Recommended Reading List

• New developments in dental adhesion. Perdigao, J. Dental

Clinics of North America. 51(2):333-57, viii, 2007 Apr.
Dental Bonding • A critical review of the durability of adhesion to tooth
tissue: methods and results
results. De Munck,
Munck J.J et al.
al Journal of
Dental Research. 84(2):118-32, 2005 Feb.
Oper 5001 • Dental adhesives of the future. Tay, F. R. Pashley, D. H.
Journal of Adhesive Dentistry. 4(2):91-103, 2002.
• Future directions in bonding resins to the dentine-pulp
Dr. Daniel C. N. Chan complex. Bouillaguet, S.Wataha, J. C. Journal of Oral
Rehabilitation. 31(4):385-92, 2004 Apr.

Interface 1 Adhesive
DENTAL Steps in Forming Good Adhesion
ADHESION
(1) Clean adherend

Adhesive System
or Luting Cement (2) Good wetting

Interface 1 Interface 2
(3) Intimate adaptation
DENTAL
Adherend 1 Adherend 2 JOINT
(4) Bonding –
+
chemical
physical mechanical
ENAMEL, DENTIN > < Composite, Amalgam bonding
bonding bonding
Liner, Base, Cement > < Cast Inlay, Onlay, or Crown (5) Good curing
Post and Core > < All-Ceramic Inlay, Onlay, or Crown
Dental Amalgam > < Veneers, Maryland Bridges
Implant > < Orthodontic Brackets
© 2004, Bayne and Thompson, UNC School of Dentistry.
© 2004, Bayne and Thompson, UNC School of Dentistry.

© 2004, Bayne and Thompson, UNC School of Dentistry.

BOND STRENGTH TESTING

What are good bond strengths?
4
1 2 3
Macro SBS

SBS
18-35 MPa (typically ≅ 20 MPa)

TBS 10-12 MPa (typically ≅ 10 MPa)

3c
3b
3a µSBS 40-80 MPa (typically ≅ 60 MPa)
3a 3b 3c µTBS 40-80 MPa (typically ≅ 60 MPa)

µTBS
© 2004, Bayne and Thompson, UNC School of Dentistry.

1
 PERFORMANCE FACTORS
5 Categories of Factors Affecting Performance
Microtensile Bond Strength Testing and
(1) OPERATOR Failure Analysis of Hybrid and Flowable
Technical ability, Age, Eyesight, ...
Composites
(2) DESIGN
SL, Bevels, Outline Form, ….
Jones, Cindy T./Chan, Daniel C. N./Pashley, David/
(3) MATERIALS Fernando de Goes, Mario/Nelson, Steven K.
Composition, Product age, T, %RH, ...

(4) INTRAORAL LOCATION

Anterior-Posterior, Maxillary-Mandibular,
Lingual-Facial, Premolar-Molar, Tooth Flexure, ...

(5) PATIENT
F-exposure, Diet, Oral Hygiene IQ, Caries Risk, ... J Adhes Dent 8 (2006), No 1
© 2004, Bayne and Thompson, UNC School of Dentistry.

ENAMEL MICROSTRUCTURE
Quick Review
DENTIN / SBMP / Z100

1. Conditioning
2. Priming
3. Bonding

.
0 10 30 40

Shear Bond Strength (MPa + s.d.)

© 2004, Bayne and Thompson, UNC School of Dentistry.

ENAMEL BONDING SYSTEMS

89v/o HA,
Advantages of enamel etching
6% Organic,
5% Water
increases surface area
FROSTY
APPEARANCE increase wettability
increase retention
decrease marginal leakage
and stain
SBS = 20 MPa

2
Enamel surface morphology

Featureless
Types 1, 2 and 3
Cli i l
Clinical significance:
i ifi
prismless deciduous &
aprismatic cervical enamel

Ideal dentin bonding agent

biocompatible
bond instantly
retentive to dentin
bond strength > polymerization
shrinkage
bond strength > thermal expansion
does not hydrolysis

Advantages of enamel etching

increases surface area
increase wettability
95
Compositon of Enamel and Dentin by
Weight and Volume
increase retention
100
90 86
80
70
60
70

50 Inorganic
decrease marginal leakage
50 Organic
40
30
20
18
12 12
2525
Water
and stain
10 4 1 2
0
Enamel Dentin Enamel Dentin
Wt % Wt % Vol % Vol %

