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Duarte QDT Cementación PDF
Duarte QDT Cementación PDF
Adhesive Resin
Cements for
Bonding Esthetic
Restorations:
A Review
1
Associate Professor, Division of Restorative Sciences, Ostrow
School of Dentistry, University of Southern California, Los Angeles,
California, USA.
2
PhD Candidate and Visiting Research Scholar, Ostrow School of
Dentistry, University of Southern California, Los Angeles, Califor-
nia, USA; Department of Dentistry, School of Dentistry, Federal
University of Santa Catarina, Florianopolis, Santa Catarina, Brazil.
3
Dean and Professor, Ostrow School of Dentistry, University of
Southern California, Los Angeles, California, USA.
4
Assistant Professor, Division of Restorative Sciences, Ostrow
School of Dentistry, University of Southern California, Los Angeles,
California, USA.
QDT 2011 41
DUARTE ET AL
Resin-modified glass-
Chemical bonding 11–21 85–160 13–25
ionomer
Phosphate-modified
composite resin 13–50 212–291 34
(self-adhesive)
Self-cured
24.3–50 292 62
composite resin
Light-cured composite
5–10 345–400 77.4
resin
Micromechanical bonding
C BONDING MECHANISMS OF
ement is a substance that produces a solid
union between two surfaces. In dentistry, three
types of luting cements are available based on
ADHESIVE RESIN CEMENTS
their interaction with the substrate: nonadhesive lut- Most resin cements require pretreatment of the dental
ing cements (eg, zinc phosphate cements), chemically substrate to promote bonding to the dental tissues.
bonded cements (eg, polycarboxylate, glass ionomer– This pretreatment can be obtained by the application
based, and phosphate-modified resin cements), and of an etch-and-rinse or self-etch dentin adhesive sys-
micromechanically bonded cements (eg, polyfunction- tem, depending on the manufacturer or the character-
al dimethacrylate–based cements) (Table 1). The adhe- istics of the resin cement. Recently, self-adhesive resin
sive properties of dimethacrylate-based cements are cements were also introduced as an alternative to
determined not primarily by the cement itself, but by multistep resin-based luting cements. Therefore, resin
the type of coupling adhesive system. Since most es- cements can be classified into one of three groups ac-
thetic restorations require adhesive cementation, cli- cording to the bonding characteristics: etch-and-rinse,
nicians must understand the performance of different self-etch, and self-adhesive resin cements.
adhesive resins to produce long-lasting restorations.
42 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
Modulus Flexural
of elasticity strength
(GPa) Solubility (MPa) Trade name
HY-Bond Zinc Phosphate (Shofu, San
13 0.2% 15–98
Marcos, CA, USA)
Durelon (3M ESPE, St Paul, MN, USA)
5–6 0.06% 14.7–16.5
HY-Bond Polycarboxylate (Shofu)
Ketac Cem (3M ESPE)
7–8 1% 7.8–24.8
GC FujiCEM (GC America, Alsip, IL, USA)
QDT 2011 43
DUARTE ET AL
Table
Etch-and-Rinse Resin Cements
2
Resin Polymerization Adhesive
cement mode Cement composition system
Paste A: silane-treated ceramic, TEGDMA, bis-GMA, silane-
treated silica, functionalized dimethacrylate polymer, 2-benzotri-
azolyl-4-methylphenol, 4-(dimethylamino)-benzeneethanol Adper
RelyX ARC Dual-cured Single Bond
Paste B: silane-treated ceramic, TEGDMA, bis-GMA, silane- Plus
treated silica, functionalized dimethacrylate polymer, 2-benzotri-
azolyl-4-methylphenol, benzoyl peroxide
Adper
RelyX Veneer Silane-treated ceramic, TEGDMA, bis-GMA, silane-treated
Light-cured Single Bond
Cement silica, functionalized dimethacrylate polymer
Plus
NX3 Nexus Third Dual- or Uncured methacrylate ester monomers, inert mineral fillers, OptiBond
Generation light-cured activators and stabilizers, radiopaque agent Solo Plus
Base: barium boron fluoroalumino silicate glass, bis-GMA resin,
polymerizable dimethacrylate resin, hydrophobic amorphous
Dual- or fumed silica, titanium dioxide, colorants are inorganic iron oxides Prime &
Calibra
Light-cured Bond NT
