ETCHING

AND
BONDING

drg. L. Cinthia H, Sp. Ort

 BONDING
BINDING TWO ADJOINING MATERALS AND PROVIDING
RESISTANCE TO THEIR SEPARATION
harus bisa menyediakan kekuatan tekan yang cukup /
EXAMPLE : maksimal. jadi satu sama lain tidak mudah lepas. L

- DENTAL HARD TISSUES, METAL, COMPOSITE, CERAMIC

ADHESION
A MOLECULAR OR ATOMIC ATTRACTION BETWEEN TWO
CONTRACTING SURFACES PROMOTED BY THE INTERFACIAL
FORCE OF ATTRACTION BETWEEN TWO MOLECULES OR
ATOMS OF TWO DIFFERENT SPECIES daya tarik menarik dua molekul dari dua
material yang berbeda
BONDING
AND
ADHESION
COMPLEX SET OF
PHYSICAL,
CHEMICAL AND
MECHANICAL

ATTACHMENT
AND BINDING OF
ONE SUBTANCES
TO ANOTHER
 BONDING

CHEMICAL MECHANICAL

PRIMARY SECONDARY MACROTAGS MICROTAGS

etching trmsuk mechanical

1. IONIC BOND 1. HYDROGEN

2. COVALENT BOND
BOND 2. VAN DER
3. METALLIC WALLS
BOND FORCES
 THREE ESSENTIAL FUNCTIONS
OF DENTAL BONDING SYSTEM

1. PROVIDES 2. DISTRIBUTES 3. SEALS THE

RESISTANCE OF AN INTERFACE VIA
ADHEREND STRESS ALONG ADHESIVE BONDING
SUBSTRATE ( ENAMEL, BONDED INTERFACES BETWEEN DENTIN
DENTIN, METAL, mendistribusikan
AND/OR ENAMEL AND
tekanan kunyah, jika
COMPOSITE AND tidak bsa gigi akan THE BONDED
pecah.
CERAMIC ) FROM A MATERIAL
RESTORATIVE OR RESISTANCE TO
CEMENTING MICROLEAKAGE AND
MATERIAL tidak ada kebocoran
RISK FOR
tepi
POSTOPERATIVE
menyediakan suatu
perlekatandari bahan
SENSITIVITY,
restoratif atau bahan
semen
MARGINAL STAINING
AND SECONDARY
CARIES
MAJOR TURNING POINTS
IN
DENTAL TECHNOLOGIES
 ACID ETCHING

CLEAN, HIGH-ENERGY, ROUGHENED

ENAMEL SURFACE

ESTABLISHING A DURABLE
MICROMECHANICAL RETENTIVE

CURRENT ERA OF ADHESIVE

DENTISTRY
 APPLICATION FOR BONDING
ACID ETCHING RESIN-BASED RESTORATIVE
MATERIALS

PROVIDED STRONG, DURABLE

BOND BETWEEN RESIN AND
TOOTH

1. BRACKET BONDING
2. PORCELAIN LAMINATE VENEER BONDING
3. PIT AND FISSURE SEALANT
4. AMALGAM BONDING
5. ENAMEL AND DENTIN BONDING
6. ADHESIVE CEMENT ( GIC AND ENDODONTIC SEALERS )
 MECHANISMS OF ADHESION

EXCHANGE INORGANIC TOOTH

SYNTHETIC RESIN
MATERIAL ( HYDROXYAPATITE )

THIS PROCESS INVOLVES 2 PARTS :

1. REMOVING HYDROXYAPATITE TO CREATE MICROPORES
2. INFILTRATION OF RESIN MONOMER INTO THE MICROPORES
AND SUBSEQUENT POLYMERIZATION

RESIN TAGS
 TRUE ADHESION
1. SOUND TOOTH
STRUCTURE MUST BE
CONSERVED

3 CONDITION
2. OPTIMAL RETENTION
MUST BE
MUST BE ACHIEVED
SATISFIED
3. MICROLEAKAGE MUST
BE PREVENTED
 FACTORS CAN PLAY MAJOR AND MINOR
ROLES IN ACHIEVING ADHESIVE BONDS

