OPERATIVE DENTISTRY

DENTAL ADHESION

Terminology: Adhesion is a process of solid and/or liquid interaction of one

material (adhesive or adherent) with another (adherend) at a single interface.

Adhesion as "the state in which two surfaces are held together by interfacial

forces which may consist of interlocking forces. An adhesive is a material,

frequently a viscous fluid, that joins two substrates together and solidifies, and

therefore is able to transfer a load from one surface to the other.

Dental adhesion also are called dental bonding. Most situations involving

dental adhesion really involve adhesive joints.

Almost every case of dental adhesion is based primarily on mechanical

bonding. Chemical bonding may occur as well, but generally makes a limited

contribution to the overall bond strength.

Chemical bonding involves bonds between atoms formed across the interface

from the adhesive to the adherend . .

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Development of dentin bonding systems

‫الموضوع لالطالع فقط‬

First generation dentin adhesives.

These products ignored the smear layer. The development of the surface active

comonomer NPG-GMA41 was the basis for Cervident, which is considered a

first generation dentin bonding system. Theoretically, this comonomer could

chelate with calcium on the tooth surface to generate water-resistant chemical

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bonds of resin to dentinal calcium. However, the in vitro dentin bond strengths

of this material were in the range of only 2 to 3 MPa.

Likewise, the in vivo results were discouraging; Cervident had very poor

clinical results when used to restore cervical erosion lesions without

mechanical retention.

It appears that no ionic bonding actually develops between NPG-GMA and

hydroxyapatite.

Second-generation dentin adhesives.

In 1978, the clearfil bond system F was introduced in Japan. Generally

recognized as the first product of the second generation of dentin adhesives. It

was a phosphate-ester material (phenyl-P and HEMA in ethanol). Its

mechanism of action was based on the polar interaction between negatively

charged phosphate groups in the resin and the positively charged calcium in

the smear layer was the weakest link in the system because of its relatively

loose attachment to the dentin surface.

In addition to the problems caused by the loosely attached smear layer , these

resins could not reach the superficial dentin to establish ionic bonding or resin

extensions into the dentinal tubules.

The in vitro performance of second-generation adhesives after six months was

unacceptable.

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The in vitro performance of second-generation adhesives after two years was

clinically unacceptable after placement in cervical tooth preparations without

additional retention such as beveling and acid etching.

Third-generation dentin adhesives.

Most of third generation materials were designed not to remove the entire

smear layer, but rather to modify it and allow penetration of acidic monomers

such as Phenyle-P or PENTA. Despite promising laboratory results some of the

bonding mechanisms developed never resulted in satisfactory clinical results.

Treatment of the smear layer with acidic primers was proposed using an

aqueous solution of 2.5% maleic acid , 55% HEMA and a trace of methacrylic

acid (Scotchbond 2). Scotchbond 2 was the first dentin bonding system to

receive provisional and full acceptance from American Dental Association

(ADA) in 1987. With this type of smear layer treatment, manufacturers

effectively combined the dentin etching philosophy advocated in Japan with

the more cautious approach advocated in Europe and United States. The result

was preservation of a modified smear layer with slight demineralization of the

underlying intertubular dentin surface. Clinical results were mixed with some

reports of good performance and some reports of poor performance.

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Fourth-generation dentin adhesives.

Although the smear layer act as a diffusion barrier that decreases the

permeability of dentin, it can also be considered an obstacle that must be

removed so that resin can be bonded to underlying dentin substrate. Based on

that consideration, fourth-generation dentin adhesives were introduced for

use on acid-etched dentin. Removal of smear layer via acid-etching has led to

significant improvements in the in vitro bond strengths of resins to dentin.

These materials such as All-bond 2,Optibond FL and Scotchbond Multipurpose

are basically composed of * An acid etching gel that is rinsed off:* Asolution of

primers that are reactive hydrophilic monomers in ethanol,aceton and/or

water; and * An unfilled or filled fluid bonding agent. The latter generally

contains hydrophobic monomers such as bisphenol glycidyle methacrylate

(Bis-GMA),frequently combined with hydrophilic molecules such as HEMA.

Application of acid to dentin results in partial or total removal of smear layer

and demineralization of the underlying dentin. Besides demineralizing

intertubular and peritubular dentin, acids open the dentinal tubules and

expose a dense filigree of collagen fibers , thus increasing the microporosity of

the intertubular dentin. When primer and bonding resins are applied to

etched dentin they penetrate the intertubular dentin forming a resin-dentin

interdiffusion zone or hybrid layer. They also penetrate and polymerize in the

open dentinal tubules forming resin tags.

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Fifth-generation dentin adhesives.

The development of dentin bonding systems is continuing at a rapid pace. In

vitro dentin bond strengths have improved.Therefore many current

developments are directed at simplification of the bonding procedure.

Nearly all dental materials manufacturers now have "one-bottle" adhesive

system available on the market.

These combine the primer and bonding agent steps, but a separate etching step

is still needed for the majority of adhesive systems.