Catalyst: barium boron fluoroalumino silicate glass, bis-GMA resin,
polymerizable dimethacrylate resin, hydrophobic amorphous
fumed silica, titanium dioxide, benzoyl peroxide
Base: bis-GMA, ethoxylated bis-GMA, triethyleneglycol One-Step
dimethacrylate, fused silica, glass filler, sodium fluoride. Plus or
C&B
Self-cured
Cement
Catalyst: bis-GMA, triethyleneglycol dimethacrylate, fused silica All-Bond 3
One-Step
Plus
Choice 2 Veneer
Light-cured Strontium glass, amorphous silica, bis-GMA
Cement
All-Bond 3
Excite F
Dimethacrylates, bis-GMA, triethylene glycoldimethacrylate, DSC
Variolink II Dual-cured urethanedimethacrylate, benzoyl peroxide, inorganic fillers, yt-
terbiumtrifluoride, initiators, stabilizers and pigments Syntac
Classic
Syntac
Dimethacrylates, urethanedimethacrylate, decandiole dimethac- Classic
Variolink Veneer Light-cured rylate, inorganic fillers, ytterbiumtrifluoride, initiators, stabilizers
and pigments Excite F
44 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
Ethyl alcohol, alkyl dimethacrylate resins, barium aluminoborosilicate glass, fumed silica, Kerr
sodium hexafluorosilicate
Coltène/Whaledent, Altstät-
2-hydroxyethyl methacrylate, GDMA, urethane dimethacrylate
ten, Switzerland
QDT 2011 45
DUARTE ET AL
(Figs 3a and 3b).3 However, excessive water in interfi- the same adhesive is used in dual-cure mode.14 There-
brillar spaces will compete with the adhesive mono- fore, dentin adhesives used in conjunction with resin
mers, diluting their concentration and preventing op- cements must be light polymerized, irrespective of the
timal polymerization (Figs 4a and 4b).4 Water within activation mode. Furthermore, extending the curing
the collagen network leads to rapid degradation of the time beyond 20 seconds is highly recommended.15,16
bonded interfaces. Therefore, some strategies will now
be suggested to improve bonding to dental tissues.
Two-step etch-and-rinse adhesives require multiple Self-Etch Resin Cements
coatings—more than recommended by the manufac-
turer—to achieve acceptable micromechanical inter- The demand for resin cements that are less technique
locking of monomers into the microretentive collagen sensitive and more user-friendly pushed manufacturers
network.5 In addition, vigorous application improves to substitute etch-and-rinse adhesive with self-etch ad-
clinical retention and bond strength.6,7 hesive. Self-etch adhesives consist of non-rinsing acidic
After dentin adhesive application, meticulous sol- monomers that simultaneously etch and prime dentin
vent evaporation must be performed. Incomplete sol- and enamel. Self-etch adhesives are available as one-
vent evaporation increases permeability and decreases or two-step adhesives. Two-step self-etch adhesives
bond strength.4 Residual water trapped within the col- comprise a self-etching primer and a hydrophobic
lagen network will lead to incomplete polymerization adhesive resin, whereas one-step self-etch adhesives
of the adhesive monomers. The solvent evaporation combine etchant, primer, and bonding in a single solu-
process must also be more prolonged than advocated tion. Self-etch adhesives simultaneously demineralize
by the manufacturer. Complete evaporation of the sol- and infiltrate the dental substrate. The etching char-
vent is almost impossible to attain.8,9 acteristics are dependent on the pH of the acidic solu-
Simplified adhesives are permeable to fluid move- tions. Ultra-mild self-etch adhesives (pH > 2.5) provide
ments across the cured adhesive layer (Fig 4b).10 Fluid nano-interaction with dental substrates. Mild self-etch
transudation has been observed on bonded surfaces adhesives (pH ≈ 2.0) feature a submicron hybrid layer
for both vital and endodontically treated teeth.11 The with less-pronounced resin tag formation (Figs 6a and
transudation of dentinal fluids significantly affects the 6b). Strong self-etch adhesives (pH ≤ 1.0) result in an
bonding of dual-cured resin cements.10 Water droplets interfacial ultramorphology resembling that produced
