Principles of Adhesion

Dr.Ghada Maghaireh

Background
 1950’s: Michael Buoncore found that applying acid to teeth
render the tooth surface more receptive to adhesion.
 1960’s: First commercial restorative resin composite.
 1970’s: Introduction of the acid-etch technique in clinical practice.
 Etching of the enamel surface by phosphoric acid to which resins
can bond.
 Since then, more improvement in restorative composites along
with improvements in bonding agents.

Adhesion
 Adhesion: Adhaerere “to add or to stick”.
 Adhesion or bonding is the attachment of one substance to
another.
 Adhesive or bonding agent: the material that is applied to the
surface of substances to join them together. (i.e. tooth surface
and resin composite).

Factors Affecting Adhesion to Tooth Tissue

 Compositional and structural aspects of enamel and dentin.
 Changes in dentinal structure.
 The smear layer.
 Internal and external dentinal wetness.

Compositional and Structural Aspects of Enamel and Dentin

 Enamel has high inorganic content (88% by volume).
 Enamel is homogenous in structure and composition irrespective
of its depth and location.
 Dentin has less inorganic content(50% by volume) and more
water (25%).
 Dentinal tissue is heterogeneous.
 Dentin is a vital and dynamic tissue.
 Dentinal tubules size and number increases from the DEJ to the
pulp side.
 Dentinal fluid is under a constant outward pressure from the pulp.

The Smear Layer

 Any debris, calcific in nature, produced by reduction or
instrumentation of dentin, enamel or cementum.
 The thickness of the smear layer vary from 0.5 to 5 µm.
 This layer of debris has a great influence on any adhesive bond
formed between the cut tooth and the restorative material.
 The smear layer can be removed by ethyl-enediaminetetraacetic
acid (EDTA), and by acidic conditioners (citric, polyacyclic, lactic
and phosphoric acids).
 Although smear layer occlude the dentinal tubules, it is porous
and allow small amount if dentinal fluids to pass through .

Internal and External Dentinal Wetness

 Remove of the smear layer creates wet bonding surface on
which dentinal fluids exudes from the dentinal tubules.
 This wet environment affects adhesion, because water competes
by hydrolysis for all the adhesion sites on the hard tissues.
 Bond strength of several adhesive systems decrease as the
depth of the preparation increased because dentinal wetness is
greater.
 External humidity or environmental humidity can also affect the
bond strength.

Wetting of the Adhesive

 Adhesive systems must sufficiently wet the tooth surface: have a
viscosity that is low enough to penetrate the micro porosities and
be able to displace the moisture and air during the bonding
process.
 HEMA (2-hydroxyethyl methacrylate) is a surface active agent
that enhance the wettability of the adhesive resins.
 Enamel Acid -Etching Techniques
 Enamel etching transform the smooth enamel surface to an
irregular high surface-free energy.
 Acid etching remove 10µm of the enamel surface and creates a
microporous layer from 5 to 50 µm deep.
 The enamel bonding agent wet the etched enamel surface and
pass through the microporosities.
 The bond between the bonding agent and the enamel is
micromechanical.
 The bond between the bonding agent and resin composite is
chemical.

Enamel Etching Patterns

 Two types of resin tags:
 Macrotags: Form circularly between enamel prism peripheries.
 Microtags: Form at the cores of enamel prisms.

Enamel Bonding Agents

 Based on bis-GMA or urethane dimethacrylate (UDMA).
 Diluted with a lower viscosity and higher hydrophilicity monomers
such as (TEG-DMA) and (HEMA).

Etching with Phosphoric Acid

 Phosphoric acid 30% to 40%.
 Etching time is not less than 15 seconds.
 Washing time 5 to 10 seconds.
 Acid gel is preferred over liquid.
 Adhesion to Dentin
Development of Resin Dentin Adhesives
 First generation adhesives:
 Very weak bond
 Only 2 to 3 MPa
 This bonding agent bonded to enamel and dentin by
chelation to calcium

 Second generation adhesives:

 Moderate bond strength
 5 to 6 MPa
 Primary bonding was to the smear layer

 Third-Generation Adhesives:
 Early 1980’s.
 Removal of the smear layer.
 Total etch concept.
 Scotchbond 2.

 Fourth-Generation Adhesives:
 Early to mid 1990’s.
 Multiple dentin adhesives.
 Treatment of dentin by primer ( make dentin more
receptive to adhesion).
 Application of low viscosity adhesive resin.
 Adhesive system replace bonding agent.

 Fifth-Generation Adhesives:
 Simpler adhesive system than fourth-generation
 Bond strength is comparable to fourth-generation
 adhesives
 One-bottle adhesive (primer + adhesive)
  Sixth-Generation Adhesives:
 Slightly acidic primers or self-etching adhesives.
 Possibility of single-dose package.
 No post conditioning rinsing.

