Bonding Considerations

Disturbed surface layers of dentin and enamel that are formed by cutting or abrading instruments must be removed or altered to obtain strong adhesive bonding between restorative materials and dentin and enamel. These layers can be removed by acids, including formic and ascorbic acids or chelating compounds both of which form soluble or insoluble reaction products (Bowen, 1978). Dental material scientists have been concerned about the smear layer in so far as it masks the underlying dentin matrix and may interfere with the bonding of adhesive dental cements such as the polycarboxylates and glass ionomers, which may react chemically with the dentin matrix. Dahl (1978) demonstrated that simply pumicing the dentin surface produced a three-fold increase in the tensile strength of the bond between dentin and polycarboxylate cement over that seen with inc phosphate cement, which relies strictly upon mechanical roughness for retention. !resumably allowing cements to react chemically with the smear layer, rather than the matrix of sound intertubular dentin, produced a weaker bond due to the fact that the smear layer can be torn away from the underlying matrix. "arly dentin bonding systems were hydrophobic and were bonded directly to the dentin smear layer. Therefore, macroshear bond strengths were found to be less than 6 MPa, because that is the strength of the bond of the smear layer to sound dentin. #hen cements were applied to dentin covered with a smear layer and then tested for tensile strength, the failure was either adhesive (between cement and smear layer) or cohesive (between constituents of the smear layer). $f one wants to increase the tensile strength of a cement-dentin interface there are several approaches to the problem. 1. Remove the smear layer by etchin with aci!" (#ee et al, 1971, 197$% Bowen, 1978% Brannstorm et al 1979a, 198&% Pashley et al 1981). This seemingly extreme procedure does not in%ure the pulp (Brannstrom, 198'), especially if dilute acids (Bowen, 1978) are used for short periods of time.

&'

Bonding Considerations

"tching dentin with () citric acid for (' seconds removed all of the smear layer (and smear plugs) as does *& seconds of etching with +,) phosphoric acid (Pashley ( others, 1981) .The advantages were that the smear layer was entirely removed, the tubules were open and available for increased retention, and the surface collagen was exposed for possible covalent linkages with primers for cavities ()*sayama ( others, 1979% Bowen, +obb ( Ra,son, 198'% Bowen ( +obb, 198$). -urther, with the smear layer gone, one doesn.t have to worry about it slowly dissolving under a leaking restoration or being removed by acid produced by bacteria, leaving a void between the cavity wall and the restoration, which might permit bacterial coloni ation. -#./elal et al ('&&$) investigated the effect of smear layer on root deminerali ation ad%acent to resin-modified glass ionomer. / cavity surface treatments were carried out prior to the placement of 012$3 no treatment (4one), polyacrylic acid (!55), phosphoric acid, and 6cotchbond 1ulti-!urpose adhesive (61!). $t was concluded that removal of the smear layer with phosphoric acid provides significantly enhanced resistance to secondary root caries formation ad%acent to 012$ restorations. The disadvantage of removing the smear layer was that, in its absence, there was no physical barrier to bacterial penetration of the dentinal tubules. -urther, with nothing occluding the orifices of the tubules, the permeability of the dentin increased / to 7 fold depending upon the si e of the molecule ( Pashley ( others, 1978b% Boyer ( 0ware, 1981). $t is clear why Brannstrom ( others (198') would prefer to remove the smear layer over and between the tubules without removing the smear plugs. 8owever, this is very difficult to achieve clinically. 5nother disadvantage is the possibility of an increase in the chemical toxicity of restorative materials after smear layer removal. Meryon ( 1ohnson (1988) found that there was increase in the cytotoxicity of some dental restorative materials after smear layer removal particularly if the intervening dentin is thin. Pe22oli ( Bal!i (1997) investigated the cytotoxicity of the composite resins applied on dentine samples with different smear layer removal. The results showed that the composite resins are surely cytotoxic if directly applied on the dentine. The smear layer is able to reduce the transdentinal diffusion of composite resin toxicity. 9n
&*

Bonding Considerations

the basis of the data obtained it is suggested that in vivo, being necessary to eliminate the smear layer due to its bacterial contents, it is possible in the deep cavities, to partially remove with "DT5 maintaining the smear plugs after their disinfection. 4evertheless "DT5 application should not exceed +' seconds. )i . ''

6mear layer (6:) in cross section. 6mear plugs (6!) are formed from cutting debris forced into the tubules. The smear layer and plugs greatly reduce the permeability of cut dentin surface.

