Professional Documents
Culture Documents
FACULTY OF DENTISTRY
OPERATIVE DEPARTMENT
: PREPARED FOR
DR. MOHAMMED ABU HASSIRA
: SUBMITTED BY
TASNEEM SAFI
LAMEES BAROUD
HANEEN AL SMMAK
BASEL AL KRONZ
2017 - 2016
ADHESIVE DENTISTRY
The Past decade has seen increased use of bonding agents in concurrence with
traditional dental materials. The availability of adhesive techniques permits the
placement of aesthetic restorations like composite resins, aesthetic inlays and
veneers, etc. Though a wide range of adhesives is available but there are some
.requirements which a dental adhesive should possess
Following factors have shown to be responsible for boost
:in adhesive dentistry
The development of tooth colored restorative materials 1
The introduction of new composite resins with superior properties .2
.Advances in the development of adhesive systems .3
Increased concern among patients for aesthetics and tooth colored .4
restorations
Indications for Use of Adhesives
.To treat carious and fractured tooth structure
.To restore erosion or abrasion defects .n cervical areas
To correct u.naesthetic contours, positions, dimensions, or shades of teehh .
.To treat dentinal hvpersensitivity
For the repair of fractured porcelain, amalgam and resin restorations .
For pit and rissure sealants .
To bond composite restorations .
To bond silver amalgam restorations
To lute crowns
To bond orthodontic brackets
Advantages of Bonding Techniques
:The following are advantages of bonding systems
.Adhesion of composite resin restorations to enamel and dentin .1
.Minimizes removal of sound tooth structure .2
.Management ot dentin hypersensitivity .3
.Adhesion reduces microleakage at tooth restoration interface .4
.As a part of resin cements for bonding cast restorations .5
.Adhesion expands range of aesthetic possibilities .6
.Bonding ot Porcelain restorations, e.g. porcelain inlays, onlavs and veneers .7
.Reinforces weakened tooth structure .8
.Reduction in marginal staining .9
For repair of porcelain or composite .10
.Bonding amalgam restorations to tooth .11
.Repair of amalgam restorations .12
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Surface Energy
Generally, harder the surface, higher is the surface energy, higher is the
adhpsive property of material. The surface tension of the liquid and the surface
.energy of the adherend, ultimately detemime the degree of wetting that occurs
Surface Contamination
Substrate surface should be clean as the contamination prevents the adhesion
Adhesive should be able to fill the irregularities making the surface smooth
. allowing proper or intimate contact
water Higher is the water content, poorer is the adhesion water can react with
both materials by the high polar group and hydrogen bond which can hamper
.the adhesion
ENAMEL BONDING
Enamel, the hardest tissue in the human body consists of 95% mineralized
inorganic substance, hydroxyapatite arranged in a dense crystalline structure
and a small amount of protein and water (Figs 1.3 A and B). To bond to enamel,
it is very important to focus on the mineral component (hvdroxvapatite) of
enamel. thionocore, in 1955, was first to reveal the adhesion of acrylic resin to
add etched eiiairiel. He used 85% phosphoric acid for etching, later Silverstone
revealed that optimum concentration of phosphoric acid shoald range behveen
3O-4O% to get a satisfactory adhesion in the enamel. Usually 37% phosphoric
acid is used for 15 to 30 seconds. If the concentration is greater than 50
percent, then monocalcium phosphate monohvdra te may get precipitated while
at concentrations lo'ver than 30 percent, dicalcium phosphate monohydra te is
.precipitated which interferes with adhesion
Several changes have taken place regarding the acid etching of enamel
:surfaces. These include
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teeth require longer time for etching than permanent teeth because of presence
.of aprismatic enamel in deciduous teeth
.Wash the etchant continuously 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 BiSGMA or UDMA wilh
TEGDMA which is 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
The finer network of numerous small tags are formed across the end of each
rod where individual hydroxvapatite crystals were dissolved and are known as
microtags. These microtags are more important due to their larger number and
greater surface area of contact. The formation of resin micro and macro tags
within the enamel surface constitute the ftuidainental mechanism of enamel.resin adhesion
Mechanism of Etching
:Etching of enamel produces a number of effects
.Cleanses debris from enamel .1
Produces a complex three-dimensional microtopography at the enamel .2
surface
.Increases the enamel surface area available for bonding .3
Produces micropores into which there is mechanical interlocking of the resin .4
(Fig. 1.3 )
.Exposes more reactive surface layer, thus increasing its wettabilitv .5
: when seen microscopicallv, three types of enamel etching patterns are seen
Type I preferential demineralization of enamel prism core leaving the prism
.peripheries intact. Here corresponding tags are cone shaped
Type II There is preferential removal of inter prismatic enamel leaving the prism
.cores intact. The corresponding enamel tags are cup shaped
Type III In this, the pattern is less distinct, including areas that resemble type I
.and II patterns and areas which bear no resemblance to enamel prism
Basically, acid etching creates a 5-50 micron deep microporous layer into which
adhesive resin flows. This result in a longlasting enamel bond achieved via
micro- mechanical interlocking between the resin and enamel. Bond strength of
.etched enamel to composite resin usually varies behveen 15-25 MPa
Among the factors that affect bonding of enamel are its fluoride content,
arrangement of crystals and impurities, e.g. presence of magnesium and
.carbonates in the hvdroxvapatite crystals
Dentin etching changes the surface energy, high protein content exposed
after etching is responsible for low surface energy (44.8 dynes/cm)
different from enamel.
