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Dentin/enamel adhesives
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Dentin/enamel adhesives: review of the
literature
Dentin/enamel adhesives in pediatric
dentistry
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Dentin/enamel adhesives: review of
the literature
Edward J. Swift, Jr, DMD, MS
Pediatric Dentistry Vol.24 No.5 September/October 2002
Pediatric Restorative Dentistry Consensus Conference
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the development of dentin bonding systems
Two primary strategies are currently
available for bonding resin to dentin: total-
etch and self-etch.
3-step, total-etch
total-etch using combined primer/adhesive
("one-bottle")
self-etch primers with a separate bonding
agent
self-etch, or "all-in-one" adhesives
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Enamel bonding
1955, Buonocore
acrylic resin could be bonded to human
enamel that was conditioned with 85%
phosphoric acid for 30 seconds
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Problems in bonding to dentin
bonding of resins to dentin is far more
difficult and less predictable than bonding
to enamel.
Dentin not only has a more complex
histologic structure than enamel, but also
varies more with location.
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Dentin
inorganic hydroxyaparite
enamel : 92% by volume
dentin : 45%, hydroxyapatite crystals are
randomly arranged in an organic matrix
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Dentin
contains numerous fluid-filled tubules that
run from the pulp to the dentinoenamel
junction (DEJ)
dentin tubules
45,000 per mm2 at the pulp 20,000 per
mm2 at the DEJ in coronal dentin
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Dentin
22%-28% of the cross-sectional area near
the pulp and only 1%-4% near the enamel.
The intrapulpal pressure is estimated to be
25-30 mm Hg
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smear layer
typically 0.5-5.0 m thick, it occludes the
orifices of the dentinal tubules
as a "diffusion barrier" that decreases
dentinal permeability
an obstruction that prevents resin from
reaching the underlying dentin substrate
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Development of dentin adhesives
Begun in the 1950s
introduction of the first commercial dentin
adhesive in 1975
very poor clinical results when used to
restore cervical erosion lesions without
mechanical retention.
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second generation dentin bonding
agents
introduced for clinical use in the early
1980s
Dual-Cure Scotchbond, 3M ESPE;
Bondlite, Kerr)
Main contents: Bis-GMA (bisphenol A-
glycidyl methacrylate) or HEMA
(hydroxyethyl methacrylate)
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second generation dentin bonding
agents
bonded to dentin via surface wetting and
interaction between their phosphate groups
and calcium ions in the smear layer
Shear dentin bond strengths
only t 1-10 Mpa
too weak to counteract the polymerization
shrinkage of composite resin
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second generation dentin bonding
agents
In clinical trials, high percentages of
cervical restorations were lost in 1 or 2
years
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third generation of adhesives
introduced in the mid- to late 1980s
modified or removed the smear layer to
permit resin penetration into the underlying
dentin
Scotchbond 2 (3M ESPE), Gluma (Bayer),
Tenure (Den-Mat Corporation), Prisma
Universal Bond 2 and 3 (Dentsply Caulk),
Synrac Classic (Ivoclar Vivadenc) and XR
Bonding System (Kerr)
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third generation of adhesives
Clinically, 3-year studies of Scotchbond 2
and Gluma in cervical areas
had considerably better clinical performance
(retention, marginal integrity, etc)
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Current strategies for resin-dentin
bonding
Total-etch adhesives
Self-etch systems
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Total-etch adhesives
in the late 1980s , Fusayama in Japan
proposed a technique:
phosphoric acid-etching of dentin as well as
enamel
then application of relatively hydrophilic
resins
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Total-etch adhesives
commercial products released in the early
1990s:
All-Bond 2 (Bisco, Inc.), OptiBond FL (Kerr),
Perma Quick (Ukradent Prod-ucts) and
Scotchbond Multi-Purpose (3M ESPE)
include 3 fundamental steps
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3-step, toral-etch adhesives
first step
phosphoric acid-etching, removes the
smear layer, opens the dentinal tubules and
decalcifies the intertubular and peritubular
dentin
Hydroxyaparite crystals are dissolved,
leaving a collagen meshwork
Then,etchant is rinsed off
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3-step, toral-etch adhesives
Second Step
a primer containing
a solvent such as acetone, ethanol and/or
water
one or more bifunctional resin monomers
(HEMA)
The primer wets and penetrates the
collagen mesh-work
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3-step, toral-etch adhesives
Third Step
bonding agent is applied and penetrates
into the primed dentin.
main contents:
hydrophobic resin such as Bis-GMA
hydrophilc resin such as HEMA to improve
wetting.
