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Resin-Dentine Bonding

Need to provide a reliable, long term seal to enamel
and dentine

When to use Dentine Bonding Agents:
Aesthetics eg shallow abrasion lesions, veneers
Inadequate space for a lining eg erosion pits
Gingival margin with exposed dentine
Desensitisation of dentine
Constantly changing materials
?Adequate enamel etch
Bonding to dentine (& enamel)
Three elements:- Effect of cavity design
1. Etching. An acidic agent removes the smear Usefulness of in-vitro testing
layer, opens & widens the dentine tubules, and ?Substrate – caries-affected/sclerotic dentine
partially demineralises the dentine & enamel. Nanoleakage – overwet/overdry dentine
The acid is applied to enamel & agitated for 15s, then – hybrid layer deterioration
enamel & dentine for 15s, then rinsed off.
“new adhesives are continually being introduced to
2. A priming agent is applied to enamel & dentine – the dental profession, unfortunately, often without
it penetrates the demineralised collagen network. A sufficient clinical validation”
primer is a methacrylate monomer dissolved in a
Van Meerbeek B et al; Oper Dent 2003; 28: 215-35
solvent (ethanol, acetone, water) containing both
hydrophilic and hydrophobic components – a “clinical trials must run much longer than 2 years to
bifunctional molecule that bonds to both dentine properly evaluate performance”
and resin. Donovan TE et al: J Prosthet Dent 2013; 110: 161-210
The primer is dried onto the enamel & dentine.
Multiple layers are often required. Adequate enamel etching?
Self-etch adhesives have higher concentrations of
3. A bonding resin penetrates the primed collagen acidic resin monomers that enable these adhesives
network, the dentine tubules and enamel to etch through thick smear layers and bond to the
microporosities. The resin is polymerised and forms underlying structure.
a “hybrid” layer of resin intermingled with collagen Tay FR , Pashley DH; Dent Mater 2001; 17: 296-308
bundles & tag penetration
Acidity (pH) of self-etch primers/adhesives
Phosphoric acid 0.1
“The simpler the clinical procedure is the lower the
Adper Prompt L-Pop 0.4
number of possible application errors.” 1-st SE
iBond 1.6
Finger W, Fritz U; Am J Dent 1996; 206-10 AdhesSE 1.4 2-st SE
Clearfil SE Bond 1.9
Types of DBA’s Prime&Bond NT 2.2
Etch + prime + bond SBMP (3M-ESPE) Single Bond 4.7
OptiBond FL (Kerr) ETCH
& Van Meerbeek B et al; Oper Dent 2003; 28: 215-
Etch + prime/bond Single Bond (3M) RINSE 35
OptiBond Solo Plus (Kerr)
Effect of cavity design
Self-etch primer + bond Clearfil SE Configuration or C-factor: ratio of bonded to
Bond(Kuraray) unbonded surfaces. Higher the C-factor the lower
AdheSE (Ivoclar) SELF- the conservation of adhesion.
Self-etching adhesive Scotchbond Universal – Conservation of adhesion +
(3M ESPE) 5/ 5/1= 5 4/2=2 3/3=1 2/4=0.5 1/5=0.2
iBond (Heraeus)