This surface energy has to be increased by surface active primer
application
Objective of priming is to transform the hydrophilic dentin surface into a
hydrophobic surface, also to wet the surface, entangle with collagen fibers
on poly-merization, if possible react with functional groups of dentin for
chemical bonding.
Dental priming molecules has been mainly concentrated on bifunctional
molecules that bond to one end on tooth tissue and other end to
composite resin.
Being an aqueous solution of a phosphonated monomer, it demineralizes and .penetrates dentin simultaneously, leaving a precipitate on the hybrid layer
Forms a thin layer of adhesive, leading to low bond strengths; a multi-coat .approach is recommended
.Incompatible with self-cure composite resins Stresses at Resin-Dentin Interface
Composites shrink as they polymerize, creating stresses of 7MPa within the
composite mass, depending on the configuration of the preparation. When the
composite is bonded to one surface only (e.g., for a direct facial veneer),
stresses within the composite are relieved by flow from the unbonded surface.
Stress relief within a three-dimensional bonded restoration is limited,
however,by its configuration factor. In an occlusal preparation, composite is
bonded to five surfacesmesial, distal, facial, lingual, and pulpal.The occlusal
surface is the only free or unrestrained surface. In such a clinical situation, the
ratio between the number of bonded surfaces and the number of unbonded
surfaces is 5, giving the restoration a configuration factor of 5.Stress relief is
limited because flow can occur only from the single free surface. Unrelieved
stresses in the composite contribute to internal bond disruption and marginal
.gaps around restorations that increase microleakage
It has been reported that immediate bond strengths of approximately 17MPa
are necessary to resist the contraction stresses that develop in the composite
during polymerization, to prevent marginal debonding. Water sorption by the
resin might compensate for the effect of the polymerization shrinkage,as the
resin might expand and seal off marginal gaps,but this occurs only over a
.relatively long time. Water sorption is directly proportional to the resin content
Enamel bond strengths usually are sufficient to prevent the formation of
marginal gaps by polymerization contraction stresses. These stresses might be
powerful enough to cause enamel defects at the margins, however. Extension of
.the enamel cavosurface bevel helps to improve the enamel peripheral seal
Each time a restoration is exposed to wide temperature variations in the oral
environment (e.g.,drinking coffee and eating ice cream), the restoration
undergoes volumetric changes of different magnitude than those of the tooth
structure. This occurs because the linear coefficient of thermal expansion of the
composite is about four times greater than that of the tooth structure.