1. SURFACE ENERGY AND WETTING

2. INTERPENETRATION ( FORMATION OF HYBRID ZONE )
3. MICROMECHANICAL INTERLOCKING
4. CHEMICAL BONDING
5. HYDROLYTIC STABILITY
 WETTING

1. MOSTLY NONWETTING ( > 90O )

2. ABSOLUTELY NO WETTING ( 180O )
3. MOSTLY WETTING ( < 90O )
4. ABSOLUTE WETTING ( 0O )
 SURFACE ENERGY OF THE
SUBSTRATE ( DENTIN,
WETTABILITY ENAMEL, SYNTHETIC
MATERIALS )

ACID ETCH
TECHNIQUE

CLEAN,
MICROROUGHNED TOOTH
SURFACE
 SMEAR LAYER
A LAYER OF ADHERENT GRINDING DEBRIS AND ORGANIC FILM
THAT LEFT ON TOOTH SURFACE AND PREVENT
STRONG BONDING

BURNISHED INTO THE UNDERLYING DENTINAL TUBULES

AND LOWERS DENTIN PERMEABILITY

LOW COHESIVE STRENGTH

 ACID ETCH TECHNIQUE

ENAMEL ETCHING DENTIN ETCHING

• MICHAEL BUONOCORE 1955 • FUSUYAMA : TOTAL ETCH CONCEPT,

• ETCH WITH VARIOUS ACID 1979 ( DENTIN & ENAMEL )
• PHOSPORIC ACID IS WIDELY • PHOSPORIC ACID 37 %
USED • NAKABAYASHI et al, 1984 :
• REMOVE SMEAR LAYER, EXPOSE HYDROPHYLIC RESIN CAN
ENAMEL PRISM 10 mcrn INFILTRATE ACID DEMINERALIZED
• HONEY COMB LIKE COLLAGEN FIBERS HYBRID
• RESIN TAGS 6 m IN DIAMETER LAYER
AND 10-20 m IN LENGTH • PRIMING STEP IS REQUIRED TO
MAINTAIN HYDRATED COLLAGEN
SURFACE OF ETCHED ENAMEL ( TYPE I ETCHING )
SCANNING ELECTRON
MICROSCOPY IMAGE
OF TAGS FORMED BY
PENETRATION OF
RESIN INTO ETCHED
AREAS OF ENAMEL
 PROCESS AND PROSEDURAL FACTORS

1. ETCHING TIME

2. RINSING AND DRYING

3. CLEANESS OF THE BONDING SURFACES

4. OTHER FACTORS
 DENTIN BONDING AGENT

• DESIGN TO PROVIDE SUFFICIENTLY STRONG INTERGACE BETWEEN

RESTORATIVE COMPOSITE AND TOOTH STRUCTURE, WITHSTAND
MECHANICAL FORCES AND SHRINKAGE STRESS
• THE SUCCESS OF ADHESIVES IS DEPENDENT ON TWO TYPES OF BONDING :
1. MICROMECHANICAL INTERLOCKING, CHEMICAL BONDING WITH ENAMEL
AND DENTIN
2. COPOLYMERIZATION WITH RESIN MATRIX OF COMPOSITE MATERIALS
• Bis-GMA WITH DILUTING MONOMERS ( TRIETHYLENE GLYKOL
DIMETRACRYLATE ( TEGMA )) TO CONTROL VISCOSITY AND ENHANCE
WETTING IMPROVE MICROMECHANICAL BONDING
 SEVERAL REQUIREMENT FOR SUCCESSFUL
DENTIN BONDING SYSTEM

1. ADEQUATE REMOVAL OR DISSOLUTION OF THE SMEAR LAYER FROM

ENAMEL AND DENTIN
2. MAINTANANCE OR RECONSTRUCTION OF THE DENTIN COLLAGEN
MATRIX
3. GOOD WETTING
4. EFFICIENT MONOMER DIFFUSION AND PENETRATION
5. POLYMERIZATION WITHIN TOOTH STRUCTURE
6. COPOLYMERIZATION WITH THE RESIN COMPOSITE MATRIX
 FACTORS AFFECTING DENTINE BONDING