trapped along the interface may plasticize the polymer, typically by total-etch adhesives, with the formation of
resulting in catastrophic failure of the restoration.10,11 abundant resin tags (Figs 7a and 7b).17
Application of an additional hydrophobic resin coating Since self-etch adhesives do not require rinsing and
over the simplified adhesive may decrease adhesive drying, the smear layer is not removed but impregnat-
permeability and increase bond stability (Fig 5). ed by the acidic monomers. Intertubular collagen is
The polymerization of an adhesive system yields ad- then exposed, and the removed minerals are replaced
equate mechanical and physical properties. Success- by resin monomers, creating micromechanical inter-
ful polymerization of a given adhesive is dependent locking within the collagen interstices. The collagen
on its composition and the distance from the light tip. fibrils are not completely deprived of hydroxyapatite,
However, especially for indirect restorations, the use in contrast with total-etch adhesives.18 For that reason,
of a self- or dual-cured adhesive may be considered chemical interaction between functional monomers
when effective light polymerization is uncertain. To ad- (10-methacryloyloxydecyl dihydrogen phosphate
dress this problem, some etch-and-rinse resin cements [MDP]) or some acids (polyalkenoic acids) and hydroxy-
include chemical co-initiators or activators to convert apatite is also observed and may improve bond dura-
the light-polymerized adhesive into a self- or dual- bility (Table 3).17 Despite the limited chemical bonding,
cured adhesive. But the use of an activator has limited micromechanical interlocking is still the main source of
effect in improving the coupling of dual-cured adhe- bonding for self-etch adhesives.
sives with self- or dual-cured composites.12,13 In addi- The effectiveness of self-etch adhesive systems varies
tion, self-polymerization alone is not advised since the considerably and is affected by composition,19,20 shelf
degree of conversion is significantly lower than when life,21 and aging.20,22,23 One-step self-etch adhesives
46 QDT 2011
1 Adhesive Resin 2Cements for Bonding Esthetic Restorations: A Review
A f
HL
RT
3a and 3b
HL
RT
ID T
W
Fig 1 Field-emission scanning electron microscopy (FeSEM) showing a longitudinal view of etched dentin (magnification ×10,000).
White arrows = dentin decalcification.
Fig 2 FeSEM showing the hybrid layer of a highly filled adhesive (magnification ×15,000). HL = hybrid layer; RT = resin tags; A =
adhesive layer; f = filler.
Fig 3a Acid-etched superficial dentin (magnification ×5,000). Note the large amount of intertubular dentin. ID = intertubular dentin;
P = peritubular dentin; T = tubule.
Fig 3b Confocal laser scanning microscopy (CLSM) showing full hybridization of an etch-and-rinse adhesive applied on superficial den-
tin (magnification ×100). The adhesive system (red) and water (green) were stained to facilitate visualization. Note that the hybrid layer
and resin tags are distinct from the intratubular water. A = adhesive layer; HL = hybrid layer; RT = resin tags; W = water.
QDT 2011 47
4a DUARTE
and 4bET AL
ID HL
RT
W
T
HL
RT
Fig 4a Acid-etched deep dentin showing a reduced intertubular dentin area and enlarged tubules (magnification ×5,000).
Fig 4b CLSM showing fluid transudation through the resin tags and hybrid layer to the adhesive layer (magnification ×100). Simpli-
fied adhesives are permeable to fluid movements across the cured adhesive layer. Note that water (green) is heavily concentrated
around the resin tags and at the bottom of the hybrid layer and flows toward the adhesive layer (yellowish-green).
Fig 5 CLSM showing a hydrophobic resin (green) applied over a simplified etch-and-rinse adhesive (red). Note the decreased adhe-
sive permeability and lack of water penetration (blue) beyond the hybrid layer. H = hydrophobic resin layer; A = adhesive layer; HL =
hybrid layer; RT = resin tags; W = water.
