificial demineralization resulted in a reduction in dentin microhardness across all experimental groups. After 14 days of pH cycling, microhardness values increased relative to the demineralized condition for all tested materials, with within-group comparisons showing statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnalysis of the microhardness recovery percentage calculated relative to baseline mineral loss revealed statistically significant differences among the groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Cention Forte applied without its primer (CF\u0026thinsp;\u0026minus;\u0026thinsp;P) demonstrated the highest recovery (74.21% \u0026plusmn; 2.48), which was statistically comparable to Equia Forte HT (EF) (72.50% \u0026plusmn; 2.10). In contrast, the application of Cention Primer (CF\u0026thinsp;+\u0026thinsp;P) resulted in a significantly lower recovery percentage (61.36% \u0026plusmn; 3.22). Two-way ANOVA confirmed a significant main effect of the remineralization process (time) on microhardness (F\u0026thinsp;=\u0026thinsp;92.843, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), but no significant main effect of material type or material-time interaction (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEnergy-dispersive X-ray spectroscopy (EDX) quantified mineral ion reprecipitation. Two-way ANOVA showed significant main effects of material and time, as well as a significant material-time interaction, on both calcium (Ca) and phosphorus (P) weight percentages (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.01, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This interaction signifies that the amount of mineral gain was dependent on the restorative material used.\u003c/p\u003e \u003cp\u003ePost-demineralization, the CF\u0026thinsp;+\u0026thinsp;P group presented with the highest residual Ca content (22.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64 wt%). However, this group exhibited the lowest Ca recovery percentage (68.91% \u0026plusmn; 3.66), which was significantly less than both CF\u0026thinsp;\u0026minus;\u0026thinsp;P (76.10% \u0026plusmn; 5.58) and EF (75.44% \u0026plusmn; 2.85) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). A similar pattern was observed for phosphorus, where CF\u0026thinsp;\u0026minus;\u0026thinsp;P achieved the highest recovery (73.15% \u0026plusmn; 1.52), followed by EF (68.61% \u0026plusmn; 2.57), with CF\u0026thinsp;+\u0026thinsp;P showing the lowest (61.38% \u0026plusmn; 1.99); all pairwise differences were significant (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Ca/P ratio, indicative of the formed mineral phase, was significantly affected by material, time, and their interaction (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). After pH cycling, both CF\u0026thinsp;\u0026minus;\u0026thinsp;P and EF showed significant increases in their Ca/P ratios (p\u0026thinsp;=\u0026thinsp;0.0005 and p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, respectively), whereas the CF\u0026thinsp;+\u0026thinsp;P group showed no significant change (p\u0026thinsp;=\u0026thinsp;0.114) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Consequently, the recovery of the Ca/P ratio was significantly higher for CF\u0026thinsp;\u0026minus;\u0026thinsp;P (79.98% \u0026plusmn; 11.42) and EF (78.74% \u0026plusmn; 2.90) than for CF\u0026thinsp;+\u0026thinsp;P (60.44% \u0026plusmn; 23.63) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRemineralization involves the displacement of the demineralized organic matrix by mineral. Significant reductions in carbon (C) and oxygen (O) weight percentages from T₁ to T₂ were observed across all groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The recovery percentages for reducing C and O content reflecting the efficacy of this mineral-for-organic substitution were significantly higher for CF\u0026thinsp;\u0026minus;\u0026thinsp;P and EF than for CF\u0026thinsp;+\u0026thinsp;P (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRepresentative EDX spectra of demineralized dentin restored with (a) CF\u0026thinsp;\u0026minus;\u0026thinsp;P, (b) CF\u0026thinsp;+\u0026thinsp;P, and (c) EF at baseline (T⁰), post-demineralization (T\u0026sup1;), and post-pH cycling (T\u0026sup2;), illustrating relative changes in calcium and phosphorus peak intensities. \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation of microhardness (VHN) and elemental composition (weight %) of dentin after demineralization (T₁) and after pH cycling (T₂) for each restorative group. *Paired t-test. CF\u0026thinsp;\u0026minus;\u0026thinsp;P: Cention Forte without primer; CF\u0026thinsp;+\u0026thinsp;P: Cention Forte with primer; EF: Equia Forte HT.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost-Demineralization (T₁)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePost-pH Cycling (T₂)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value (T₁ vs T₂)*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVHN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e47.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e52.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e47.69\u0026thinsp;\u0026plusmn;\u0026thinsp;2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e51.