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3-step, toral-etch adhesives
Third Step
The bonding agent copolymerizes with the
primer to form an intermingled layer of
collagen fibers and resin called the "hybrid
layer," "resin-reinforced zone" or "resin-
infiltrated layer."
hybrid layer---first described by
Nakabavashi et al, in 1982
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3-step, total-etch adhesives
Third Step
Resin penetration into partially
demineralized dentin and irregularities
within the dentin just beneath the collagen
meshwork
may be more important than formation of
the hybrid layer
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"one-bottle" systems
primer and bonding functions are combined
into a single solution
Prime & Bond NT (Dentsply Caulk),
OpriBond Solo (Kerr) and Single Bond
(3M ESPE)
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"one-bottle" systems
In a moist-bonding technique, the surface is not
dried after etching and rinsing, and, therefore, the
collagen remains in position and behaves almost
as a sponge. The acetone or ethanol solvent
displaces water and carries the resins into the
collagen.
A 3-years study on such adhesives reported a
retention rate of about 90% for Class V
restorations placed without mechanical retention
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Total-etch adhesives
Disadvantage:
high incidence of postoperative sensitivity
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Self-etch systems
self-etch primer systems included two steps:
an acidic, self-etching primer
Then, a separate bonding resin
self-etch adhesives
"all-in-one," and contain etch, prime and bond
functions in a single solution
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self-etch primer (2-step) systems
Clearfil SE Bond and ClearfU Liner Bond
IIV (both from Kuraray)
Weakness: they might not etch enamel
effectively
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self-etch adhesives (all-in-one)
system
Prompt L-Pop (3M ESPE), One Up Bond F
(Tokuyama and J. Morita USA) and Touch
& Bond (Parkell).
One clinical trial of Class I posterior
composites reported essentially zero
postoperative sensitivity, compared with
20% for restorations placed using Prime &
Bond, a total-etch adhesive.
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self-etch adhesives (all-in-one)
system
Six-month retention rates of 76%-100%
have been reported for Class V restorations
placed using Prompt as the adhesive
Long-term study is needed for more
information about the long-term reliability
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Bonding to primary teeth
primary dentin has more large dentinal
tubules than permanent dentin
Studies with earlier generation of adhesive
systems routinely reported lower bond
strengths to primary than to permanent
dentin
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Bonding to primary teeth
recent studies of total-etch adhesives have
revealed similar bond strengths to both
types of dentin
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Summary
4 distinct categories of dentin adhesives
can be identified
3-step, total-etch;
total-etch using combined primer/adhesive
("one-bottle")
self-etch primers with a separate bonding
agent
self-etch, or "all-in-one," adhesives.
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Summary
At present, the profession seems to be
moving in the direction of the self-etch
adhesives, but the clinical performance of
these materials is not yet proven.
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Dentin/enamel adhesives in pediatric
dentistry
Franklin Garcia-Godoy,DDS,MS Kevin J. Donly,DDS,MS
Pediatric Dentistry Vol.24 No.5 September/October 2002
Pediatric Restorative Dentistry Consensus Conference
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Adhesives
From the literature search, proper handling and
light curing of the materials are perhaps the most
significant steps to obtain the maximum potential
of the materials' mechanical properties
Most in vitro studies evaluating adhesives and
resins in primary and permanent teeth show that
bond strength and micromorphological adaptation
to enamel and dentin is basically similar for
primary and permanent teeth.
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Enamel and dentin conditioning for
resin-based composites and
compomers
The etchant should be applied for 20 ro 30
seconds to both the enamel and dentin.
There is no statistically significant
difference between the bond strengths of
resin placed to enamel etched for 20 or 60
seconds
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Enamel and dentin conditioning for
resin-based composites and
compomers
The cavity preparation should be
thoroughly rinsed with an air-water spray
for 1 to 15 seconds.
Rinsing for as brief as 1 second does not
impair the bond strength nor affect the
microleakage at the enamel site
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Enamel and dentin conditioning for
resin-based composites and
compomers
The dentin must remain moist and should
not be dehydrated. Ideally, the enamel
should be thoroughly dried, but the dentin
must remain moist.
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Primer/adhesive placement
A primer/adhesive may be applied over the
entire cavity preparation as it improves the
retention of the occlusal restoration
If the adhesive contains acetone, the
enamel should remain moist, and it is not
necessary to overdry it
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Adhesives used with compomers
According to most manufacturers, enamel
etching is not required before placing
compomers.
several laboratory studies have shown a
higher bond strength and more intimate
marginal adaptation of compomers when
the enamel was acid-etched
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Rebonding the restoration
After polymerization of the composite or
compomer, a filled adhesive (ie, Fortify,
OptiGuard, PermaSeal) may be used as a
rebonding agent to
extend the lifetime of the restoration
prevent its discoloration.
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Summary
Based on the clinical success of resin and
adhesives in primary and permanent teeth,
more conservative preparations can be
performed when using resin-based
composites to maintain more tooth
structure
Meticulous care in the placement of
adhesives and, subsequently, resin-based
composites and compomers is necessary to
produce long-term satisfactory results
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Thanks for your attention!
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Adhesives used with compomers
A glass-ionomer base may be used as a
"dentin replacement" or lining material,and
the composite or compomer is then placed
in increments as an "enamel replacement"
material.
If a glass-ionomer is used, it should be
placed before placing the primer/adhesive.