When a commercially available adhesive proves to be satisfactory under in

vitro conditions but takes several time-consuming steps to be applied in vivo,

the clinician usually prefers a material that would be easier to apply.

Manufacturers have been attempting to reduce the number of steps needed

and the corresponding application time, making more user-friendly adhesive

systems.

Current Strategies. In fact, the resin-based adhesive systems developed to

date can be categorized as one of two types:

etch-and-rinse (total-etch) adhesive systems, available as three-step and two-

step systems and “self-etch” adhesive systems, available as two-step and one-

step systems .

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*Total-Etch Dentin Adhesive Systems.

etch-and-rinse (total-etch) adhesive systems, available as three-step and two-

step systems.

*Typically, etch-and-rinse adhesives produce high and substantive adhesion

values for both enamel and dentin.

*Total etch materials use 30 to 40 % phosphoric acid to etch dentin and

enamel before the clinician applies the adhesive to the preparation. Etching

dentin removes the smear layer and opens up the dentinal tubules .

In comparison, self-etch adhesives generally demonstrate better adhesion to

dentin than to enamel. These are key considerations for anterior restorations. If

the surface to which the adhesive will be applied consists of significantly more

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enamel than dentin and particularly if a minimally prepared adhesive bridge

an etch-and-rinse system is preferred. There is proven long-term bond

stability using etch and- rinse systems with both enamel and dentin. Some

studies have shown bonding to enamel is more consistent, with higher initial

bond-strength values and less breakdown at the enamel margin over time

than with self-etching adhesive systems.

 Self-etching Adhesives

*Self-etch adhesives are available as one-step systems and two-step systems.

They offer an advantages over etch and-rinse systems: they do not require a

separate etching procedure. Thus there is no need to rinse and then dry the

preparation prior to application of the adhesive.

*In addition, these systems are more tolerant of the presence of moisture on the

preparation. Finally, the etching process proceeds in conjunction with the

penetration of the adhesive, thus eliminating the potential for over-etching

when treating dentin .

*Since self-etch adhesive systems demineralize and penetrate the dentin at the

same time, there is no concern over incomplete penetration and residual gaps

within demineralized dentin. *The recently introduced one-step self-etch (all-

in one) adhesives contain two liquids which are applied to tooth substrates

after mixing .

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*The main disadvantage of self-etch adhesive systems is that the enamel must

be instrumented to provide an effective etch. Self-etch adhesives typically do

not provide as high an enamel bond compared to etch-and-rinse adhesives.

DENTIN ADHESION

The classic concepts of operative dentistry have been challenged in the last two

decades by the introduction of new adhesive techniques, first for enamel and

then for dentin. Nevertheless, adhesion to dentin still remains difficult.

Adhesive materials can interact with dentin in different ways-mechanically,

chemically, or both .

chemical bonding involves bond between atoms formed across the interface

from the adhesive to the adherend. the bonding system copolymerizes with the

matrix phase of composite producing strong chemical bonding.

Mechanical bonding is the result of an interface that involves undercuts and

other irregularities that produce interlocking of the materials.

The common method for producing surface roughness for better mechanical

bonding is to grind or etch the surface. Grinding produce gross mechanical

roughness but leaves a smear layer, so whenever tooth structure is prepared

with bur or other instrument residual organic and inorganic components form

a smear layer of debris on the surface. The smear layer fills the orifices of

dentinal tubules (forming smear plugs and decreases dentin permeability by

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up to 86%). The composition of smear layer is basically hydroxyapatite and

altered denatured collagen that is approximately 1 to 3 um thickness.

Acid etching or conditioning dissolves the smear layer and produces

microscopic relief with undercuts on the surface to create an opportunity for

mechanical bonding.

If the mechanical roughness produces a microscopically interlocked adhesive

and adherend with dimensions of less than approximately 10 um then the

situation is described as micromechanical bonding or micromechanical

retention.

An etching time of 15-30 seconds was originally recommended for permanent

enamel using 30% to 40% phosphoric acid.

Enamel bonding system

Acid etching transforming the smooth enamel into an irregular surface. When

the fluid resin-based material is applied to irregular etched surface , the resin

penetrates into the surface . monomers in the material polymerize and the

material becomes interlocked with the enamel surface forming resin tags that

are responsible for enamel bonding.

Resin tags that formed between enamel rod peripheries are called macrotags.

A much finer network of thousands of smaller tags form across the ends of

each rod where individual hydroxyapatite crystals have been dissolved leaving

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crypts outlined by residual organic material these fine tags are called

microtags.

Microtags and macrotags are the basis for enamel micromechanical bonding

Microtags are probably more important because of their large number and

great surface area of contact.

Factors affecting bond to dentin:

The following factors decrease the bond strength to dentin;

1.Dentin contains less mineralized tooth structure and more water than does

enamel.

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2.The presence of the smear layer makes wetting of dentin by the adhesive

more difficult ;even when good wetting does occur polymerization shrinkage

can pull the smear layer away from dentin and produce microgap.

3.Fluid in dentinal tubules reduces the stability of composite resin to

dentin bond.

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