Operative Dentistry

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Lecture (7)

Enamel and Dentin Bonding (Agents and Techniques)

Definition
The bonding agents (dental adhesives) are resinous materials used to
enable the restorative material to bond and adhere to dental tooth structures
(enamel and dentin).
Requirements of Dentin Bonding Agents
1. Provide high bond strength to enamel.
2. Provide bond strength to dentin similar to that to enamel.
3. Show good biocompatibility to dental tissue, including the pulp.
4. Minimize microleakage at the margins of restorations.
5. Prevent recurrent caries and marginal staining.
6. Be easy to use.
7. Possess a good shelf life.
8. Be compatible with a wide range of resins.
Indications
1. To aids in bonding composite and even amalgam restorations to tooth
structure.
2. To treat dentinal hypersensitivity.
3. For the repair of fractured porcelain, amalgam and resin restorations.
4. For pit and fissure sealants.
5. To lute crowns.
6. To bond orthodontic brackets.

Enamel Bonding
Bonding to enamel requires two clinical steps; 1) Acid etching, followed by
2) The application of the adhesive resin to the etched surface.
Usually 37% phosphoric acid is used for 15 to 30 seconds.

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 The goals of enamel etching are 1) to clean enamel surface from debris,
2) to increase the enamel surface area available for bonding, and 3) to
partially dissolve the mineral crystallites to create retentive microporosities
into which the resinous bonding agent can infiltrate and form retentive resin
tags (micromechanical retention). 4) In addition, acid etching increases the
surface energy and lowers the contact angle of resins to enamel.
It has been shown that optimal enamel–resin bonds could be achieved as
long as the etched enamel surface was clean and free from any
contamination.
• If phosphoric acid concentration is greater than 50%, then monocalcium
phosphate monohydrate will get precipitated.
• If concentration is lower than 30%, dicalcium phosphate monohydrate is
precipitated which interferes with adhesion.
• Deciduous teeth require longer time for etching than permanent teeth
because of the presence of aprismatic enamel in deciduous teeth.

Procedure
Apply acid etchant in the form of liquid or gel for 15 to 30 seconds.
• Wash the etchant continuously with water for 10 to 15 seconds.
• Note the appearance of a properly etched surface. It should give a frosty
white appearance on drying.
• If any sort of contamination occurs, repeat the procedure.
• Now apply bonding agent and low viscosity monomers over the etched
enamel surface. Generally, enamel bonding agents contain Bis-GMA or
UDMA with TEGDMA added to lower the viscosity of the bonding agent.
The bonding agents due to their low viscosity, rapidly wet and penetrate the
clean, dried, conditioned enamel into the microspaces forming resin tags.
The resin tags which form between enamel prisms are known as Macrotags
• Finer network of numerous small tags is formed across the end of each
rod where individual hydroxyapatite crystals were dissolved and are known
as microtags. These microtags are more important due to their larger number
and greater surface area of contact.
Micro and macrotags within the enamel surface constitute the fundamental
mechanism of enamel-resin adhesion.

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 Enamel Etching and Bonding

Dentin Bonding
Bonding to dentin has been proven more difficult and less reliable and
predictable than enamel. This is because of morphologic, histologic and
compositional differences between them.

Problems Encountered During Dentin Bonding

1. Dentin contains more water than does enamel.
2. Hydroxyapatite crystals have a regular pattern in enamel whereas in
dentin, hydroxyapatite crystals are randomly arranged in an organic
matrix.
3. Presence of smear layer makes wetting of the dentin by the adhesive
more difficult.
4. Dentin contains dentinal tubules which contain vital processes of the
pulp, odontoblasts. This makes the dentin a sensitive structure.
5. Dentin is a dynamic tissue which shows changes due to aging, caries or
operative procedures.
6. Fluid present in dentinal tubules constantly flows outwards which
reduces the adhesion of the composite resin.

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 Ideally a dentin bonding agent should have both hydrophilic and
hydrophobic ends. The hydrophilic end displaces the dentinal fluid to wet
the surface. The hydrophobic end bonds to the composite resin.
Bonding to the inorganic part of dentin involves ionic interaction among
the negatively charged group of the bonding agent (for example, phosphates,
amino acids and amino alcohols, or dicarboxylates) and the positively
charged calcium ions.
Commonly used bonding systems employ use of phosphates. Bonding to
the organic part of dentin involves interaction with Amino (–NH), Hydroxyl
(–OH), Carboxylate (–COOH), Amide (–CONH) groups present in dentinal
collagen. Dentin bonding agents have isocyanates, aldehydes, carboxylic
acid anhydrides and carboxylic acid chlorides which extract hydrogen from
the above mentioned groups and bond chemically.

Classification of Dentin Bonding Agents

Historically, dentin bonding agents have been classified based on
chemistry and the manner in which they treat the smear layer into 7
generations.
The first three generations failed to provide adequate bond strength to
dentin.

