Self-etch Approach (Etch-and- Dry)

1- Classification according to their acidity or etching aggressiveness:

► Strong ► such as Adper Prompt-L Pop (3M ESPE), produce rather deep demineralization
(pH > 1),
effects in both enamel and dentin.
►The interfacial ultramorphological features promoted by these adhesives on
dental substrates resemble those of etch-and-rinse systems.
►the products originated from demineralization are not rinsed away.

►Intermediate

(pH ≥ 1.5)
► Mild (pH ☻It demineralizes dentin only partially, leaving a substantial amount of
=2). hydroxyapatite crystals around the collagen fibrils→ possible additional
chemical interaction.
☻This twofold bonding mechanism (i.e. micromechanical and chemical adhesion)
is believed to be advantageous in terms of bonding effectiveness and durability.
☻The hybrid layer formed by such adhesives is no deeper than 1 um and resin
tags are hardly observed. (neither the thickness of hybrid layer, nor the
length of resin tags seems to be important for the achievement of
bonding effectiveness and stability.)

►Ultra-mild ♫ A more recent self-etch adhesive presents a relatively low acidity and,
(pH=2.7). consequently, a considerably reduced ability to dissolve the smear layer and
demineralize the underlying dentin surface.
♫ This ultra-mild self-etch adhesive, Clearfil S3 Bond (Kuraray) can only very
superficially expose collagen on dentin, creating a characteristic nanometer-sized

hybrid layer, which has been termed a “ nano-interdiffusion zone ”.

♫ However, the key factor in this ultra-mild adhesive is related to the presence of
10-MDP in its composition and its consequent ability to chemically bond to the
mineral content of the partially demineralized dentin.

♣ self-etch adhesives interact with the smear layer rather than eliminating it→their acidic potential
may be buffered by the mineral content of a thick and dense smear layer→ poor interaction with
underlying substrate.
♣ the less acidic the adhesive → the more the smear layer → interfere with bonding. Therefore,
techniques and instruments that produce thinner and less compact smear layers should be preferred
during cavity preparation.
♣ Finishing the cavity walls with an extra-fine diamond instrument →in thinner smear layers →
promote a better interaction between mild and ultra-mild self-etch adhesives and the dental substrate.
♣ some self-etch adhesives bond reasonably well to ground enamel, but there are general concerns
nowadays about the adhesion of such adhesives to unground aprismatic enamel where
micromechanical retention is hardly achieved → preparing beveled cavosurface margins is helpful for
 improving the bonding effectiveness of self-etch adhesives in cavities whose margins are placed in
enamel
2- Classification According to Steps of Application
♫ Some self-etch systems are most accurately described as non-rinsing conditioners or

self-priming etchants.
♫ Acidic primers include a phosphonated resin molecule that performs two functions
simultaneously→etching and priming of dentin and enamel.
♫ The bonding mechanism of self-etch primer (SEP) is based on→ the simultaneous
etching and priming of enamel and dentin → forming a continuum in the substrate
1.Two-Step Self- and incorporating smear plugs into the resin tags In addition to simplifying the
Etch Systems bonding technique,
♫ ADVANTAGE
1-the elimination of rinsing and drying steps → reduces the possibility of
overwetting or over drying, either of which can affect adhesion adversely.
2-less technique sensitive than are etch-and-rinse adhesives
3-do not remove the smear layer from dentin completely (, which is the main
reason that they might result in less postoperative sensitivity compared with
etch-and-rinse adhesives.
♫One disadvantage of SEPS : they do not etch enamel as well as phosphoric acid,
particularly if the enamel has not been instrumented. The seal of enamel margins in
vivo might be compromised

♣ Continuing the trend toward simplification, no-rinse, self- etching materials that
incorporate the fundamental steps of etching, priming, and bonding into one
solution have become increasingly popular.
♣ These one-step self-etch or "all-in-one" adhesives contain: uncured ionic
monomers that contact the composite restorative material directly.
♣ One-step adhesives tend to behave as semi-permeable membranes → resulting in a
hydrolytic degradation of the resin-dentin interface.
♣ Because these adhesives must be acidic enough to be able to demineralize enamel
and penetrate dentin smear layers, the hydrophilicity of their resin monomers,
(usually organophosphates and carboxylates), also is high.
2. One-Step ♣ Some of these resin monomers are too hydrophilic → liable towater degradation.
Self-Etch Concerns about One-step Self-etch Adhesives
Adhesives ►Attempting to provide faster and thus more user-friendly adhesives,
manufacturers have introduced one-step self-etch adhesives which etch, prime and
bond the dental substrate simultaneously.
►For this purpose, these adhesives have been made more acidic and more hydrophilic

than their two-step counterparts → a wide variety of seemingly unrelated problems

that may jeopardize the effectiveness and stability of adhesion to a dental substrate.
♣ Actually, none of the contemporary all-in-one adhesives can compete with the more
traditional multi-step systems in terms of bond effectiveness and durability.
♣ One of the main disadvantages of one-step self-etch adhesives is related to their
excessive hydrophilicity that makes the adhesive layer more prone to attract water