)i '$

1ost dentin bonding systems remove or solubili es smear layer, allowing resin to penetrate and form ;hybrid layer< with dentin structures. $deally, smear plugs would not be removed.

&=

Bonding Considerations

5cids are among several agents that can remove the smear layer. -or enamel, phosphoric acid in gel or solution in a concentration ranging from +'(&) is the most popular agent. The application of this agent to dentin removes the smear layer and, by dissolution of the peritubular dentin, the lumen of the dentinal tubules is significantly enlarged. Brannstrom an! 3or!envall (1977) and 4winnett (1977) demonstrated that conditioning of dentin with phosphoric acid facilitates penetration of resin into the dentinal tubules. )i . '5

6"1 of resin which had penetrated deep into the dentinal tubules after conditioning with phosphoric acid and sodium hypochlorite. 0esin was disclosed by tissue dissolution. >*&'

6uch penetration probably contributes to the increased bond strengths of resins employing acid conditioning of dentin ()*sayama ( others, 1979). There was e?uivocation as to whether the values decline or are stable with time in the presence of water. $t was clear from many studies that while phosphoric acid removes the smear layer and enlarges the dentinal tubules, it also appears to degrade the collagen matrix. 6ome of the degradation products may be removed with water but the surface of the acid-conditioned dentin appears relatively smooth with a gelatinous ?uality even after a thorough lavage. 6ubse?uent treatment of the same surface with a solution of sodium hypochlorite brings about significant morphological changes.
&+

Bonding Considerations

)i . '6

)i . '6

-ig. =& @ =(3 6canning "lectron 1icrograph show dentin etched for *' seconds with &') phosphoric acid. 5 significant morphological difference exists following additional treatment for (' seconds with &-=&) sodium hypochlorite (-ig.=() > *&='.

The sodium hypochlorite dissolves the organic material to produce a rougher texture to the surface, which is dependent upon the time of application of this agent. #hen tubules are exposed in longitudinal section, lateral canals increase in number with time of application of sodium hypochlorite.

&/

Bonding Considerations

)i . '7

)i . '8

7
-ig. =, @ =A3 6"1 showing the tubules exposed in longitudinal section. 5fter (' sec of &') phosphoric acid and (' sec of &-=& ) 4a9Bl treatment, the surface appears smooth (fig =,). $ncreasing the time of application of 4a9Bl brings about a roughening of the surface and the exposure of numerous lateral canals.

The biocompatibility of this method was contentious, and therefore, the preparation of the dentin surfaces for bonding must take into account the viability of this tissue and its morphological and physiological association with the pulp. $n addition the composition of dentin and its surface following instrumentation also dictates the choice of treatment. 1ethods that raise the surface energy of dentin by removing the smear layer while leaving the tubules plugged with cutting debris are preferred.

