Bonding to Enamel & Dentine

Compositional and structural aspect of

enamel and dentine
The inorganic content of enamel is 95% to 98% by
weight and 86% by volume.
Primary content is hydroxyapetite reminder water 4
%by wt. and 12% by vol.
Organic 1-2% by wt. and 2 %by vol.

The natural surface of enamel is smooth and ends of

rods are exposed ( Key Hole pattern).
Dentine
Dentine contain higher % of water 12% by weight and
organic material 18% , mainly type 1 collagen and 70%
by weight hydroxyappetite
Diameter of tubules decreases from pulp (2.5um) to
DEJ (0.8um).
No of tubule decreases from pulp (45000/mm2) to DEJ
(20000/mm2).
Intertubular dentine is less mineralized
Peritubular dentine is hyper mineralized.
Bonding / Adhesion
Definition:
According to American society for Testing Materials,
‘A state in which two surfaces are held together by
interfacial forces which may consist of valence forces
or interlocking forces or both.’
Adhesives
Material frequently a viscous fluid.
Join two substrate together and solidifies.
Able to transfer a load from one surface to another.
For good adhesion, close contact must exist b/w
adhesive and the substrate (Enamel & Dentine).
Dental adhesive should provide a strong initial bond
to resist the stresses of resin shrinkage.
Types of Adhesion
Mechanical Adhesion:
Interlocking of adhesive with irregularities in the surface of
substrate or adherent.

Adsorption Adhesion:
Chemical bonding b/w adhesive and adherent.

Diffusion Adhesion:
Interlocking b/w mobile molecules, such as Adhesion of two
polymers through diffusion of polymer chain ends across an
interface.

Electrostatic Adhesion:
An electrical doubled layer interface of metal with polymer.
 In dentistry , bonding of resin to tooth surface is a result of
four possible mechanism,

Mechanical----- Penetration of resin and formation of resin

tags within tooth surface.

Adsorption-----Chemical bonding to inorganic component

(hydroxyapetite) or organic components (mainly type I
collagen of tooth).
Diffusion-----Precipitation of substances on tooth
surface to which resin monomers can bond
mechanically or chemically.

Combination of all three process.

Advantages of Adhesive Techniques
Retention and Stabilization of restoration.
Reduces micro leakage at restoration tooth interface.
Reduces Post Operative sensitivity.
Reduces marginal staining.
Reduces recurrent caries.
No additional loss of tooth structure.
Indication of Adhesive Dentistry
Class I, II, III, IV, V, VI carious or traumatic defects.
Veneers, Inlays and Onlays.
Improve retention for metallic crown and PFM crowns.
Bond all ceramic restorations.
Bond indirect resin based restoration.
Seal Pits and Fissures.
Bond Orthodontic brackets and periodontal splints.
Repair existing restoration.
Desensitize exposed root surfaces.
Seal beneath or bond amalgam restoration to tooth surface.
Factors Affecting Adhesion to Tooth
Physiochemical properties of adherent and adhesive.
Structural properties of adherent.
Formation of surface contaminants during cavity
preparation.
External stresses.
Mechanism of transmission and distribution of load
applied through bonded joint.
Surface moisture.
Physical stresses.
Changes in Temperature.
PH.
Dietary components.
Chewing habits.
Beside an intimate contact, sufficient wetting of
adhesive will occur only if the surface tension is less
than surface energy of the adherent.

Wetting of surface by liquid is characterized by the

contact of a droplet placed on the surface. If liquid
spreads completely on the solid surface , this indicate
complete wetting or a contact of 0 degree.
Adhesion to enamel is easier than adhesion to dentine
because enamel contains hydroxyapatite which has high
surface energy, where as dentine has hydroxyapatite and
collagen and has low energy.
Likewise, instrumentation of tooth substrate during
cavity preparation produces a smear layer with a low
surface energy. Therefore, natural tooth surface should
be thoroughly cleaned and pretreated before bonding
procedure to increase its surface energy.
Enamel adhesion
Acid etching transform smooth enamel surface into
irregular and increases its surface energy.
When a fluid resin based material is applied to
irregular etched surface, resin penetrates, added by
capillary action monomer is polymerized and material
become interlocked with enamel results in micro tags
formation.
Application of 30 to 40% phosphoric acid results in
retentive enamel surface. Conc. greater than 40%
seems to dissolves less calcium and poor acid etched
patterns.
Dentine Adhesion
Dentine is intrinsically hydrated tissue penetrates by
1-2.5um diameter fluid filled tubules.
Movement of fluid from pulp to DEJ is a result of slight
pulp pressure.
Adhesion can be affected by remaining dentine
thickness after tooth preparation.
Bond strength are less in deep dentine than
superficial.
When ever tooth structure is prepared with bur,
residual organic and inorganic components form a
smear layer which form smear plugs resulting in
decrease dentine permeability.
The removal of smear layer and smear plug with acid
solution results in increase fluid flow on exposed
dentine which interfere with adhesion.
Vasoconstrictor affect permeability by decreasing
pulpal pressure and fluid flow in tubules.
Smear Layer
0.5-2um thick layer.
Debris , calcific in nature produce by reduction or
instrumentation of dentine , enamel or cementum.
The burnishing action of cutting instruments generate
frictional heat and shear forces results in attachment
of smear layer with underlying surface.
EDTA (brittle in nature) was found effective
conditioner for removing the smear layer and opening
orifices of dental tubules results in increase in
permeability of tubules for bonding.
Adhesive Resin
Bonding agents are equivalent to the former enamel
adhesive agents and consist of hydrophobic monomer
Bis-GMA, UDMA & TEGMA.
A viscosity regulator and hydrophilic monomer such
as HEMA ( wetting agent).It stabilizes hybrid layer and
forms resin extension in dentinal tubules, i.e., Resin
tags.
Resin Tags:
In dentine, smear layer and smear plugs are removed
by acid etching and low viscosity adhesive resin flows
in to the dentinal tubules resulting in the formation of
tags .

Hybridization:
Process of resin interlocking in to the demineralized
dentine surface thereby producing micromechanical
retention in dentine.
 Classificaton Of Adhesives
Adhesive Steps Generation Smear Examples
Layer
removal
OptiBond FL
3 4th Scotch Bond (3M)
Syntac(Vivadent)
Etch and rinse or Complete
Total Etch OptiBond Solo (Kerr)
5th Single Bond 2 (3M)
2 Prime & Bond NT
(Dentsply)

Clear Fill Se Bond

6th Opti Bond Solo + SE
(Kerr)
2
Self-etch Partial Adper Prompt L Pop (3M)
7th AdheSE (Vivadent)
Xenon IV (Dentsply)
OPtiBond All in one
1 8th (Kerr)
Xenon V (Dentsply)
7th and 8th Generation Bonding system
Self etch adhesive.
Etchant, Primer and bonding agent are in same
solution.
Its advantage is that it will penetrate and demineralize
to same depth as the etching, resulting in a fully
supported Hybrid layer, less chances of micro leakage
and post operative sensitivity.
Its disadvantage is that the acidity of the etching /
bonding component will inhibit the amine effect and
thus polymerization of chemically cured composite.
Which one is the Best?
The 3 step ( etching, priming, bonding) system or the
4th generation (2 step) adhesive system, are still the
gold standards, demonstrating the best clinical results
and highest bond strength to enamel and dentine.
Etch and bond should be used when retention of the
restoration is poor. Self etch should be used when
retention is not an issue.
Thank you