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e47.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e52.36\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCa (wt%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e15.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e25.99\u0026thinsp;\u0026plusmn;\u0026thinsp;1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e22.90\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e28.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e18.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e27.75\u0026thinsp;\u0026plusmn;\u0026thinsp;1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP (wt%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.93\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e10.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.24\u0026thinsp;\u0026plusmn;\u0026thinsp;0.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCa/P Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.89\u0026thinsp;\u0026plusmn;\u0026thinsp;0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.25\u0026thinsp;\u0026plusmn;\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e2.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.21\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.1142\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e1.59\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation recovery percentages of microhardness and elemental composition for dentin restored with Cention Forte without primer (CF\u0026thinsp;\u0026minus;\u0026thinsp;P), Cention Forte with primer (CF\u0026thinsp;+\u0026thinsp;P), and Equia Forte HT (EF) following pH cycling. *One-way ANOVA followed by Tukey\u0026rsquo;s post-hoc test. Values within the same row sharing a common superscript letter (A, B, C) are not significantly different (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Different superscript letters indicate statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). For all parameters except Phosphorus (P), groups CF\u0026thinsp;\u0026minus;\u0026thinsp;P and EF (both labeled 'A') are not significantly different, but both are significantly higher than CF\u0026thinsp;+\u0026thinsp;P (labeled 'B'). For Phosphorus, all three groups are significantly different from each other (CF\u0026thinsp;\u0026minus;\u0026thinsp;P\u0026thinsp;\u0026gt;\u0026thinsp;EF\u0026thinsp;\u0026gt;\u0026thinsp;CF\u0026thinsp;+\u0026thinsp;P).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCF\u0026thinsp;\u0026minus;\u0026thinsp;P\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCF\u0026thinsp;+\u0026thinsp;P\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEF\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVHN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (Ca)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphorus (P)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.38\u0026thinsp;\u0026plusmn;\u0026thinsp;1.99\u003csup\u003eC\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.61\u0026thinsp;\u0026plusmn;\u0026thinsp;2.57\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCarbon (C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.78\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.08\u0026thinsp;\u0026plusmn;\u0026thinsp;4.98\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen (O)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77.37\u0026thinsp;\u0026plusmn;\u0026thinsp;7.09\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.85\u0026thinsp;\u0026plusmn;\u0026thinsp;7.47\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.29\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCa/P Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.98\u0026thinsp;\u0026plusmn;\u0026thinsp;11.42\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.44\u0026thinsp;\u0026plusmn;\u0026thinsp;23.63\u003csup\u003eB\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.90\u003csup\u003eA\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTwo-way ANOVA results (F-values and p-values) for the effects of restorative material, time (mineralization state), and their interaction on dentin microhardness and elemental composition.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSource\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eF-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVickers Hardness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.705\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.843\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial \u0026times; Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (Ca)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184.360\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial \u0026times; Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphorus (P)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39.770\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial \u0026times; Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.737\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCa/P Ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.894\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaterial \u0026times; Time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.863\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*\u003cb\u003eTime\u003c/b\u003e refers to the mineralization state (demineralization T₁ vs. remineralization T₂). Bold p-values indicate statistical significance (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).