&&

Bonding Considerations

82t*r9 et al ('&&5) compared in vitro the sealing properties of five different dentine adhesive materials (!rime@Cond 4T (!C4T)D !rompt :-!op (!:!)D Blearfil 6" Cond (B6"C)D 6cotchbond 1ulti !urpose !lus (61!!)D "C6-1ulti ("C61)) inside the pulp chamber. The pulp chambers were treated with &) sodium hypochlorite (4a9Bl) for * min prior to bonding agent application. :eakage values of the materials were significantly different at different measurement periods. $n all groups, leakage values decreased with time. 6"1 observation of pulp chamber walls demonstrated that the irregular dentine surface without smear layer was present in the nontreated group. 8owever, 4a9Bl application removed the collagen fibrils leaving the dentine surface smooth. 5t resin-dentine interfaces of specimens, no hybridi ation one was observed. $t was concluded that none of the materials had created a perfect seal to the pulp chamber walls. !C4T and !:! had better sealing over the short term, but over the long term, there were no differences between the materials. 8EC0$D :5E"0 -9015T$943 5cid treatment of dentin removes the smear layer and hydroxyapatite from the treated dentin and exposes the fibrillar collagen matrix thereby providing a substrate for the resin monomers to infiltrate and form a hybrid layer. Criefly, the substitution of resin in the subsurface of minerali ed tissues is the essence of the creation of the hybrid layer. #hen primer and bonding resins are applied to etched dentin, they penetrate the intertubular dentin, forming a resin-dentin interdiffusion one, or :hybri! layer;. They also penetrate and polymeri e in the open dentinal tubules, forming :resin ta s;. Thus hybridi ed dentin is a molecular-level mixture of collagen and resin polymers. $t has a concentration gradient structure, because it is prepared by diffusion of monomers that have been placed on the conditioned dentinal surface and subse?uently polymeri ed in situ. The bond strengths achieved by the ;total-etch dentin adhesive systems< is between 17 to $& MPa. ".g.3 /th generation bonding agents3 5ll-Cond = (Cisco, $llinois), 9ptibond -: (Ferr, Balifornia), 6cotchbond 1ultipurpose (+1, "6!").

&(

Bonding Considerations

&th generation bonding systems3 9ne-6tep (Cisco, $llinois), !rime @ Cond, !rime @ Cond =.* (Dentsply Baulk, Delaware), 9ptibond 6olo !lus (Ferr), 2luma 9ne Cond (8araeus Ful er). )i . '9

Conding of resin to dentin, using a ;total-etch< techni?ue

Mitchem ( 4ronas (1991) determined the adhesion to dentin with and without smear layer under varying degrees of wetness. The bond strengths of glass ionomer cements to prepared dentin ranged between =.* and /., 1!a for all test conditions and did not appear to be adversely affected by the presence of fluid under physiologic pressure or by the presence or absence of a smear layer. 9n the other hand, the resin dentin adhesive was adversely affected by the presence of moisture (1 <=. 1.$ MPa when the tubules were full of fluid and under pressureD 9.5 <=. 1&.6 MPa when the tubules were full of fluid but not under pressureD and 18.$ <=. 7.6 MPa when the tubules were empty. 1inerali ed dentin usually does not permit much monomer diffusion into its substance. Therefore, dentin must be suitably conditioned to permit diffusion of monomers, which should have a good affinity for deminerali ed dentin, into the substrate. !repared dentinal surfaces are covered with a smear layer that adheres
&,

Bonding Considerations

weakly to the underlying dentin. Dentin conditioning involves the removal or the modification of the smear layer to permit monomer diffusion into the deminerali ed collagen matrix. !hosphoric acid denatures the peptides exposed during the removal of the smear layer ( 0cott ( #eaver, 1975% Mi2*n*ma, 1986% 89amoto, 1991). The degree of denaturation depends on the phosphoric acid concentration and time of exposure. 6imilar results were obtained with *') citric acid. The deminerali ed dentinal matrix, composed mainly of collagen, can collapse easily upon air-drying, causing a decrease in the interfibrillar spacing and loss of permeability to resin monomers. The challenge is to maintain the spaces between the deminerali ed collagen fibrils after the hydroxyapatite crystals have been removed. )i . $&

Bollapse of etching dentin by air-drying

9ne approach to overcome this challenge is by adding $> ?erric chlori!e to *') citric acid. -erric chloride prevents the collapse of the deminerali ed dentin by getting adsorbed on the deminerali ed dentin and cross-link peptides, thereby immobili ing them and preventing collapse when air-dried.