1. SALIVA / BLOOD
2. MOISTURE AND OIL FROM HANDPIECES
3. FLUORIDE
4. PLAQUE, CALCULUS, EXTRINSIC STAINS OR DEBRIS
5. TOOTH DEHYDRATION
6. PRESENCE OF RESIDUAL TEMPORARY CEMENTS
7. SMEAR LAYER
 COMPOSITION

1. ETCHANT
- RELATIVELY STRONG ACIDS ( PH 1-2 )
- PHOSPORIC ACID 30 % – 50%, TYPICALLY 37 % ( CONSISTENT ETCHING PATTERN
WHILE NOT DAMAGING THE PULP )
2. PRIMERS
- NECESSARY TO MAINTAIN AN EXPANDED COLLAGEN NETWORK
- CONTAINING HYDROPHYLIC ADHESIVE MONOMER DISSOLVED IN ACETONE,
ETHANOL OR WATER
- HEMA ( 2-hydroxylethyl methacrylate ) WIDELY USED PRIMER MONOMER
HIGH HIDROPHILICITY AND SOLVENT LIKE NATURE
- IF PRIMER HAS THE ABILITY TO ETCH AND PRIME SELF ETCHING PRIMER
3. SOLVENT
- WATER, ETHANOL, ACETON
- IMPROVE BOND ADHESION
4. ADHESIVES
- TO FILL INTERFIBRILLAR SPACE OF THE COLLAGEN NETWORK, CREATING A
HYBRID LAYER AND RESIN TAGS
- PREVENT FLUID LEAKAGE ALONG THE RESTORATIVES MARGIN
- GENERALLY, MAINLY COMPOSED :
- HYDROPHOBIC : bis-GMA, TEGDMA AND UDMA
- HYDROPHYLIC MONOMER : HEMA
5. INITIATORS
- PHOTOINITIATOR : PHOTOSENSITIZER ( CAMPORQUINONE ) AND INITIATOR
( TERTIARY AMINE ) LIGHT CURED
- CHEMICAL INITIATOR ( BENZOIL PEROXIDE ) SELF CURED
- OR DUAL CURED
6. FILLER PARTICLES
- NANOMETER-SIZED SILICA TO PRODUCE HIGHER BOND STRENGTH
- THICKER PROMOTE BOND STRENGTH BY PREVENTING OXYGEN
INHIBITION AND REDUCE SHRINKAGE STRESS
7. OTHER INGRIDIENTS
- GLUTARALDEHYDE DESENSITIZER
- MONOMER 12-methacryloyloxydodecylpyridinium bromide AND
PARABENE ANTIMICROBIAL
- FLUORIDE PREVENT SECONDARY CARIES
- BENZALKONIUM CHLORIDE AND CHLORHEXIDINE PREVENT
COLLAGEN DEGRADATION
 ABBREVIATIONS COMMONLY USED FOR RESIN CHEMICALS

• Bis-GMA : Bisphenol glycidyl methacrylate

• HEMA : 2- Hydroxyethyl methacrylate
• TGDMA / TEGDMA : Triethylene glycol dimethacrylate
• 4-META : 4- Methacryloxyethyl trimellitate anhydride
• UDMA : Urethane dimethacrylate
• PMDM : Pyromellitic acid diethylmethacrylate
• NPG-GMA : N-phenylglycine glycidyl methacrylate
• GPDM : Glycerophosphoric acid dimethacrylate
• EDTA : Ethylene diamine tetra acetic acid
 CLASSIFICATION