*\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe high global prevalence of dental caries underscores a clinical requirement for restorative materials that provide therapeutic ion exchange in addition to structural replacement \u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. While conventional resin composites demonstrate adequate mechanical and esthetic properties, their bio-inert nature limits their efficacy in high-caries-risk environments. This study evaluated the remineralization potential of two distinct bioactive systems: an alkasite material (Cention Forte) and a high-viscosity glass hybrid (Equia Forte HT), focusing on their ability to facilitate dentin mineral recovery.\u003c/p\u003e \u003cp\u003eCention Forte was selected based on its alkaline glass filler technology, which is engineered to release Ca\u0026sup2;⁺, F⁻, OH⁻ ions in response to acidic challenges \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In the context of a dentin substrate, the release of OH⁻ ions is critical, as the resulting localized pH elevation may stabilize the demineralized collagen matrix and create an environment conducive to calcium phosphate precipitation \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. While the earlier powder-liquid formulation (Cention N) has shown promising remineralization outcomes \u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, evaluating the updated capsulated system allows for a more standardized assessment of these ion-release kinetics.\u003c/p\u003e \u003cp\u003eThe inclusion of the proprietary primer with Cention Forte represents a clinically relevant modification intended to enhance adhesion. However, adhesive systems are known to alter the physicochemical environment at the dentin interface. Acidic functional monomers may partially infiltrate the dentin surface and form resin-rich interfacial layers that restrict ion diffusion \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Therefore, Cention Forte was tested with and without primer to determine how the adhesive interface affects remineralization. Conversely, Equia Forte HT served as a validated comparator due to its fluoroaluminosilicate glass composition. The ion-release profile of glass hybrids is characterized by an initial burst of F⁻ followed by sustained, long-term diffusion of both F⁻ and Ca\u0026sup2;⁺ ions \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDentin was selected as the substrate to reflect the clinical complexity of remineralizing a partially demineralized collagen matrix. Unlike enamel, which is predominantly inorganic, dentin repair requires mechanisms that both stabilize the collagen scaffold and facilitate intrafibrillar mineral nucleation \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. To evaluate this process comprehensively, Vickers microhardness and EDX elemental analysis were combined. Microhardness measured functional recovery of tissue resistance, while EDX provided direct compositional quantification. Monitoring the Ca/P ratio allowed assessment of not only mineral quantity but also stoichiometric quality, an indicator of hydroxyapatite-like mineral maturity \u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven the clinical importance of bioactive materials in caries management, the findings of this study demonstrate that remineralization efficacy is critically dependent on material composition and interfacial conditions. The superior performance of unprimed Cention Forte, the comparable yet mechanistically distinct recovery by Equia Forte HT, and the significant inhibition caused by the adhesive primer collectively indicate that not all restorative systems promote dentin mineral recovery equally, leading to the rejection of the null hypothesis.\u003c/p\u003e \u003cp\u003eIn the current study, results revealed significant microhardness recovery for the CF-P which is consistent with previous literature evaluating the bioactive potential of alkasite materials. Theerarath \u0026amp; Sriari, reported that Cention N enhanced enamel surface hardness recovery more effectively than Equia Forte and conventional composites following pH cycling \u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Similarly, Kim et al., observed that the acid-neutralizing capacity and calcium release of Cention N promoted effective surface recovery and enamel resistance to demineralization \u003csup\u003e[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e. While these studies focused on enamel where remineralization is largely driven by fluoride-mediated surface redeposition \u003csup\u003e[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e. The present findings extend this bioactive efficacy to dentin, a more complex substrate requiring mineral deposition within a collagenous matrix. This suggests that the alkasite mechanism, which involves alkaline buffering and multi-ion release, may be versatile across different dental tissues, supporting collagen