&A

Bonding Considerations

+*,ric ions added to *') phosphoric acid also cross-link collagenous and non-collagenous proteins, thereby stabili ing the structure of interfibrillar spaces that are necessary for monomer permeation during bonding. @ato ( 3a9abayashi (1997) added 1> calci*m ,hos,hate to *') phosphoric acid and obtained very high ?uality hybrid layers. !resumably the calcium ions stabili ed the collagen network and immobili ed non-collagenous proteins and glycosaminoglycans (@*bo9i, 1979). 5nother approach to over the disadvantage of collapse of deminerali ed dentinal matrix is to re-expand the collapsed collagen network to regain the permeability of the inter-tubular dentin for hybridi ation by the primer. $f water or an aA*eo*s ,rimer were added to dried dentin, the water molecules would form hydrogen bond with the collagen peptides, breaking intermolecular hydrogen bonds. 0esidual stresses that were created in the network when it shrank could permit elastic recoil, allowing the network to actively re-expand ( Balooch et al, 1996). Bombination of 1&> citric aci! an! /BM- (8ydroxy "thyl 1eth5crylate) priming provided good bonding of the resin to dentin even in the absence of ferric ions, though it took * hour to re-expand the deminerali ed dentin ( 3a9abayashi ( Ca9ara!a, 199'). The collapsed deminerali ed dentin re-expanded &') when it was treated with $&> /BM- in water for *minute and *'') when the primer was allowed to diffuse for *' minutes. 5pplication of 1> Phenyl.P in $&> /BM- in water for * minute to etched, air-dried, collapsed dentin caused much more re-expansion than did application of +') 8"15 for the same time (D arashi ( 3a9abayashi, 1996). 9ne recent approach to preventing the collapse of deminerali ed dentin is to leave the smear layer in place but to use acidic monomers to etch through the smear layer into the underlying dentin and to avoid rinsing the conditioned surface. This prevents loss of dentin mass but solubili es enough apatite crystals
&7

Bonding Considerations

from around collagen fibrils to permit infiltration of adhesive monomers (Eatanabe, 199'% Coi!a, 1996). 0el?.etchin con!itioners an! ,rimers eliminate several bonding steps at which errors can occur. $n conventional multistep bonding procedures, an acidic conditioner is applied and rinsed off with water, the water is blown off (at the risk of drying or collapsing the deminerali ed dentinal mesh) and then the primer is applied. $f too little rinsing occurs residual acid may over-etch the dentin or residual reaction products may block the narrow channels around the collagen fibrils. 6elf-etching and self-priming systems may avoid these problems. The li?uid is applied, allowed to react for +' seconds and then air-dried. =. Fse o? a resin that wo*l! in?iltrate thro* h the entire thic9ness o? the smear layer an! either bon! to the *n!erlyin matriG or ,enetrate into the t*b*les3 The impressive tensile strength for 6cotchbond (+1) may be due to such a process. 0esults indicate stronger bonds between the resin and pumiced dentin than between the resin and etched dentin. "tching with acid, in addition to removing the smear layer and exposing the surface collagen, also removed the peritubular dentin from the top &-l' m of the tubules, yielding a tubule with a funnel shaped orifice which provides less retention since the walls are divergent as compared to normal parallel walls of unetched tubules. 5dditionally, etching with acid deminerali ed the surface, which would lower the adhesive bond between cements and the minerali ed dentin. H* et al (1991) examined teeth treated with smear layer-mediated dentinal bonding agents and restored with composite resin, at the dentin-restoration interface. 0esults indicated that these dentinal bonding agents actually bonded to the smear layer, and samples demonstrated delamination of the smear layer from underlying dentin following thermocycling. This finding suggests that the stresses developed within the composite resin exceeded the adhesive strength of the smear layer to dentin. Thus, the bond strength for dentinal bonding agents that re?uire

('

Bonding Considerations

the presence of the smear layer cannot exceed the adhesion of the smear layer to dentin. 6mear layers on deep dentin may have more organic material in them than those on superficial dentin. This may be due to the number of odontoblastic process or to the greater amount of proteoglycans lining the tubules ( Chomas ( Paine, 198$). "tching with acid, i.e., removal of the smear layer increased the adhesive strength of composite resins (5daptic, Blearfil) to superficial dentin by A''-*''') over that to deep dentin even though far more tubules were available for penetration of resin in deep dentin than in the superficial dentin. This indicates that composite resins probably do not derive their adhesiveness from penetration of resin into the tubules, but rather by interacting with minerali ed intertubular dentin. 5nother variable interfering with the adhesive of substances to dentin was the presence of dentinal fluid, a fluid much like other interstitial fluids ( Pashley, 1979 ) both within the dentinal tubules and within the smear layer. Brannstrom el al (1979a) indicated that, in dentin etched with acid, dentinal fluid could be removed by blasts of air and replaced by tags of resin extending deep into the tubules. BowenIs (198') approach was to treat the dentin with solutions of resins in acetone which was miscible with dentinal fluid yet compatible with hydrophobic polymers. The recently introduced self-etching primers (6"!s) perform two functions simultaneously-etching and priming of dentin and enamel. They are applied to the smear layer-covered dentin for a designated period of time. #ithout further rinsing, a layer of adhesive resin is then applied to the treated dentin. $n these systems, the goal is to incorporate the smear layer into the hybrid layer and the smear plugs into the resin tags.