48 QDT 2011
6a and 6b Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
SL
P CF
ID
ID P
SP
T
7a and 7b
HL
ID
RT
T
Figs 6a and 6b FeSEM showing decalcification of dentin after application of a mild self-etch adhesive. (a) Intertubular collagen is
exposed, while the smear layer is still within the tubules (magnification ×20,000). (b) Longitudinal view showing superficial decalci-
fication of the dentin and smear plug inside of the tubule (magnification ×50,000). ID = intertubular dentin; P = peritubular dentin;
T = tubule; SM = smear layer; CF = collagen fibers; SP = smear plug.
Figs 7a and 7b (a) FeSEM showing aggressive dentin etching with a strong self-etch adhesive. Ultramorphology resembles that of
dentin etched with phosphoric acid (magnification ×20,000). (b) FeSEM showing the hybrid layer obtained with a strong self-etch
adhesive (magnification ×15,000). Note the similarity to an etch-and-rinse adhesive, except for the smaller hybrid layer.
QDT 2011 49
DUARTE ET AL
Table
3 Self-Etch Resin Cements
Polymerization
Resin cement Cement composition
mode*
Paste A: Silane-treated ceramic, TEGDMA, bis-GMA, silane-treated silica,
functionalized dimethacrylate polymer, 2-benzotriazolyl-4-methylphenol,
4-(dimethylamino)-benzeneethanol
RelyX ARC Dual-cured
Paste B: Silane-treated ceramic, TEGDMA, BIS-GMA, silane-treated silica, func-
tionalized dimethacrylate polymer, 2-benzotriazolyl-4-methylphenol, benzoyl
peroxide
NX3 Nexus Third Dual- and Uncured methacrylate ester monomers, inert mineral fillers, activators and stabi-
Generation light-cured lizers, radiopaque agent
TEGDMA = triethylene glycol dimethacrylate; bis-GMA = bisphenol glycidyl methacrylate; HEMA = hydroxyethyl methacrylate.
*As per the manufacturer.
50 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
Acetone, ethyl alcohol, uncured methacrylate ester, monomers, TWA, inert min-
OptiBond All-In-One
eral fillers, ytterbium fluoride, photoinitiators, accelerators, stabilizers, water
Primer: Acetone, ethyl alcohol, HEMA, GPDM, mono- and di-functional meth-
Kerr
acrylate monomers, camphorquinone
OptiBond XTR
Adhesive: monomers, ethyl alcohol, camphorquinone, barium glass nano-silica,
sodium hexafluorosilicate
QDT 2011 51
DUARTE ET AL
8
HL
Fig 8 CLSM showing water permeation through the hybrid layer of a one-step self-etch adhesive (magnification ×100). Self-
etch adhesives act as a semi-permeable membrane, allowing diffusion of water through the bonded interfaces even after
polymerization.
showed the highest annual failure rate compared to since water accumulation jeopardizes the longevity of
two-step self-etch and etch-and-rinse adhesives.24,25 the bonded interface.34
The application of all-in-one adhesives is not neces- The placement of a hydrophobic resin coat seems
sarily simpler or less time consuming,19,26 and their to improve the sealing ability of one-step self-etch ad-
sealing properties are still problematic.27 The clinical hesive.36 However, one-step self-etch adhesive is still
performance of newer one-step self-etch adhesives technique sensitive.37,38 Two-step self-etch adhesives
has shown some improvement.28,29 However, caution are more stable and reliable and should be preferred.
is advised when bonding one-step self-etch adhesive Despite all recent advances in the bonding of self-
to dual-cured resin cements because of the adverse etch adhesives, acceptable long-term enamel bonding
chemical interaction between the acidic adhesive and is only achieved by pretreatment with phosphoric acid.