stabilization and intrafibrillar mineralization in dentin \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. The consistency of bioactive performance may be influenced by the material\u0026rsquo;s delivery system. Earlier studies predominantly evaluated the powder\u0026ndash;liquid formulation of Cention N, which can introduce variability in powder-to-liquid ratios during manual mixing, potentially affecting ion-release behavior \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. In contrast, the capsulated Cention Forte used here ensures standardized mixing and improved reproducibility, enabling a clearer assessment of functional recovery under dynamic pH-cycling conditions. The observed microhardness recovery aligns with the acid-neutralizing capacity of alkasite materials, a mechanism that supports sustained mineral deposition under acidic challenge \u003csup\u003e[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, the literature presents variable findings regarding the comparative remineralization performance of alkasite and glass hybrid restorative materials. Khurana et al., reported that Equia Forte exhibited the highest nanohardness values in both normal and fluorosed enamel, outperforming Cention N, Fuji VIII, and a resin composite \u003csup\u003e[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]\u003c/sup\u003e. Similarly, Salinović et al., observed that after 28 days, Equia Forte HT and Fuji TRIAGE achieved the highest dentin microhardness values, while Cention Forte demonstrated comparable but not superior performance relative to Riva SC \u003csup\u003e[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]\u003c/sup\u003e. Dhumal et al. further demonstrated significantly higher microhardness values for Equia Forte at depths ranging from 100 to 300 \u0026micro;m from the restoration interface compared with several fluoride-releasing materials, including Cention N \u003csup\u003e[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThese findings may be explained by differences in ion diffusion patterns and evaluation depth. The sustained fluoride release characteristic of glass hybrid materials may promote mineral recovery over a broader subsurface region, particularly at greater distances from the restoration interface. In contrast, the present study focused on dentin immediately adjacent to the restorative material, where localized alkaline buffering and rapid calcium ion availability associated with alkasite materials may exert a more pronounced effect \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eApparent discrepancies across studies are therefore likely attributable to methodological variables that influence remineralization kinetics, including substrate type, evaluation depth, and duration of assessment. The time-dependent nature of mineral precipitation further complicates direct comparisons. Ghilotti et al. demonstrated that carbonated hydroxyapatite formation induced by glass ionomer-based materials may only become detectable after a 14-day threshold, with outcomes additionally modulated by residual dentin thickness \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Accordingly, the 14-day evaluation period employed in the present investigation likely represents an intermediate stage of mineralization rather than a definitive endpoint. This interpretation is supported by longitudinal investigations, such as that of Ubolsa-Ard et al., which showed that material performance rankings may shift over extended durations as ion-release kinetics and mineral maturation evolve \u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe elemental analysis via EDX provided quantitative evidence of mineral re-deposition across all experimental groups, though distinct recovery patterns were observed between materials. The CF\u0026thinsp;\u0026minus;\u0026thinsp;P group demonstrated the highest calcium recovery, followed closely by EF. The observed functional recovery is consistent with previous investigations into the ion-release kinetics of the Cention N formulation. Ruengrungsom et al. and Kim et al., characterized the high calcium ion-release capacity of alkasite materials as a primary driver of their remineralization efficacy \u003csup\u003e[29, 35]\u003c/sup\u003e. Eriwati et al. further confirmed the strong ion-release potential of bioactive materials, though they noted significant differences in acid buffer capacity among different formulations \u003csup\u003e[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]\u003c/sup\u003e. However, Di Lauro et al. presented contradictory data, showing that Equia Forte HT consistently released higher levels of calcium than Cention N across various pH and temperature conditions \u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. This discrepancy likely originates from fundamental methodological differences between static and dynamic experimental designs. Di Lauro et al. quantified cumulative ion release into static solutions, a metric that reflects a material\u0026rsquo;s theoretical ion-release potential. In contrast, the present study evaluated functional mineral incorporation into a demineralized dentin matrix under dynamic pH-cycling conditions.