from the intrinsically moist substrate

 EXPANDED CLINICAL INDICATIONS FOR DENTIN ADHESIVES
►Treatment of Dentin Hypersensitivity
Dentin hypersensitivity is a common clinical condition that is difficult to
treat because the treatment outcome is not consistently successful. Dentin
hyper sensitivity will be discussed in details in chapter 9.
►Bonded Amalgam Restorations
Postoperative sensitivity, marginal discoloration and recurrent carious
lesions are potential consequences of the penetration of oral fluids and
bacteria through gaps at the dentin resin interface toward the pulp. With
amalgam restorations, delayed interfacial marginal leakage occurs at the
amalgam-tooth interface. Corrosion products from amalgam seal the
interface after a few months; however, this process may take more than 6
months for copper-rich amalgam alloys, such as the spherical and blended
ER
amalgam alloys currently used in dentistry. High-copper amalgam alloys
undergo a much slower corrosion process than conventional amalgam alloys
because of the elimination of the y2 phase.
To help overcome the inevitable marginal microleakage, the use of dentin
adhesive systems has been proposed for amalgam restorations, and some
laboratory and clinical studies have shown that resin-based adhesives can
be used to bond amalgam restorations.
The attachment mechanism between the adhesive and the amalgam is not
fully understood, but it may be micromechanical entanglement of the
uncured adhesive material with the setting amalgam mix during
condensation of the amalgam. The bonding mechanism might depend on
178
the type of amalgam used (e.g. spherical amalgam alloys typically have
higher bond strengths than dispersed phase or admixed amalgam alloys).
The earliest shear bond strengths between amalgam and dentin were
reported to range from 3 to 5 MPa. Other studies have shown, however,
that some current adhesive systems provide initial bond strengths ranging
10 to 14 MPa. Nevertheless, primary mechanical retention features
wol
ve still recommended when an adhesive system is used with amalgam
because it is unclear whether the initial bonds would he maintained at an
adequate level over years of clinical service,.
The use of adhesive systems beneath amalgam restorations might reduce
marginal leakage and improve marginal integrity of the restoration
compared with the use of a copal varnish. Despite anecdotal evidence to
the contrary, however, post-operative sensitivity may be one clinical
parameter that dentin adhesives do not improve over the rise of copal
varnishes. Another potential advantage from the use of dentin adhesives
under amalgam restorations is that the residual tooth structure becomes
more resistant to fracture than when teeth are restored with a copal
varnish and amalgam. Any reinforcing effect may not be as evident for wide
tooth preparations as for narrow tooth preparations.
►Indirect Adhesive Restorations
Some current dentin adhesive systems are considered as uniyersal
adhesives because they bond to various substrates besides dentin
Developments in adhesion technology have led to new indications for
bonding to tooth structure, such as indirect ceramic and resin- based
restorations (crowns, inlays, onlays, and veneers). The use of a universal
adhesive system in conjunction with resin cement provides durable bonding
of indirect restorations to tooth structure.
Ceramic restorations (with the exception of aluminous-core porcelains,
such as In-Ceram High Strength Ceramic [Vita Zahnfahrik, Bad Sdckingen,
Germany] and zirconia-core porcelain such as Lava [3M FSPF., St. Paul,
Minn]) must be etched internally with 6% to 10% hydrofluoric acid for 1 to
2 minutes to create retentive microporosities analogous to those that occur
in enamel on etching with phosphoric acid. Hydrofluoric acid must be
rinsed off carefully with running water for at least 2 minutes.
08T
After rinsing off the hydrofluoric acid and drying with an air syringe, a
silane coupling agent is applied on the etched porcelain surface and air
dried. The coupling agent acts as a primer because it modifies the surface
characteristics of etched porcelain. Because etched porcelain is an
inorganic substrate, the coupling agent makes this surface more receptive
to organic materials, the adhesive system and composite resin cement.
Indirect composite restorations also can he bonded to etched dental
substrates using a universal adhesive system and a resin luting cement. One
of the great advantages of indirect composite restorations is the
polymerization shrinkage occurs outside the mouth. Additionally, the
181
degree of monomer conversion is higher for indirect resin-based
restorations.
This increased level of double bond conversion results however, in only a
tew monomer double bonds on internal surface of the indirect composite
restoration decreasing the potential for bonding with the adhesive system
and with the composite luting cement. To overcome this unsuitable
bonding surface, the composite may be treated with surface activators to
re-establish the surface energy (e.g., Composite Activator; Bisco Inc,
Schaumburg, Il, USA)
Another alternative is sandblasting the bonding surface of the indirect
restoration to expose an internal area where more double bonds may be
present. Hydrofluoric acid is contraindicated for heating indirect
composites because it softens some composite materials.
Cast metal restorations traditionally have been cemented with zinc phosphate, polycarboxylate, or glass-
ionomer cements. With the advent of new adhesive techniques, the treatment of the internal surface of the
metal restoration with acids, sandblasting, or tin- plating (for gold) has resulted in high bond strengths
between metal and tooth structure using resin cements.