ETCH AND RINSE SELF ETCHED

ADHESIVES ADHESIVES

1. 4th GENERATION 1. 6th GENERATION

THREE STEP TWO STEP
2. 5th GENERATION 2. 7th GENERATION
TWO STEP ONE STEP
CLASSIFICATION OF DENTAL BONDING SYSTEMS
REPRESENTATIVE PRODUCTS CURRENTLY MARKETED
FOR CLINICAL USE
CLASSIFICATION OF CURRENT ADHESIVE SYSTEM
ACCORDING TO VAN MEERBEEL ET AL 2003
1st GENERATION ADHESIVES ( 1960 )
• DEVELOPMENT OF SURFACE-ACTIVE COMONOMER NPG-GMA
• COMONOMER COULD CHELATE WITH CALCIUM ON THE TOOTH
SURFACE TO GENERATE WATER RESISTANCE CHEMICAL BOND OF RESIN
TO DENTINAL CALCIUM
• BOND STRENGTH 2 – 3 Mpa
• POOR CLINICAL RESULT

2nd GENERATION ADHESIVES ( LATE 1970 )

• PHOSPHATE ESTER DENTIN BONDING AGENTS CONTAINING PHENYL P
AND HEMA IN ETHANOL
• MECHANISM IN ACTION BASED ON POLAR INTERACTION BETWEEN
NEGATIVELY CHANGED PHOSPHAT GROUP IN RESIN AND POSITIVELY
CHANGED Ca++ IN SMEAR LAYER
• BOND STRENGTH 5 – 6 MPa

3rd GENERATION ADHESIVES ( 1980)

• DESINGNED NOT TO REMOVE THE ENTIRE SMEAR LAYER BUT RATHER
THAN MODIFY IT AND ALLOW PENETRATION OF ACIDIC MONOMERS
• INTRODUCED ACID-ETCHING TO REMOVE SMEAR LAYER AND
DEMINERALIZING DENTIN AND SEPARATE PRIMER
• UNFILLED ADHESIVE OR PARTIALLY FILLED RESIN TO INCREASE BOND
STRENGTH
• BOND STRENGTH 3 – 8 MPa
 LUTING AGENT AND RESIN CEMENT

• BOND TO DIFFERENT SUBSTRATES : TOOTH STRUCTURE, RESIN

COMPOSITE, GOLD, METAL ALLOYS, TITANIUM, PORCELAIN AND
CERAMICS
• ETCH AND RINSE ADHESIVE OR SELF ETCH ADHESIVE
• LIGHT CURED, SELF CURED OR DUAL CURED
• NON SELF ADHESIVE RESIN IS BETTER COMPARE WITH SELF ADHESIVE
CEMENT
• MOST RESIN CEMENT SHOW SUPERIOR MECHANICAL PROPERTIES AND
HIGHER BOND STRENGTH OF RESTORATIVE MATERIAL TO TOOTH
STRUCTURE THAN CONVENTIONAL LUTTING AGENT
 ORTHODONTIC BRACKET BONDING SYSTEM

CONTEMPORARY BONDING PROCESS TO ENAMEL INVOLVES THE

FOLLOWING :
1. PROPHYLAXIS OF BONDING SURFACE
2. ETCHING WITH PHOSPORIC ACID GEL OR AQUOUS SOLUTIONS
3. RINSING WITH WATER
4. DRYING WITH AIR
5. APPLICATION OS SEALANT OR PRIMER
6. BONDING OF BRACKETS WITH RESIN CEMENT
7. LIGHT-CURING THE DUAL-CURED OR LIGHT-CURED CEMENT
• SELF ADHESIVE CEMENT ARE NOT RECOMMENDED LOW
BOND STRENGTH
• SEVERAL TYPES OF SURFACE TREATMENT : ETCHING,
ROUGHENING WITH A DIAMOND BUR AND SANDBLASTING
TO CREATE IRREGULARITIES AND INCREASE SURFACE AREA,
PROMOTE BOTH MICROMECHANICAL RETENSION AND
CHEMICAL ADHESION
• CONSIDERING ABOUT “WHITE SPOT” AREA AND DEBONDING
 ROOT CANAL SEALERS