\u003c/p\u003e \u003cp\u003eElemental analysis indicated robust phosphate recovery across the experimental groups, with EF performing comparably CF-P. This finding is consistent with previously reported ion-release behavior of glass hybrid restorative materials. Ruengrungsom et al., reported that Equia Forte Fil demonstrated notable phosphate-related behavior among ion-releasing restorative materials, which has been attributed to the fluoroaluminosilicate glass composition of these materials \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. In contrast, Kasraei et al., reported higher phosphate ion release from Cention N compared with a resin-modified glass ionomer (Fuji II LC) over a six-month evaluation period \u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. The difference between those findings and the present results can be attributed to differences in study design and outcome measures. Kasraei et al. quantified cumulative phosphate ion release into solution over an extended period, whereas the present study evaluated phosphorus incorporation into dentin after a 14-day pH-cycling protocol. The time-dependent nature of ion release and mineral deposition has been documented in previous studies. Ghilotti et al. reported that mineral deposition associated with glass ionomer-based materials continues beyond 14 days, with more evident changes observed at later evaluation periods \u003csup\u003e[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e. Accordingly, the present findings reflect phosphorus recovery under short-term, dynamic pH-cycling conditions and do not represent long-term mineral exchange behavior. Differences in evaluation duration should therefore be considered when comparing phosphate-related outcomes across studies. Both CF-P and EF demonstrated an increase in the Ca/P ratio following pH cycling, an increase in the Ca/P ratio is commonly interpreted as an indicator of improved mineral composition and structural maturity of the deposited phase \u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]\u003c/sup\u003e. Similar findings were reported by Puttipanampai et al., who observed a significant increase in the Ca/P ratio for both Cention N and Equia Forte adjacent to Class II restorations in demineralized enamel after 14 days of pH cycling \u003csup\u003e[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]\u003c/sup\u003e. In contrast, CF\u0026thinsp;+\u0026thinsp;P exhibited a markedly lower Ca/P ratio following pH cycling. A reduced Ca/P ratio suggests altered mineral stoichiometry and may indicate incomplete maturation of calcium phosphate phases rather than the formation of crystalline hydroxyapatite. This observation is consistent with the findings of Par et al., who demonstrated that adhesive coatings substantially reduced ion release from bioactive materials and inhibited the formation of apatite-like precipitates on material surfaces \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. These results suggest that the presence of an adhesive interface may interfere with the local conditions required for effective ion supersaturation and crystal nucleation, thereby affecting not only the extent but also the compositional quality of remineralization at the dentin interface \u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe most significant clinical observation in this study is the consistent inhibitory effect of the proprietary primer on the remineralization potential of the alkasite material across all evaluated parameters. This inhibitory effect can be explained by well-established physicochemical mechanisms. Following polymerization, resin-based primers form a hybrid layer that significantly reduces dentin permeability, restricting the diffusion of calcium, phosphate, and fluoride ions from the restorative material into the demineralized dentin substrate \u003csup\u003e[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Additionally, acidic functional monomers present in adhesive systems such as 10-MDP can chelate calcium ions \u003csup\u003e[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]\u003c/sup\u003e, reducing local ion availability and disrupting the supersaturation conditions necessary for hydroxyapatite nucleation. Beyond acting as a diffusion barrier, adhesive layers physically separate the bioactive material from the dentin surface, which may impede the formation of a stable nucleation interface required for the maturation of calcium phosphate phases into crystalline hydroxyapatite \u003csup\u003e[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]\u003c/sup\u003e. This finding aligns with established literature characterizing the physical and chemical barriers imposed by adhesive resins. Abdallah reported negligible calcium gain at the restorative interface when Cention N was used with a bonding agent, corroborating the inhibited mineral incorporation observed in our CF\u0026thinsp;+\u0026thinsp;P group \u003csup\u003e[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]\u003c/sup\u003e. Additionally, Sauro \u0026amp; Pashley noted that resin-rich hybrid layers can significantly reduce dentin permeability, limiting the transport of remineralizing ions to the underlying substrate \u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, the impact of adhesive systems on bioactivity appears to be subject to temporal and formulation-specific variables. Obaees et al. reported that although Cention Forte with primer initially exhibited restricted ion diffusion, fluoride release surpassed that of the unprimed material by day 28 \u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. Similarly, Kelić et al. observed that while adhesive application reduced cumulative fluoride release, the capacity for fluoride recharging remained intact \u003csup\u003e[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]\u003c/sup\u003e. These data suggest that while standard resin primers act as a kinetic barrier that delays ion mobilization, they may not entirely eliminate long-term bioactivity in static environments.