(*

Bonding Considerations

)i $1

Conding to dentin using a self-etching primer

The use of self-etching, self-priming adhesives (( th @ ,th generation bonding agents) is attractive because they are used on dry dentin and re?uire only one primer application which is subse?uently air-dried rather than rinsed. 6elf-etching systems are less techni?ue sensitive compared with systems that utili e separate acid conditioning and rinsing steps, thus reducing the possibility of overwetting or overdrying (i.e. collapse of air-dried deminerali ed collagen), which can have a negative influence in adhesion. The susceptibility of moisture contamination of the adhesive through transudation of dentinal fluid is reduced. The disadvantage of self-etching systems is that they must diffuse by deminerali ing though the smear layer and into sound underlying dentin if they are to give high bond strengths. There is the danger that if the smear layer is thick, the 6"! may not be ale to penetrate through it. The acidity of the primer may also be buffered by the mineral components of the dentin smear layer ( Ean ( /*me, 1988), thereby reducing the potential for deminerali ation and hybrid layer formation within the subsurface intact dentin. This property, in addition to the tight packing of the smear layer particles to each other, seem to limit the depth of penetration of monomer to about = m. $f the smear layer is *.& m thick, then
(=

Bonding Considerations

the acidic co-monomer mixture may only penetrate '.& m into the underlying intact dentin (Hoshiyama et al, 1996). 6mear layer represents a diffusion barrier, depending on how they have been prepared and their thickness. 5 smooth smear layer, '.& m thick offers much less resistance to diffusion than does a rough smear layer that is = m thick. 8owever, it is also seen that despite the short resin tags, a good seal is achieved as the smear plugs are left intact ( )errari et al, 1997). Cay ( Pashley ('&&1) examined the aggressiveness of three self-etching adhesives systems in penetrating dentin smear layers of different thickness. Teeth with thin and thick smear layers were bonded using one of the following3 Blearfil 1ega Cond (Furaray), 4on-0inse Bonditioner and !rime @ Cond 4T (Dentsply DeTrey) and !rompt :-!op ("6!"). -or 1ega Cond, thin authentic hybrid layers between './-'.& m were found and smear layer and plugs were retained as part of the hybridi ed layer. -or the 40B group the hybrid layers were about *.=-=.= m thick, with the smear layer and plugs completely dissolved in dentin with thin smear layers and partially retained in dentin with thick smear layers. -or !rompt :-!op, hybrid layers were =.&-& m thick and smear layer and plugs were completely dissolved even in dentin with thick smear layers. Thus contemporary self-etching systems may be classified as mild, moderate and aggressive based on their ability to penetrate dentin smear layers and their depth of deminerali ation into the subsurface dentin. The ideal self-etching self-priming bonding system is one that can penetrate = m of smear layer and engage underlying dentin to a depth of about * m. This should provide sufficient retentive strength and an ade?uate seal even if the infiltrated smear layer fails. #hether this ideal can be achieved remains to be determined through clinical experience. 8owever, bond strengths ranging between '& to '8 MPa have been reported with ;self-etching dentin adhesive systems< which are similar to those strengths obtained with phosphoric acid-etching of enamel.