1. Ceballos L et al.. J Dent Res 2003.. HEMA is unstable in aqueous Sclerotic dentine environments and will degrade when exposed to “lower micro-tensile bond strengths were found in oral fluids. Santini A. Thinning /disappearance of the collagen fibrils Bond to caries affected dentine (MPa) Using etch & rinse and self-etch systems: 1.. Pashley D. 9: 43-8 . Due to: compromises the integrity of the restoration-  Etch & rinse systems – disparity between depth adhesive interface. Pashley D. 81: 556-60  Polymers contained in composite resins have been shown to host & nurture aerobic & anaerobic Overwet/overdry dentine organisms.. Tay FR et al.. J Biomed Mater Res 2010.” Calcium and phosphate ions dissolved in the Donovan. Tay FR. Degradation … Normal Caries affected “the adhesive dentine interface is a porous collagen Prime & Bond NT (E&R) 56 41 web infiltrated mainly by hydrolytically unstable Single Bond (E&R) 44 36 HEMA. Am J Dent 1996.  Water trees Clinical studies are the ultimate test for any dentine  Decreased bond strengths adhesive. J Canad Dent Assoc 2003. sclerotic lesions. laboratory-measured bond strengths are not a Water interferes with the polymerization process. 46: 277-301 The etch & rinse adhesives produced higher bond There are two aspects to the degradation of the strengths to normal and caries affected dentine than hydrid layer: self-etching systems. Miletic V. J Dent 2004. 66: 1636-9 “ …a substantial amount of monomers remained unpolymerized within the hybrid layer. these microbes are capable of “ . Dent Clin North Am 2002.” membranes after polymerization. 31: 469-77 resin by microbes. 110: 161-210 polymerized acidic adhesive attract water: “Laboratory tests use ideal dentine from extracted  Water blisters teeth.” ClearFil SE Bond (SE) 36 22 Prompt L-Pop (SE) 18 13 HEMA is a hydrophilic monomer that penetrates etched dentine more effectively than Bis-GMA. Feilzer AJ Degree of conversion: J Dent Res 1987. creating moisture required for keeping the demineralized pockets & channels within the resin. J Esthet Dent 1994.  Self-etching systems – residual water within the Shokati B et al. collagen stable .. J Dent 2003. Hydrolytic degradation by water sorption. as well as the resin composite. 6: 227-44 “laboratory methods provide little more than screening tools for evaluating adhesives and that Hybrid layer deterioration long-term clinical studies are the only valid “Single-step adhesives behave as permeable predictors of performance. 2. J Dent Res 2002. Eur J Oral Sci 2008. a delicate balance exists in the amount of depolymerising & digesting polymers. With the etch & rinse DBA’s …  Additionally.” Wang Y et al.. 94B: 230-7 adhesive. J Dent Res 1999. 78: 906-11 Nanoleakage Biodegradation of Bis-GMA by salivary esterases is Submicron-sized porous zones beneath or within a clinically relevant process that progressively hybrid layers. 116: 177-83 Erickson RL E.” the resin leaving porosities in the hybrid layer. which does not reflect the clinical reality. 69: 726-31 Perdigao J. good predictor of retention or seal of restorations .” Tay F. TE et al: J Prosthet Dent 2013. ” Tay FR et al. of demineralization and monomer diffusion with time. J Dent 2003..” E&R 2stSE 1stSE Adhesive layer 85% 82% 55% Hybrid layer 59% 70% 45% . 31: 469-77 However. 82: 141-5 “ … was attributed to the obliteration of dentinal tubules with sclerotic castes and the presence of an This results in chemical degradation & washout of acid-resistant hyper-mineralised layer. 32: 173-96 Sano H et al.. biodegradation of Bis-GMA & depolymerisation of Ceballos L et al.

wash and dry Bourbia M et al.2% in preventing loss of microtensile bond strength over time (6mnth compared with immediate testing). Eur J Oral Sci 2006. Elizabeth Martin …. acids contained in etch & rinse and self-etch May 2014 bonding agents can activate MMP’s in dentine. in vitro as a result of MMP activity. Matasa CG. 84: 118-32 41 De Munck J et al.” Nishitani Y et al. These adhesives appear to be most resistant to hydrolytic degradation as they provide a separate. Biomaterials 2006 27: 4470-6 A/Prof. Eur J Oral Sci 2006.” .use multiple primer coats infiltrated dentine by the action of host-derived .apply a thin layer of bonding agent (2 coats if matrix metalloproteinases (MMP’s). Zhou J et al.0 CHX 32. The 2-step self etch adhesives form the second-best performing group.apply 2% CHX for 1min. 1995.ensure adequate isolation degrade composites and adhesives… This finding . J Dent Res 2013.2 Carrilho MRO et al. 114: 160-66 The 3-step etch & rinse adhesives are the best performing and are regarded as the “gold standard”.7 32. . Nishitani Y et al. . 989-94 . 351-7 Etch & rinse technique “ S. 12: 27-31 “Clearly the durability of the resin-dentin bond is more complex than previously thought. J Dent Res 2012. De Munck J et al. mutans has esterase activities at levels that .3 19. This results in the breakdown and loss of collagen fibres of the hybrid zone via collagenase and gelatinase activity.apply & agitate primer on enamel & dentine..wash 20s & leave dentine “just moist” progression of secondary caries. J Dent 2009. 86: 529-33 “The addition of chlorhexidine to a two-step self- etching adhesive primer (Clearfil SE Bond Primer) has no adverse effect on the immediate resin- dentine bond strength. Campos EA et al. J Adhes Dent 2009. 37: 108-14 In–vivo bond strengths measured after 14 months in function showed a 38% reduction without 2% CHX treatment.avoid contamination & place CR Mazzoni et al. Orthop. then dentine & enamel suggests that the resin-dentin interface could be for 15 sec + agitate while etching compromised by oral bacteria that contribute to the . 108: 132. J Dent Res 2007.”.etch enamel for 15 sec.. Thinning/disappearance of collagen fibrils … . 91. Immed. J Dent Res 2005.(MPa) 14mth (MPa) Control 29. 114: 160-66 2% CHX was more effective than 0. & dry 2. low viscosity) & cure (check curing intensity) .completely evaporate solvent Auto-degradation of collagen occurs in resin. more hydrophobic resin layer as the final application step. Am J Orthod Dentofac.