\u003c/p\u003e \u003cp\u003eCrucially, the degree of interference is highly dependent on the chemical composition of the adhesive system. Samy et al. emphasized that interfacial interactions are critically influenced by specific primer formulations \u003csup\u003e[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]\u003c/sup\u003e, while Chou et al. demonstrated that biomimetic primers containing polyacrylic acid and sodium tripolyphosphate can actively enhance remineralization \u003csup\u003e[\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]\u003c/sup\u003e. This highlights a fundamental distinction between the passive delay of ion release in static solution studies and the functional failure of mineral recovery in dynamic models.\u003c/p\u003e \u003cp\u003eDespite the methodological rigor of the present study, certain limitations should be acknowledged. The artificial caries model, while ensuring standardization, does not replicate the structural heterogeneity or microbial ecology of natural carious lesions. Moron et al. demonstrated that variations in demineralization protocols influence lesion characteristics and subsequent remineralization outcomes \u003csup\u003e[\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]\u003c/sup\u003e. Additionally, the influence of the adhesive primer may evolve over longer durations, as suggested by studies observing time-dependent changes in ion diffusion through resin interfaces \u003csup\u003e[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]\u003c/sup\u003e. Future studies should incorporate microbiological caries models and extended evaluation periods to better simulate clinical conditions and assess the long-term stability of the remineralized interface.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eWithin the limitations of this in vitro study, both Cention Forte and Equia Forte HT promoted remineralization of demineralized dentin under pH-cycling conditions. Cention Forte applied without primer showed greater microhardness and mineral recovery than the primed alkasite. The use of the adhesive primer significantly reduced the remineralization potential of the alkasite material.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003eThe study was approved by the Ethical Committee of the Faculty of Dentistry, Suez Canal University (Approval No. 623/2023). All methods were carried out in accordance with relevant guidelines and regulations. The need for informed consent was waived by the Ethics Committee as the study used anonymized extracted human teeth.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eSelf-financed.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e- **Yasmin Labib Nasr:** Conceptualization, methodology, investigation, data curation, formal analysis, writing \u0026ndash; original draft.- **Ahmed Fawzy Abo El-Ezz:** Supervision, methodology, validation, writing \u0026ndash; review \u0026amp; editing.- **Dina Mohamed Ali:** Supervision, methodology, validation, writing \u0026ndash; review \u0026amp; editing.All authors read and approved of the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eYu OY, Panpisut P, Baysan A, Chu CH. 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Strategies to stabilise dentine-bonded interfaces through remineralising operative approaches\u0026ndash;State of The Art. Int J Adhes Adhes. 2016;69:39\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDi Lauro A, Di Duca F, Montuori P, Dal Piva AM, Tribst JP, Borges AL, Ausiello P. Fluoride and calcium release from alkasite and glass ionomer restorative dental materials: in vitro study. J Funct biomaterials. 2023;14(2):109.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrenes-Alvarado A, Cury JA. Fluoride release from glass ionomer cement and resin-modified glass ionomer cement materials under conditions mimicking the caries process. Oper Dent. 2021;46(4):457\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCherian NM, Girish TN, Ponnappa KC. Comparative evaluation of remineralizing potential of commercially available agents MI paste, Remin pro, and Clinpro using Scanning Electron Microscope and Energy Dispersive X-ray: An: in vitro: study. J Conservative Dentistry Endodontics. 2020;23(5):457\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou Z, Ge X, Bian M, Xu T, Li N, Lu J, Yu J. Remineralization of dentin slices using casein phosphopeptide\u0026ndash;amorphous calcium phosphate combined with sodium tripolyphosphate. Biomed Eng Online. 