(+

Bonding Considerations

".g.3 Blearfil :iner Cond = (Furaray, Gapan), !rompt :-!op (+1, "6!") i.e.3 ( th generation bonding system, 40B 4on 0inse Bonditioner (Dentsply DeTrey, 2ermany), iCond (,th generation bonding system). Jan Meerbee9 et al (1999) compared the hybridi ation effectiveness of two adhesive systems that are applied in respectively three (9ptiCond Dual-Bure) and two (9ptiCond 6olo) steps. $t was demonstrated that some collapse of the exposed collagen fibril network, due to gentle postconditioning air-drying of the dentin surface, may not have been totally recovered through hybridi ation by the twostep adhesive formulation as opposed to the three-step precursor. The findings suggest that simplifying the application procedure of adhesives by combining the primer and adhesive resin into a single application step may reduce hybridi ation effectiveness. Br*nton et al (1999) found that with the possible exception of excellent color match, Boltene 50T CondHCrilliant restorations may be found to perform favorably in mixed Blass I lesions in selected adult patients over a period of at least three years. The findings indicated that resin composite restorations placed with a smear-layer mediated dentin bonding agent may be found to have a favorable clinical outcome in non-carious cervical lesions. Cole!ano M et al ('&&5) evaluated the effect of the hydration status of the smear layer on the wettability and bond strength of a self-etching primer to dentin. Differences were found between contact angles on completely and briefly airdried smear layer when the primer was used and micro tensile bond strength was greater when the adhesive was applied on the completely air-dried smear layer. +han @M et al ('&&$) compared the microtensile bond strength (microTC6) and the ultrastructure of resin-dentin interfaces of four self-etching systems that were applied to dentin with thick smear layers. -or each adhesive, agitation produced significantly higher microTC6 than passive application. #ith passive application, all systems diffused through thick smear layers and formed thin hybrid layers in intact dentin. #ith continuous agitation, smear layers were
(/

Bonding Considerations

completely dispersed or dissolved, and thicker hybrid layers with upstanding collagen fibrils were produced. +. Dissol*tion o? the smear layer" The dissolved smear layer plays a part in the chemical attachment of the dentin bonding agent to dentin. ".g.3 6cotchbond = (+1)-i.e.3 + rd generation bonding system, 1irage Cond (Bhameleon Dental, Fansas). The +rd generation of bonding agents as coined by Retie? (1987) contained cleansers or mordants for removal or modification of the dentinal smear layer. Een!t et al (199&) evaluated the shear bond strengths of a light-cured composite to dentin treated with one proprietary ('.& 1 "DT5) cleanser and one experimental (*3*polyacrylicHmaleic acid solution) cleansing agent using 2luma (Cayer Dental, 2ermany) bonding adhesive. $t was found that bond strengths with the experimental cleanser were significantly greater than bond strengths of teeth cleansed with "DT5. /. )iGin the smear layer" 2lutaraldehyde (/o,,enbro*wers, Driessens an! 0ta!ho*!ers, 1975) or tanning agents such as tannic acid or ferric chloride ( Powis et al, 198')A,are the agents used for this approach. The idea was to increase the cross linking of exposed collagen fibers within the smear layer and between it and the matrix of the underlying dentin to improve its cohesion. &. Removal o? the smear layer by etchin with aci! an! re,lacin it with an arti?icial smear layer com,ose! o? a crystalline ,reci,itate" This is one of the most convenient approaches to the problem ( +a*ston an! 1ohnson, 198'). Bowen used this approach by treating dentin with &) ferric oxalate (in acidic solution), which replaced the original smear layer with a new complex permitting extremely high bond strengths to be produced between resin and dentin (Bowen ( others, 198'% Bowen ( +obb, 198$ ). 6olutions of ferric oxalate (Tenure, Den1at Borp, 6anta 1aria, B5) dissolved the smeared surface layer yet form insoluble reaction products that apparently occlude the openings of
(&