Fourth Generation Dentin Bonding Agents

They were made available in the mid 1990s. Fourth generation bonding
agents represented significant improvements in the field of adhesive
dentistry. These agents are based on total etch technique (now it is called
etch and rinse technique) and moist bonding concept.
Mechanism of Bonding
Fourth “generation” is characterized by the process of hybridization at
the interface of the dentin and the composite resin. Hybridization is the
phenomenon of replacement of the hydroxyapatite and water at the dentin
surface by resin. This resin, in combination with the collagen fibers, forms a
hybrid layer. In other words, hybridization is the process of resin
interlocking in the demineralized dentin surface. This concept was given by
Nakabayashi in 1982.

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Components of Fourth Generation Adhesives
1. Conditioner (Etchant): Commonly used acids are 37% phosphoric acid,
nitric acid, maleic acid, oxalic acid, pyruvic acid, hydrochloric acid, citric
acid or a chelating agent, e.g. EDTA.
Use of conditioner/etchant causes removal or modification of the smear
layer, demineralizes peritubular and intertubular dentin and exposes collagen
fibrils.
2. Primer: Primers consist of monomers like HEMA (2-Hydroxyethyl
methacrylate) and 4-META (4-Methacryloxyethyl trimellitate anhydride)
dissolved in acetone or ethanol. Thus, they have both hydrophilic as well as
hydrophobic ends which have affinity for the exposed collagen and resin
respectively. Use of primer increases wettability of the dentin surface,
bonding between the dentin and resin, and encourages monomer infiltration
of demineralized peritubular and intertubular dentin.
3. Adhesive: The adhesive resin is a low viscosity, filled or unfilled resin
which flows easily and matches the composite resin. Adhesive combines
with the monomers to form a resin reinforced hybrid layer and resin tags to
seal the dentin tubules.

Etching of dentin results in removal of smear layer and minerals from dentin
structure, exposing the collagen fibers. Areas from where minerals are
removed are filled with water. This water acts as a plasticizer for collagen,
keeping them in an expanded soft state. Thus, spaces for resin infiltration are
also preserved.
If the dentin surface is made too dry, there will be collapse of the collagen
fibers of demineralized dentin. This results in low bond strength because of
ineffective penetration of the adhesive into the dentin.

Primers are used to increase the diffusion of resin into moist and
demineralized dentin and thus optimal micromechanical bonding. For
optimal penetration of primer into demineralized dentin, it should be applied
in multiple coats.

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Total etch technique involves the complete removal of the smear layer by
simultaneous acid etching of enamel and dentin. After total etching, primer
and adhesive resin are applied separately or together.

A B

C D

Dentin Etching. A: prepared cavity showing smear layer SL, B: acid

etching, C: demineralized dentin, D: exposed collagen fibrils.

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Dentin bonding with 4th generation dentin bonding agents (etch and rinse technique)

Advantages
• Ability to form a strong bond to both enamel and dentin.
• High bond strength to dentin (17–25 MPa)
• Ability to bond strongly to moist dentin
• Can also be used for bonding to substrates such as porcelain and alloys
(including amalgam).
Disadvantages
• Time consuming
• More number of steps
• Technique sensitive

Fifth Generation Dentin Bonding Agents

Fifth-generation DBAs were made available in the mid-1990s. Similar to the
fourth generation, they are based on the total etch technique (a separate step
of acid etching is needed). They are also known as “one-bottle” or “one-
component” bonding agents. In these agents the primer and adhesive resin
are in one bottle. Basic differences between fourth and fifth generation is the
number of basic components of bottles.
Fourth generation bonding system is available in two bottles, one primer and
other adhesive, fifth generation dentin bonding agents are available in one
bottle only.

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Sixth Generation Dentin Bonding Agents
These were made available in 2000. In fifth-generation, primer and adhesive
are available in single bottle, and etchant in separate bottle. In sixth
generation etching step is eliminated, because in sixth generation etchant,
primer and bonding are available in single solution.
Most self-etching primers are moderately acidic with a pH that ranges
between 1.8 and 2.5. Because of the presence of an acidic primer, sixth
generation bonding agents do not have a long shelf-life and thus have to be
refreshed frequently.
In these agents as soon as the decalcification process starts, infiltration of the
empty spaces by the dentin bonding agent is initiated
Advantages
• Reduces postoperative sensitivity because they etch and prime
simultaneously.
• It etches the dentin less aggressively than total etch products.
• Demineralized dentin is infiltrated by resin during the etching process.
• Since they do not remove the smear layer, the tubules remain sealed,
resulting in less sensitivity.
• They form a relatively thinner hybrid layer than traditional product, which
results in complete infiltration of the demineralized dentin by the resin
monomers.
• Much faster and simpler technique.
• Less technique sensitive as fewe number of steps are involved for the self-
etch system.

Seventh Generation Dentin Bonding Agents

They achieve the same objective as the sixth generation systems except that
they simplified multiple sixth generation materials into a single component,
single bottle one-step self-etch adhesive, thus minimizing the number of
steps and avoiding any mistakes that could be encountered (the bottle
contains all the components which are the weak acid, primer, and the
adhesive).