2020;19(1):18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim MJ, Lee MJ, Kim KM, Yang SY, Seo JY, Choi SH, Kwon JS. Enamel demineralization resistance and remineralization by various fluoride-releasing dental restorative materials. Materials. 2021;14(16):4554.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCury JA, Tenuta LM. Enamel remineralization: controlling the caries disease or treating early caries lesions? Brazilian oral Res. 2009;23:23\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKunert M, Piwonski I, Hardan L, Bourgi R, Sauro S, Inchingolo F, Lukomska-Szymanska M. Dentine remineralisation induced by bioactive materials through mineral deposition: an in vitro study. Nanomaterials. 2024;14(3):274.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta N, Jaiswal S, Bansal P. Comparison of fluoride ion release and alkalizing potential of a new bulk-fill alkasite. J Conserv Dent, 22: 296\u0026ndash;9, 2019 [Internet].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRai S, Kumari RA, Meena N. Comparative assessment of fluoride release and recharge through newer fluoride releasing posterior restorative materials: An: in vitro: study. J Conservative Dentistry Endodontics. 2019;22(6):544\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKavoor S, Ranjini M, Aziz NA, Nadig RR. Evaluation of the buffering action of an alkasite restorative material: An in vitro study. Int J Appl Dent Sci. 2023;9:411.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhurana S, Gehlot PM. Surface nanohardness of normal and fluorosed enamel adjacent to restorative materials: An in vitro Study and polarized light microscopy analysis. J Contemp Dent Pract. 2021;21(9):1034\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eŠalinović I, Schwendicke F, Askar H, Yassine J, Miletić I. Effects of Ion-releasing materials on Dentine: analysis of Microhardness, Appearance, and Chemical Composition. Materials. 2023;16(23):7310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhumal A, Gaddalay S, Badgire A, Wagh Y. Effect of four different fluoride releasing restorative materials on root dentin microhardnesss after exposures to demineralization and remineralization cycles: an in vitro study. Biochem Cell Archives. 2024;24(1).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhilotti J, Fern\u0026aacute;ndez I, Sanz JL, Melo M, Llena C. Remineralization potential of three restorative glass ionomer cements: an in vitro study. J Clin Med. 2023;12(6):2434.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUbolsa-Ard P, Sanon K, Hiraishi N, Sayed M, Sakamaki Y, Yiu CK, Shimada Y. Influence of surface pre-reacted glass-ionomer (s-prg) filler eluate on collagen morphology, remineralization, and ultimate tensile strength of demineralized dentin. J Mech Behav Biomed Mater. 2024;150:106295.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEriwati YK, Hanyouri WA, Dharma M, Irawan B. Acid Buffer Capacity and Compressive Strength of Bioactive Restorative Materials in the Cariogenic pH Solution. InMaterials Science Forum 2022 Sep 30 (Vol. 1069, pp. 167\u0026ndash;173). Trans Tech Publications Ltd.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuttipanampai O, Panpisut P, Sitthisettapong T. Assessment of fluoride-releasing materials in remineralization of adjacent demineralized enamel. Appl Sci. 2025;15(4):2077.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePashley DH, Tay FR, Breschi L, Tj\u0026auml;derhane L, Carvalho RM, Carrilho M, Tezvergil-Mutluay A. State of the art etch-and-rinse adhesives. Dent Mater. 2011;27(1):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoshida Y, Yoshihara K, Nagaoka N, Hayakawa S, Torii Y, Ogawa T, Osaka A, Meerbeek BV. Self-assembled nano-layering at the adhesive interface. J Dent Res. 2012;91(4):376\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTay FR, Pashley DH. Biomimetic remineralization of resin-bonded acid-etched dentin. J Dent Res. 2009;88(8):719\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdallah A. Elemental and micromorphological analysis of new alkasite based restorative material/tooth interface. Egypt Dent J. 2022;68(1):1065\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObaees RK, Alkhalidi EF, Hamdoon SM. Fluoride release and antibiofilm of Alkasite restorative materials. Edelweiss Appl Sci Technol. 2024;8(4):447\u0026ndash;59.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelić M, Kilić D, Kelić K, Šutej I, Par M, Peroš K, Tarle Z. The fluoride ion release from ion-releasing dental materials after surface loading by topical treatment with sodium fluoride gel. J Funct biomaterials. 2023;14(2):102.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamy FM, El-Kholany NR, Hamama HH. Evaluation of bond durability of different self-adhesive bioactive restorative systems to dentin. Sci Rep. 2025;15(1):3667.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChou YF, Pires PM, Alambiaga-Caravaca AM, Spagnuolo G, Hibbitts A, Sauro S. Remineralisation of mineral-deficient dentine induced by experimental ion-releasing materials in combination with a biomimetic dual-analogue primer. J Dent. 2025;152:105468.