resin cement.30–32 In addition, water from dentin can
mix with the hydrophilic co-monomers during evap-
oration of solvent, creating nanoleakage pathways Self-Adhesive Resin Cements
within the hybrid and adhesive layers.33 As a result,
these adhesives act as a semi-permeable membrane Self-adhesive resin cements can bond to dental tis-
with blisters filled with water and incompletely polym- sues without previous etching procedures or the ap-
erized monomers, allowing diffusion of water through plication of bonding adhesive (Table 4). Their applica-
the bonded interfaces even after polymerization (Fig tion is accomplished in one step, which makes them
8).34,35 This process is deleterious to the restorations clinically attractive. After mixing, the phosphoric acid
52 QDT 2011
Artistry and CAD/CAM Technology: Predictable Outcomes in Contemporary Implant Dentistry
Table
Self-adhesive Resin Cements
4
Resin Polymerization
Cement composition Manufacturer
cement mode
Base: Silane-treated glass powder, 2-propenoic acid, 2-methyl-,
1,1’-[1-(hydroxymethyl)-1,2-ethanediyl] ester, reaction products with
2-hydroxy-1,3- propanediyl dimethacrylate and phosphorus oxide,
RelyX TEGDMA, silane-treated silica, sodium persulfate, glass powder, tert-
Unicem 2 Dual-cured butyl peroxy-3,5,5-trimethylhexanoate 3M ESPE
Automix
Catalyst: Silane-treated glass powder, substituted dimethacrylate,
silane-treated silica, 1-benzyl-5-phenyl-barbic-acid, calcium salt,
sodium p-toluenesulfinate, 1,12-dodecane dimethycrylate, calcium
hydroxide
Maxcem Uncured methacrylate ester monomers, inert mineral fillers, ytterbium
Dual-cured Kerr
Elite fluoride, activators, stabilizers, colorants
Bisphenol A diglycidylmethacrylate, sodium fluoride, triethylene
glycol dimethacrylate, 10-methacryloyloxydecyl dihydrogen phos-
Clearfil SA
Dual-cured phate, hydrophobic aromatic dimethacrylate, hydrophobic aliphatic Kuraray
Cement
dimethacrylate, silanated barium glass filler, silanated colloidal silica,
dl-camphorquinone, initiators, accelerators, catalysts, pigments, other
Base: bis-GMA, uncured dimethacrylate monomer, glass filler
BisCem Dual-cured Bisco
Catalyst: Phosphate acidic monomer, glass filler
Dimethacrylates, methacrylated phosphoric acid ester, benzoyl
Self- or light- Ivoclar
SpeedCem peroxide, inorganic fillers, copolymer, ytterbium trifluoride, initiators,
cured Vivadent
stabilizers and pigments
TEGDMA = triethylene glycol dimethacrylate; bis-GMA = bisphenol glycidyl methacrylate.
*As per the manufacturer.
methacrylate is able to demineralize the hard tissues. cements, since the chemical bond is achieved with hy-
However, despite the initial low pH (pH < 2.0), the droxyapatite. Acid etching the dentin with phosphoric
enamel and dentin demineralization is only superfi- acid before the application of self-adhesive resin ce-
cial.39,40 An increase in pH (up to 7.0) is observed as a ment is detrimental to bond strength and must be
consequence of the reaction between the phosphate avoided.39,45 Conversely, the application of mild acidic
groups and alkaline fillers and the hydroxyapatite from agents, such as 25% polyacrylic acid (same dentin
enamel and dentin, neutralizing the resin’s inherent conditioner used for glass-ionomer cements), might
acidity.41 The bonding mechanism of these newly de- remove the superficially loose bound fraction of the
veloped resins relies more on chemical bonding than smear layer, thus improving adhesion.46,47 However, the
on micromechanical retention. The acid groups che- effect of mild acidic conditioner on self-adhesive resin
late the calcium ions of the hydroxyapatite, promoting cements must be validated clinically. Pretreatment of
chemical adhesion.42 In addition, carboxylic groups of enamel with strong acid, such as 35% phosphoric acid,
polyalkenoic acid (found in RelyX Unicem, 3M ESPE) is highly recommended.32,45
form ionic bonds with calcium present in the hydroxy- Most self-adhesive resin cements yield bond
apatite, positively influencing the chemical bonding.43 strengths lower than etch-and-rinse resin cements or
Self-adhesive resin cements are able to partially dis- 10-MDP self-etch resin cements.48,49 With the excep-
solve the smear layer without removing the smear plug tion of RelyX Unicem, most self-adhesive resin ce-
within the dentinal tubules.44 A thick smear layer may ments maintain low pH for a long time after setting,
negatively influence the bond strength of self-adhesive which can adversely influence the bonding.41
QDT 2011 53
DUARTE ET AL 9
UN2
HL
Fig 9 CLSM of self-adhesive resin cement showing water blisters protruding from the interface of the dentin and self-
adhesive resin cement in a deep preparation. White arrows = water blisters; HL = pseudo hybrid layer; UN2 = Unicem 2;
W = water.