Bonding Considerations

the dentinal tubules (Bowen, +obb ( Ra,son, 198'A/). These solutions also remove the smeared layer on cut enamel, revealing typical patterns of enamel prisms. #hen the ferric oxalate was followed by treatment with solutions of a specific surface active compound and then a polymeri able coupling agent, strong adhesive bonds with composites are possible on dentin and enamel in vitro (Bowen et al, 198'). 4reenhill an! Pashley (1981) have produced similar artificial smear layer with a variety of chemicals as a method of desensiti ing hypersensitive radicular dentin. $t must be remembered that, in general, diamonds, through the introduction of grooved anomalies produce a greater surface area than burs. This has implications in bonding where differences in the bond strength of resin attached to enamel have already been reported to be higher for diamonds compared to burs (-9er, -9er ( 0orensen, 1979). The increased surface area probably offered a larger number of reaction or retentive sites. These sites in enamel are primarily micromechanical and the retention mechanism for this tissue lies in the multitude of superficial micropores enhanced following acid conditioning of the tissue. 6everal st*!ies have been carried out which either support removal or retention of the smear layer for improvement in bonding3 RBM8J-# 8) 0MB-R #-HBR D0 BBCCBR )8R B83DD34 was demonstrated by 3a9abayashi (199$) who determined the long-term durability of photocured phenyl-! in T"2D15 to smear layer retained bovine dentin. 8e found that long-term water-immersion weakened the bonds between the adhesive resin and the smear layer-retained dentin because there was insufficient diffusion of the adhesive resin through the retained smear layer. Davis et al (199') compared the effect on bond strength of smear layer removal (/') polyacrylic acid or *') phosphoric acid) versus smear layer conditioning for dentin bonding agents re?uiring conditioning. 0esults indicated no difference in shear bond strength for groups in which the smear layer was conditioned or removed with phosphoric acid. 6mear layer removal with polyacrylic acid resulted in lower
((

Bonding Considerations

bond strengths between DC5s and dentin than either phosphoric acid removal or conditioning. 0antini ( Mitchell (1998) investigated the effect of conditioners (2luma B!6 etchant and =') phosphoric acid li?uid) on smear layers produce by different bur types and speeds and the interaction of applied primer (2luma B!6) with these surfaces. $t was found that 2luma B!6 conditioner did not completely remove the smear layer but a one of deminerali ation did occur beneath it which was only partly filled with the primer. 6mear layers were completely removed by the =') phosphoric acid to expose a delicate collagen network. Thus, with the 2luma B!6 system, partially filled deminerali ation ones may contribute to microleakage and bond failure. +hen K ( D*an / (1998) determined whether removing of smear layer and using of self-cured adhesive can increase retentive strength of amalgam restoration. 0emoving smear layer had little effect on retentive force of amalgam, while removing smear layer and applying self-cured adhesive improved the retentive strength of amalgam fillings significantly. They also (1997) evaluated the effect of removing smear layer and applying adhesive on the marginal adaptation of amalgam fillings to cavity walls. 0esults indicated that removing smear layer and using adhesive resin significantly improved the adaptation of amalgam to cavity walls. -b!alla ('&&&) evaluated the micromorphological interface between dentin and several hybrid ionomer restoratives with and without smear-layer removal. The three poly-acid-modified composite resins showed the formation of hybrid layers and resin tags at the interface to the dentin. 0emoval of the smear layer significantly improves hybridi ation of these materials. 5lso, among the resinmodified glass ionomers, -u%i $$ :B produced a hybrid layer while the !hotac--il showed no evidence of hybridi ation. +haves P et al ('&&') evaluated the tensile bond strength of two self-etching adhesive systems and one one-bottle system applied on dentin surfaces after different smear layer treatments, i.e.3 direct application over smear layer (no
(,