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoron BM, Comar LP, Wiegand A, Buchalla W, Yu H, Buzalaf MA, Magalh\u0026atilde;es AC. Different protocols to produce artificial dentine carious lesions in vitro and in situ: hardness and mineral content correlation. Caries Res. 2013;47(2):162\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Alkasite, Glass hybrid, Adhesive primer, Remineralization, Dentin, Cention Forte, Equia Forte HT","lastPublishedDoi":"10.21203/rs.3.rs-8450406/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8450406/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBioactive restorative materials can promote dentin remineralization, but their efficacy may be influenced by adhesive interfaces. This study aimed to evaluate the effect of an adhesive primer on the remineralization potential of an alkasite material (Cention Forte) compared to a glass hybrid material (Equia Forte HT) on artificially demineralized dentin.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eForty-two human molars with standardized Class V cavities were chemically demineralized and randomly divided into three restorative groups (n\u0026thinsp;=\u0026thinsp;14). Cention Forte without primer (CF\u0026thinsp;\u0026minus;\u0026thinsp;P), Cention Forte with primer (CF\u0026thinsp;+\u0026thinsp;P), and Equia Forte HT (EF). After restoration, all samples underwent 14 days of pH cycling. Remineralization was evaluated using Vickers microhardness and energy-dispersive X-ray spectroscopy (EDX) at baseline (T₀), after demineralization (T₁), and after pH cycling (T₂). Recovery percentages were calculated for microhardness and mineral content (calcium, phosphorus, oxygen and carbon). Statistical analysis was performed using two-way ANOVA and post hoc tests (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAll groups showed significant increases in microhardness after pH cycling (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). CF\u0026thinsp;\u0026minus;\u0026thinsp;P demonstrated the highest microhardness recovery (74.21\u0026thinsp;\u0026plusmn;\u0026thinsp;2.48%), followed by EF (72.50\u0026thinsp;\u0026plusmn;\u0026thinsp;2.10%), while CF\u0026thinsp;+\u0026thinsp;P showed the lowest recovery (61.36\u0026thinsp;\u0026plusmn;\u0026thinsp;3.22%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). EDX analysis revealed significant gains in calcium and phosphorus in all groups. Calcium recovery was highest in CF\u0026thinsp;\u0026minus;\u0026thinsp;P (76.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58%) and EF (75.44\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85%), both significantly higher than in CF\u0026thinsp;+\u0026thinsp;P (68.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.66%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Phosphorus recovery followed a similar pattern.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe use of an adhesive primer significantly reduced the remineralization capacity of the alkasite material. Cention Forte without primer performed comparably to the glass hybrid Equia Forte HT, whereas primer application limited its bioactive efficacy.\u003c/p\u003e","manuscriptTitle":"Effect of adhesive primer on dentin remineralization by an alkasite compared to a glass hybrid restorative material: an in vitro study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-22 11:15:16","doi":"10.21203/rs.3.rs-8450406/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"30916114975263668710906756570616073679","date":"2026-05-16T13:15:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256748662557793736278938198933254069082","date":"2026-05-16T08:16:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-07T19:45:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21904937746666537839665406941779730582","date":"2026-01-28T19:11:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76434940735222013659112989400412021428","date":"2026-01-28T17:34:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"289754451336292041105305019304921528399","date":"2026-01-23T18:59:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-21T12:25:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"227549158534623248955148965939179038224","date":"2026-01-20T19:22:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-20T14:46:35+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-29T10:14:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-29T06:42:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-29T06:41:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2025-12-25T17:27:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"92e272a6-af66-4abe-901f-9c82ed293c73","owner":[],"postedDate":"January 22nd, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"30916114975263668710906756570616073679","date":"2026-05-16T13:15:25+00:00","index":84,"fulltext":""},{"type":"reviewerAgreed","content":"256748662557793736278938198933254069082","date":"2026-05-16T08:16:10+00:00","index":83,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-22T11:15:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-22 11:15:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8450406","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8450406","identity":"rs-8450406","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}