Conditioning of Dentin
 Any chemical alteration of the dentinal surface by acids with the
objective of removing the smear layer and simultaneously
deminerlizing the dentinal surface.
 The deminerlization process expose the collagen fibrils and thus
increase the microporosities of the intertubular dentin.
 Conditioners are applied to enamel and dentin (Total-etch
technique).
 The demineralization process exposing the collagen fibrils affect
the surface-free energy of dentin.

Dentin Primers
 Primers are adhesion-promoting agents.
 Contain hydrophilic monomers dissolved in organic solvents such
as acetone or ethanol.
 Those solvents are volatile and so can displace water from the
dentinal surface and collagen network.
 This promote infiltration of the monomer of the adhesive in the
nanospaces of the exposed collagen network.
 Primers have hydrophilic properties that have affinity to the
collagen fibrils and hydrophobic properties to copolymerize with
the adhesive resin.
 Many Modern adhesives have HEMA as a primer and contain
other monomers.
 One-bottle adhesives: combine priming and bonding function.
 Adhesive Resin
 Consist of hydrophobic monomers such as GMA and UDMA and
hydrophilic monomers such as TEG-DMA and HEMA as wetting
agent.
 Adhesive resin stabilize the hybrid layer and form resin
extensions into dentinal tubules (resin tags).
 Self cured or light cured adhesive.
 Light cure the adhesive before the application of the resin
composite.
 Oxygen inhibited layer on top of adhesive provide sufficient
double bonds for copolymerization with the resin composite.

Hybridization
 Hybrid layer is the area or zone of the adhesive system which
micromechanically interlocks with the dentinal collagen.

Resin Tag Formation

 Penetration of the resin to the dentinal tubules to form resin tags.
 Resin infiltrates even lateral tubule branches forming submicron
resin tags.
 The contribution of formation resin tags to bond strength has
been a matter of speculation.

Adhesion Strategies- A Scientific Classification of Modern

Adhesives
 Depends on the number of application steps and on their
interaction with the dentinal substrate.

 Smear Layer-Modifying Adhesives.

 Smear Layer-Removing Adhesives.
 Smear Layer-Dissolving Adhesives.
 Smear Layer-Modifying Adhesives
 Based on weak acidity smear layer-modifying primers.
 The smear layer is not removed that provides a natural barrier to
the pulp.
 The interaction of theses adhesives with dentin is very
superficial, with only limited penetration into dentin.
 Selective etching of enamel in a separate step.

Smear Layer-Removing Adhesives

 Most common adhesives.
 Removing of the smear layer using the total-etch concept.
 Formation of hybrid layer and resin tags.
 Three-step smear layer-removing adhesives (Acid etching +
dentin primer + adhesive)
 Two-step smear layer removing adhesives or one-bottle
adhesives (Acid etching + primer & adhesive)

Smear Layer-Dissolving Adhesives

 Smear layer dissolving adhesives or self-etching adhesives.
 Slightly acidic primers or self-etching adhesives.
 Partially demineralize the smear layer and the underlying dentin
with simultaneous resin infiltration.
 Possibility of single-dose package.
 No post conditioning rinsing.
 Insufficient long term studies.

Critical Steps in Adhesion.

 Isolation
 Dentin and pulp protection
 Enamel and dentin conditioning
 Wet Vs Dry Bonding
 Primer application
 Adhesive resin application
 Restorative procedure

Isolation
 Isolation and moisture control is very critical for the bonding
procedure.
 Bonding to acid etched enamel requires a dry surface to allow
the bonding resin to flow into the microporosities created by acid
etching.
 Accidental contamination of the substrate with external fluids
prevent effective contact between the adhesive and the bonding
substrate.
 Salivary contamination is detrimental because salivary proteins
block the microtentive porosities on the acid etched enamel and
dentin and may block infiltration of the resin.

Enamel and Dentin Conditioning

 Phosphoric acid etchant (35%) for both enamel and dentin in one
application.
 Etching time should be for 15 seconds staring with enamel.
 The etchant should be thoroughly rinsed.

Wet Vs Dry Bonding

 After acid etching enamel surface should be dried.
 On dentin, a certain amount of moisture is needed “wet bonding”.
 Dehydration of the acid-etched dentin surface through air drying
can result in collapsing and shrinkage of the exposed collagen
fibril network which can prevent resin infiltration.
 On the other hand the acid-etched dentin surface should not be
kept too wet.
 Excess water should be removed with a short air blast or with a
dry sponge.
 Primer Application
 The primer should be applied for at least 15 seconds.
 Primer should be actively rubbed into the dentin surface with
disposable brush or sponge applicator.
 After short and gentle air drying the primed surface should
appear glossy.

Adhesive Resin Application

 Spreading of the adhesive layer to the bonded surface should be
done by a brush.
 The adhesive should be light cured for 20 seconds before the
application of the restorative resin composite.

References: Chapter #8 of The Fundamentals of Operative Dentistry.