During cementation, self-adhesive resin cements self-adhesive resin cement bonded interface in a deep
must be seated under pressure to ensure maximum preparation (Fig 9). These water blisters may soften
contact of the cement with the dentin.40 Insufficient the resin cement and weaken the bond strength.
seating pressure leads to a lack of intimate contact be- A recent clinical trial revealed good performance of
tween the resin and tooth substrate, resulting in poor a self-adhesive cement (RelyX Unicem) over 38 months
adaptation or low bond strength.39,50 for luting alloy–based restorations.52 Another clinical
Water degradation is still a problem for self-adhe- investigation showed promising results when self-ad-
sive cements. Fluid permeation during the initial set- hesive cement was used to adhesively cement lithium
ting period deteriorates the bonding quality of the ce- disilicate inlay restorations.53 However, long-term clini-
ment.51 Findings from our laboratory at the Herman cal trials are needed to fully recommend self-adhesive
Ostrow School of Dentistry, University of Southern resin cements as substitutes for etch-and-rinse resin
California Biomaterials Laboratory, California, USA, cements for onlay, inlays, or porcelain veneers.
showed water blisters protruding from the dentin/
54 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
IMPROVING THE LONGEVITY OF used as a luting agent exhibited reduced wear com-
pared to that of methacrylate- or phosphate-based
EXPOSED RESIN CEMENT MARGINS resin cements (Figs 10 to 17).
Low-viscosity composite resins can be used as resin
cements to retain indirect restorations and to achieve
an adequate seal between the restoration and tooth Preheating
substrate. However, regardless of the marginal adap-
tation, a certain amount of resin cement at the margin In recent studies, the positive effect of preheating on
of the indirect restoration will be exposed to the oral the bond strength of composite materials was report-
environment. Over time, the exposed cement will be ed. The data showed that preheating to 55°C or 60°C
subjected to water sorption,54 subsurface degrada- reduced viscosity, improved flowability, and decreased
tion,55 and wear processes that may result in marginal film thickness of restorative composite resins.70,71 Fur-
ditching.56 All of these shortcomings lead to cement thermore, preheating of light-cured composite resins
wear gap formation and marginal discoloration. resulted in significantly less microleakage at the cervical
Wear of dental restorative materials and resin ce- margins compared to that of flowable and non-preheat-
ments is a complex phenomenon involving both the ed composites.71 As a result of the enhanced monomer
material and the working environment.57 Environmen- conversion, preheating was claimed to positively affect
tal factors influencing material wear usually include properties such as surface hardness, flexural modulus,
the type of load and counterbody,57–59 applied force,60 fracture toughness, tensile strength,70,71 and wear re-
type and abrasiveness of abrasive medium,57,61 and sistance,72 which may also be clinically relevant for lut-
contact duration.60 ing agents. Neither repeated nor extended preheating
Wear of resin cements is influenced by the filler type affected the degree of conversion.73 However, recent
and size,58,62–64 filler load,65 silane coupling agent,65–67 investigations showed that preheating composite resin
nature of the matrix, degree of porosity, and degree might increase polymerization shrinkage.74,75
of conversion.68 The width of the exposed cement sur- The applicability of preheating procedures to lut-
face, determined by the marginal gap between the ing agents has also been investigated. For self-etch or
restoration and preparation, also significantly influ- self-adhesive resin cements, it was shown that warm-
ences wear of the cement.69 ing the cements from refrigerator temperature to room
The use of toothpaste with lower abrasiveness and or body temperature before use improved adhesion.76
less force during brushing results in less deteriora- Preheating composite resins to 37°C and 54°C im-
tion.60,62 In vitro wear studies using a three-body wear proved the adaptation to preparation walls.77,78 How-
model simulating the food bolus between contact- ever, temperatures higher than 37°C increased cuspal
ing teeth reported higher wear values in comparison movement and may lead to postoperative sensitivity.78
to simulations of toothbrush wear.57–59 Tooth brushing Resin cements were practically unusable at 60°C due
movement parallel to the margin of the restoration re- to the accelerated setting mechanism, which meant
sults in increased wear by abrading the filler particles that the cement was already set prior to dispensing.76,79
and resin matrix of the cement. Brushing movement Unfortunately, it is impossible to predict heated com-
perpendicular to the restoration margin results in less posite resin film thickness irrespective of the brand,
vertical wear by washing out only the resin matrix filler shape, or volumetric filler loading (Figs 18a to
around the filler particles.57 Resin cements with larger 18c).77 Therefore, while preheating a composite resin
filler particles were shown to exhibit increased wear to slightly higher than body temperature has potential
in comparison to resin cements with smaller filler par- benefits, clinicians should be aware that increased film
ticles.58,62 A recent evaluation performed at our labo- thickness might interfere with the bonding procedures
ratory showed that preheated microhybrid composite of all-ceramic restorations.