Bonding Considerations

treatment), sandblasting for *' s, etching with +() phosphoric acid for *& s, or conditioning with '.& 1 "DT5 for = min. 1ean bond strength for !rime @ Cond was significantly higher than self-etching systems. 4o significant differences were observed among smear layer treatments within the same dentin adhesive. Ba h!a!i ('&&$) determined the shear bond strengths (6C6) of 4on-0inse Bonditioner (40B) combined with !rime @ Cond 4T (!C4T) and 6C6 of conventional !hosphoric acid (!5) etching and bonding application to permanent and primary dentin. 8e found that 6C6 were remarkably greater in the groups etched with !5 in comparison with those conditioned with 40B. C/B RBCB3CD83 8) C/B 0MB-R #-HBR during dentin bonding procedures is supported by the following studies3 Dshio9a ( +a,*to (1989) studied the interaction between dentinal smear layer removal with various agents, a dentinal adhesive, and the shear bond strength of a posterior composite resin to dentin. The use of 6cotchbond dentinal adhesive in con%unction with the composite !-+', with the smear layer intact, produced the highest shear bond strengths. 0emoval of the smear layer produced bond strengths similar to those obtained with the smear layer intact. 5pplication of ferric oxalate, and to a lesser degree *,) "DT5, resulted in diminished bond strengths. $t was concluded that optimal bond strengths with the adhesive-composite resin systems tested may be obtained with an intact smear layer. Ehite et al (1989) examined the effect of smear layer removal on the bond strengths of a glass-ionomer cement and three representative dentin bonding agents. -or all but one dentin bonding agent (2luma), treatment with *,) "DT5 caused a reduction in bond strength. #hile 2luma probably bonds via dentinal collagen, the other materials interact primarily with dentinal calcium. 0emoval of smear layer for adhesives reliant on the presence of calcium is therefore undesirable. /aya9awa et al (1996) measured the adhesion of composite to dentin retaining the smear layer. The a?ueous bonding agent tested was capable of penetrating the smear layer and the bond strength exceeded the values obtained by bonding agents that remove the smear layer. @on*ma.M (1996) found that the bond strength of dental cements using three surface conditioners was not stronger than that of no treatment.
(A

Bonding Considerations

Cay et al ('&&&) evaluated the effect of absence and presence of smear layer on bonds made to dentin using a self-etching primer system, Blearfil 6" Cond. 6" Cond produced high bond strengths to both smear layer-free and smear layercovered dentin. $t was found that self-etching primers create thin hybrid layers that incorporate the smear layer and that formation of true hybrid layers occurs irrespective of smear layer thickness. $n another study Cay et al ('&&&) determined the depth of deminerali ation into intact dentin using several selfetching primer systems with different p8 values and whether hybridi ation by Blearfil 6" Cond may be affected by variation in the thickness of the smear layer. 5ll three systems etched beyond the smear layer to from true hybrid layers with the thickest (*.=-*./ m) one occurring with Blearfil :iner Cond $$ and thin layers ('.& m) formed by Blearfil :iner Cond =I and Blearfil 6" Cond. 5pplication of 6" Cond to dentin of different surface roughness produced hybridi ed smear layers of variable thickness. 8owever, the thickness of the underlying true hybrid remained consistent for the / groups ('./ -'.& m). Thus, the suspicion that thick smear layers may interfere with the diffusion of self-etching primers into the underlying intact dentin was not confirmed. Cani ( )in er ('&&') investigated the effect of dentin smear-layer thickness on the bond strength of three all-in-one adhesives of different acidity. 6mear layer thickness (6:T) increased with decreasing 6iB grit numbers and increasing diamond bur roughness. $n spite of the widely differing acidity, all three adhesives tested were e?ually effective over the range of 6:T from =.( micron through '.7 micron. 6hear bond strengths for the individual adhesives did not differ significantly by 6iB grit si e. @oib*chi et al ('&&1) investigated the effect of smear layers on the tensile bond strength (TC6) to dentin. 6ignificantly different TC6 of approx. *' 1!a and =A 1!a were found for J*A' and J('' abrasive paper prepared dentin respectively. The former specimens fractured within the hybridi ed relatively coarse smear layer, while the latter demonstrate adhesive failure between the composite and the attached !115 rod, not between dentin and applied adhesive agent. Thus, the presence and ?uality of smear layer yields significantly different
(7

Bonding Considerations

bond strengths and a TC6 of approx. *' 1!a is evidently ade?uate. 8liveira et al ('&&$) determined the effect of dentinal smear layers created by various abrasives on the adhesion of a self-etching primer (6") and total-etch (6C) bonding systems. $t was found that overall, the shear bond strength (6C6) was lower when 6C was used than when 6" was used. 8owever, 6C6 decreased with increasing coarseness of the abrasive (which caused an increase in thickness of the smear layer) in the 6" group. The higher 6C6 and thin smear layer of the carbide bur group, suggests its use when self-etching materials are used in vivo.

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