• FILL AND PROMOTE A CLOSE SEAL BETWEEN THE CORE AND DENTINAL WALLS
OF THE CANAL, PREVENTING OR MINIMIZING LEAKAGE, ENTOMBING
RESIDUAL MICROORGANISMS AND POSSIBLY FILLING INACCESSIBLE AREAS OF
THE ROOT CANAL SYSTEM
• LOW VISCOSITY METHACRILATE RESIN BASED SEALERS
• ENDODONTIC SEAL : PENETRATION OF THE HYDROPHILIC SEALER INTO
DENTINAL TUBULES AND LATERAL CANAL FOLLOWING REMOVING OF SMEAR
LAYER
• SELF ETCHING PRIMERS
• LONG, NARROW SPACE : APPLICATION OF SELF ETCH ADHESIVES BECOMES
CHALLENGING AND MIGHT NOT BE UNIFORM THROUGHTOUT THE ENTIRE
INTERFACE
 GLASS IONOMER RESTORATIVES
• CONSIT OF POWDER, ACID SOLUBLE ALUMINOSILICATE GLASS AND AN

AQUEOUS SOLUTION OF POLYACRYLIC ACID OR AN ANALOGOUS POLYACID.

• Ca2+ and Al3+ IONS RELEASED FROM THE POWDER REACT WITH THE

CARBOXYLIC ACID (-COOH ) GROUPS TO FORM DIVALENT SALT AND CURE

THE POLYMERIC ACID.

• CARBOXYLATE GROUP INTERACT STRONGLY WITH Ca2+ IONS IN ENAMEL OR

DENTIN CHEMICAL ADHESION TO TOOTH STRUCTURE

BENEFICIAL IN TERM OF RESISTANCE TO HYDROLYTIC DEGRADATION.

• POLYALKENOIC ACID CAN BE USED TO CLEAN THE TOOTH SURFACE AND

REMOVE SMEAR LAYER.

• EXPOSING COLLAGEN FIBRILS TO A DEPTH OF ABOUL 0.5 – 1

MICRON.

• MICROMECHANICAL BONDING OCCUR BY INTERDIFFUSION

• RESIN MODIFIED GLASS IONOMER ( RMGI ) LIGHT CURED

RAPID POLYMERIZATION.

• FLUORINE RELEASEING CAPABILITY SANDWICH

TECHNIQUE.

• ALTERNATIVES TO AMALGAM RESTORATION CLASS V

• LOW SHEAR BOND STRENGTH ( 3 MPa ) BUT EXCELLENT

RETENTION ( LOW STRESS ON SETTING )

GLASS IONOMER RESTORATION OF ENAMEL
CLASS V LESSION
 AMALGAM BONDING
MODERN CONSERVATIVE
HALLMARK OF TRADITIONAL PHYLOSOPHY FOR IMPROVED
AMALGAM PREPARATION METHODS FOR RETAINING AND
DESIGN SEALING AMALGAM
RESTORATION

AMALGAM RESTORATION
COMBINE WITH A DENTIN
BONDING SYSTEM

REDUCING MICROLEAKAGE
AND INCREASING FRACTURE
RESISTANCE
 SEALANT

• ACHIEVEMENT OF AN IMPERMEABLE BARRIER BETWEEN THE CAVITY

WALL AND THE RESTORATIVE MATERIAL TO PREVENT THE PASSAGE OF
BACTERIA AND DEBRIS
• CYANOACRYLATE, UDMA OR bis-GMA MONOMERS
• UNFILLED OR FILLED RESIN
• CHEMICAL ACTIVATED OR LIGHT ACTIVATED
• SUCCESS OF THE SEALANT TEHNIQUE IS HIGHLY DEPENDENT ON
OBTAINING AND MAINTAINING AN INTIMATE ADAPTATION OF THE
SEALANT TO THE TOOTH SURFACE.
 SCHEMATIC OF TOOTH CROSS-SECTION,
ILLUSTRATING PENETRATING OF SEALANT INTO AN
OCCLUSAL FISSURE