QDT 2011 55
DUARTE ET AL
NX3
10a
NX3
10b
NX3
10c
11
56 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
CE
12a
CE
12b
CE
12c
13
QDT 2011 57
DUARTE ET AL
UN2
14a
UN2
14b
UN2
14c
15
58 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
Z250
E
16a
Z250
E
16b
Z250
E
16c
17
QDT 2011 59
DUARTE ET AL
CE
A
HL
D
18a
UN2
HL
18b
Z250
HL
18c
Fig 18 FeSEM showing the film thickness of different resin cements and preheated composite
resin. (a) Clearfil Esthetic Cement (magnification ×1,500); (b) Unicem 2 (magnification ×1,500);
(c) preheated Filtek Z250 (magnification ×350). D = dentin; A = adhesive layer; CE = Clearfil Esthet-
ic Cement; UN2 = Unicem 2; Z250 = Filtek Z250; HL = hybrid layer; white arrow = film thickness.
60 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
QDT 2011 61
19 DUARTE ET AL
Fig 19 CLSM showing prebonded dentin after preparation and
AL2 after adhesive cementation. There is minimal interaction of the
second adhesive layer with the original hybrid layer. The adhe-
ALi sive layer interface is the area susceptible to adhesive failure.
HL = hybrid layer; AL1 = first adhesive layer (after prebonding);
AL2 = second adhesive layer (after cementation),
ALi = adhesive layer interface; RT = resin tags.
AL1
HL
RT
20a
Fig 20a CLSM showing the effects of aluminum oxide cleaning
AL2 on prebonded dentin after preparation and after adhesive ce-
mentation. Aluminum oxide air abrasion (white arrows) resulted
in partial removal of the original hybrid layer (HL), followed
ALi by the formation of a new ghost-like hybrid layer (HL2). The ad-
AL1 hesive layer interface (ALi) was also modified, allowing for the
HL
HL2 incorporation of aluminum oxide powder even after cleaning.
AL1 = first adhesive layer; AL2 = second adhesive layer;
RT RT = resin tags; W = water.
20b
Fig 20b CLSM showing the effects of tribochemical coating on
AL2 prebonded dentin. Tribochemical coating resulted in removal
of the first hybrid layer (HL) and formation of a new ghost-
like hybrid layer (HL2) susceptible to dentinal fluid transuda-
tion. The first adhesive layer (AL1) was partially removed, and
microgaps (white arrows) were found at the new adhesive layer
(AL2). ALi = adhesive layer interface; RT = resin tags;
HL
HL2 W = water.
RT
62 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
21a
21b
21c
64 QDT 2011
Adhesive Resin Cements for Bonding Esthetic Restorations: A Review
38. Albuquerque M, Pegoraro M, Mattei G, Reis A, Loguercio AD. 57. Belli R, Pelka M, Petschelt A, Lohbauer U. In vitro wear gap
Effect of double-application or the application of a hydropho- formation of self-adhesive resin cements: A CLSM evaluation. J
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66 QDT 2011
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