Microleakage around dentin margins is potentiated by this discrepancy in linear
.coefficient of thermal expansion between the restoration and the substrate
Loading and unloading of restored teeth can result in transitional or permanent
interfacial gaps. Additionally, the tooth substrate itself might be weakened by
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cyclic loading. A study found that 71% of Class V composite restorations in third
molars with antagonists have significantly more microleakage than restorations
placed in teeth without opposing contact. Another study found that cyclic
loading and preparation configuration significantly reduced the microtensile
bond strengths of a self-etching primer (SEP). Also, when half of a wide occlusal
Class I composite restoration is fatigued for 100,000 cycles between 5N and
35N,while the other half is kept as control, the bond strengths of Single Bond
.(3M ESPE,St.Paul,Minn) decrease by 40% to 60%
Self-etch technique
Advantages
.Easy and time efficient application procedure
.No etching, post-conditioning rinsing, or drying
.Possibility for single-dose packaging
.Consistent and stable composition
."Possibility for particle- filled adhesive, act as "shock absorber
.Simultaneous demineralization and resin infiltration
.Less technique sensitivity
Disadvantages
Consists of both hydrophobic and hydrophilic components, together with water
.and high concentration of solvent
.Prone to phase separation and entrapment of droplets in adhesive layer
.Most self-etch systems contain water, it influences polymerization badly
.Reduced shelf life because of hydrolysis of monomers
.High hydrophillicity due to presence of acidic monomers
.Bonding effectiveness depends on composition of adhesive solution
.No long term clinical evaluation
.Impaired durability
.Incompatibility with autocuring composites
Total-etch technique
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Advantages
Separate application of conditioner, primer, and adhesive resin
Low technique sensitivity
Better adhesion to enamel and dentine
More effective and consistent result
"Possibility for particle-filled adhesive, act as "shock absorber
Disadvantages
Risk of over-etching dentine because of presence of highly concentrated
.phosphoric acid etchants, resulting in incomplete resin infiltration
.Three step application procedure
.Risk of surface contamination because post-conditioning rinsing required
.Sensitive to overwet or overdry dentine surface conditions
Weak resin-collagen interaction, this may result in nanoleakage and early bond
.degradation
:Bond generation
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Smear
layer
tion
Bond
strength
Preparation steps
1st
generatio
n
2_3mpa
3steps
2nd
generatio
n
5-6mpa
3steps
3rd
generatio
n
Modify
the
smear
layer(remov
e it without
distrusting
the plugs)
4th
generatio
n
Remove
5th
generatio
n
Remove
6th
generatio
n
Remove
7th
generatio
n
Remove
3steps
25mpa
3steps
2step
(Bond
+primer+
adhesive in )in the
same bottel+etching
2step
(Etch + primer)+
(adhesive+resine)
All in non bottel
Hybr
idiza
Hybrid composite was developed in an effort to obtain even better finish than small particle composite while still maintaining desirable properties of the
. latter
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It contain two kind of fillers,this bimodal distribution of filler loading and better .surface finish
Fillers are colloidal silica and ground particles of glass containg metal Smaller filler particle and greater amount of microfillers increase surface area .and thus filler loading will not be as high as small particle filled
: Layer of hybrid zone
.top layer amorphous electron dense phase.1
middle layer cross sectioned and longitudinally sectioned collagen fibril .2
. separated by electron lucent spaces
base layer is characterized by gradual transion to underlaying unaltered .3
.dentin
Role of hybrid layer :
This layer forms following initial demineralization of dentinal surface with an
acidic conditioner exposing a collagen fibril network with inter fibril
microporosities that subsequently become intediffused with low viscosity
monomers .this zone in wich resin adhesive system interlocks
micromechanically with dentinal collagen is termed hybrid layer or zone.
hybrid layer act as stress breaker or stress reliever eith youngs modulus of
3Gpa
sealing the surface against leakage and imparting a high degree of acid
resistance
Hybridoid layer is the region of demineralized dentin into which resin failed to
penetrate .concurrent to hybrid layer formation is penetration of primer into
open dentinal tubule.
Microtagd-formed within intertubular dentin.
Macrotags-within dentinal tubules.
Macrotags are generally of little value as these are under cured.
astudy using SEP showed that the dentin bond strength did not vary from 1
day to 6 monthes to 1 year on tooth subjected to occlosal function . it also
showed the porpsity in hybrid layer increase the significantly at 1 year , owing
to loss of resin between the collagen fibers.becouse these result obtained with a
hybrid layer being created by SET , they cant be generalized by to total etch
adhesion. They do support the theory ,however,that collagen may play an
important role in the strength of the resin dentin interface.
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away at the natural tooth structure, and will eventually result in the need for
root canal therapy or tooth extraction.
Dental bonding patients should follow these aftercare instructions to ensure that
:the composite resin bonding material lasts as long as possible
Brushing: Brush the teeth twice a day, ideally once in the morning and
once at night, using toothpaste that contains fluoride; Brush the outside, inside,
and top of each tooth, and then brush the tongue. Replace your toothbrush
every three to four months to ensure that your teeth are properly cleaned.
Flossing: Floss once a day; be sure to bring the floss all the way up to the
gum line and thoroughly remove all plaque before moving on to the next tooth.
Drink water after meals: Drinking water after meals will help flush out
food particles and reduce acidity levels in the mouth.
Avoid Products that stain the teeth: Use of tobacco products, such as
cigarettes or chewing tobacco, causes yellow and brown stains to appear on the
teeth and bonding material.
Avoid Foods and drinks that wear down the bonding
material: Acidic foods (such as citrus, soda, and wine) eat away at tooth
enamel and the composite resin; hard or crunchy foods such as candy, pretzels,
and beef jerky can wear down and even chip the bonding material due to the
force that is exerted while chewing on these foods.
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Avoid Habits that wear down the bonding material: Certain habits,
such as biting on fingernails, pen caps, pens, pencils, and other hard objects,
wears down the bonding material and tooth enamel over time.
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