Adhesive dentistry

Dr/ Rasha
prevention of leakage, reducing risk of
pulpal damage
Allows more conservative tooth
preparations
Bonded restorations strengthen tooth
tissue.
 Compositon of Enamel and Dentin by
Weight and Volume
100 95
90 86
80 70
70
60 50 Inorganic
50 Organic
40 Water
30 2525
18
20 12 12
10 4 1 2
0
Enamel Dentin Enamel Dentin
Wt % Wt % Vol % Vol %
The basic structural unit of
enamel is the hydroxyapatite
crystal. The hydroxyapatite
crystals can be very long
indeed in comparison to their
width, behaving rather like the
fibres in a rope; this, in
conjunction with the
complexity of the prism shape
and course, leads to an
extremely tough and hard-
wearing biomaterial
The major structural unit of dentine is the
dentine tubule, running from the enamel
dentine junction to the pulp. This 12 m
diameter tubule conveys pulpal fluid from
the pulp to the enamel, so maintaining the
hydration of the tooth and other
physiological functions .
Cutting these hard tissues produces a new
structure called the smeared layer (<20 m
thick) on both the enamel and dentine.
 Requirements for adhesion

1-Good substrate wetting,

a low contact angle, and

a clean substrate are normally considered
essential.
2-The surface tension of the liquid bonding agent
must always be less than the surface energy of the
enamel or dentine.
Co n t ac t A n g le

> 90o < 90o

Su b s t r at e
Currently, the etching times with
phosphoric acid vary between 1530 seconds
depending
on the state of the tooth. As an example, a
tooth with fluorotic enamel would be etched
for the longer period.
 it is a living, wet tissue
and contains less
mineralized tissue than
enamel.
Drying causes the fragile, exposed collagen
network to collapse and the resin cannot
penetrate this collapsed structure.
The main problem of dentine bonding is that
a hydrophobic resin composite is required to
stick to a watery substrate.
 Three-step or Conventional systems
This group represents those materials that have
separate etching, priming and adhesive steps. It just so
happens that this group of materials is also the oldest.
However, they are still widely used and have been
shown to provide reliable bonding.
The greatest problem with this group would seem to
be that three distinct steps are needed, which gives
rise to possible problems through contamination of
the bonded surface prior to placement of the resin
composite filling material; in other words, they are
more technique sensitive
 Two-step systems
This group has two subgroups; the first includes:
those systems that have a separate etch and
have combined the priming and bonding steps.
These systems are often referred to as Single-
bottle systems.
In general, the problems experienced with the
Conventional Systems still exist with the Single-
bottle systems. Although one step has been
eliminated, the great problem is ensuring good
infiltration of the priming-bond into the
demineralized dentine.
 The other subgroup combines the etching and priming
steps together and are referred to as Self-etching primers.
These systems also have not been without their problems.
The major concern has been their ability to etch the
enamel to a great enough extent to ensure a good seal.
This seems to be overcome now.
The problem of technique sensitivity also seems to have
been significantly reduced with these systems compared
with the Conventional and Single-bottle systems.
This is attributed to the fact that the self-etching priming
agent does not have to be washed off the dentine,
therefore eliminating the need to maintain the dentine in a
moist state.
 One-bottle or All-in-one systems
This fourth group is the simplest of all the DBAs.
They combine all steps into one process. Their
mode of demineralization is identical to that of
the self-etching priming materials, but the
bonding resin is also incorporated. These systems
also have the problem of not etching the enamel
as effectively as phosphoric acid. In addition
these systems are the newest and have no long-
term clinical data to demonstrate their
effectiveness, although early studies are showing
some variability in the success of these materials
 Because of the ant cariogenic quality, glass
ionomer may be the material of choice for
restoring root-surface caries in patients with
high caries activity and where esthetics is not
as critical .
 LIGHT-CURED SELF-CURED

Extended working time Limited

improved physical Poor qualities
properties and esthetic
qualities. Sensitive to moisture and
more resistant to dehydration
dehydration and
cracking during setting are not usually
recommended for use in
may be used in some areas of significant
esthetically demanding esthetic concern
areas.

 deeply excavated areas (within 0.5 mm of the
pulp) may need protection with a calcium
hydroxide liner.
Most conventional glass ionomer systems require
etching the dentinal surfaces to remove the smear
layer, thereby effecting improved adhesion of the
glass ionomer to the dentin. To etch the dentin, a
mild acid such as 10% polyacrylic acid is placed
in the preparation for pproximately 20 seconds,
followed by rinsing and removal of excess water,
leaving the dentin moist.
 mixing a powder and liquid within 30 seconds
to optimize powder incorporation (higher
powder/liquid ratio). Encapsulated versions
for triturator mixing are available also.
Self-cured glass-ionomer material should be
placed into the preparation in slight excess
and quickly shaped with a composite
instrument
 If a conventional type of glass ionomer is
used, place a thin coat of light-cured resin
bonding agent on the surface immediately
after placement to prevent dehydration and
cracking of the restoration during the initial
setting
 If a resin modified, light-cured glass ionomer
is used, cure for a minimum time of 40
seconds.
Conventional versions of glass ionomers
ideally require a polymerization period of 24
hours before final contouring and finishing.
However, most resin-modified light-cured
glass ionomers available can be contoured
and finished immediately after light-curing.