3
• Acid etching of enamel increases retention
and adaptation of resin restorations by:
• 1. increasing the surface area
2. conditioning the surface for better wetting
3. creating surface irregularities for better
mechanical locking
4. producing enamel irregularities ranging
from 5-30 micrometers in depth
•
• A. 1, 2 and 4
• B. 1 and 3
• C. 2 and 3
• D. all of the above

DENTIN MICROSTRUCTURE
Resin/etched enamel interface Quick Review

wettability: increase
Dentin
Zones ?
contact angle: decrease
critical surface tension: 3 v/o

low surface tension; high 28 v/o

surface energy

Dentin is a living tissue!

diameter of tubules: 2.5

microns at the pulpal side,
0.5 micron
i at DEJ

30,000 tubuli per square mm

in the middle

4
As a function of depth or different
regions within the same tooth
Intertubular dentin: 96% of superficial dentin;
2% near the pulp
Peritubular dentin: 3% of superficial
Dentinal fluid: 1% of superficial
p dentin;;
22% near the pulp

Chan

Degree of mineralization
Methods to achieve dentin bonding
Sclerotic dentin Chelation to hydroxyapatite
Young dentin Bonding to collagen
E
Entanglement
l through
h h
1. Occlusion of the tubules by mineral
crystals
polymerization with intact
2. Contain a hypermineralized surface that
resists the etching action of both self-etching
collagen matrix
primers and phosphoric acid.
3. Bacteria are often detected (hybrid layer, interdiffusion
Resin bonding to cervical sclerotic dentin: a review. Tay, F.
R. Pashley, D. H. Journal of Dentistry. 32(3):173-96, 2004
Mar.
zone)

Goals of acid etching dentin Disadvantage of etching dentin

Remove the intrinsic weakness of the S.L.
Demineralize the superficial dentin matrix
Increase in dentin permeability; increased
Uncover both intertubular and peritubular outward flow of fluid ~96%
dentin Increase in dentin wetness
Acid--exposed collagen
Acid
Smear layer and plugs Increased potential for pulpal irritation
Potential for denaturing of collagen
Discrepancy between depth of
demineralization and depth of resin
Vargas Van penetration
Meerbeek

5
 Smear layer (S.L.) and bonding
The buffer capacity of dentin
is adequate
q to pprotect itself and
the pulp from transient acid attack
Reduces dentin permeability
Weak cohesive strength
Easily removed by acids
Most primers can alter the S.L.
and increase the micromechanical
penetration and attachment to the
dentin surface

Intra- and Intertubular Permeability

Micromechanical retention by the interdiffusion of the

adhesive resin system into an acid-
acid-exposed collagen
network on the surface of the dentin ⇒ hybrid layer

Diffusion of Different Sizes Monomer Wet & Dry Bonding

Collapsed of the fully demineralized zone (red)

Smaller molecules diffuses faster

6
 Surface roughness
Resin tags
Hybrid layer

Total Etch Systems Self--Etching Adh

Self
E+nP
E+nP+B Æ E+n
Designing Bonding
E+nP
PB P+B Æ nE
Systems
or nEP
nE nEP
PB nP + B Æ E + nP
E + nP nPB nEP + B Æ nE
or nEP nEP
PB
Self-Etching
Self- Self-Etching
Self- Self--Etching Primer
Self
Primer Adhesive

US Companies Japanese Companies B= B=

hydrophobic “restorative material” Bis-GMA, TEGDMA
Bis- MMA, Bis-
Bis-GMA, TEGDMA,
Acetone or Alcohol (Polymers),
Acetone or Alcohol

BONDING =2 nP =
HEMA … ,
HEMA,
nPB =
HEMA … , TEGDMA
HEMA,
2= (Polymers), (Polymers),
Alcohol, H2O, Acet Alcohol, H2O, Acet
AGENT
=1 E= E= nEP = nEP =
1= PRIMER H3PO4,
H2O
H3PO4,
H2O
Acid Monomer,
HEMA,
H2O
Acid Monomer,
HEMA,
Polymer,
(TEGDMA),
ETCHANT
hydrophilic tooth structure
H2O, Alcohol

???
© 2004, Bayne and Thompson, UNC School of Dentistry.
© 2004, Bayne and Thompson, UNC School of Dentistry.

Total--Etch Systems
Total Self--Etch Systems
Self A comparison of contemporary adhesives revealed
E+nP
E+nP+B E+nPB
E+nPB nEP+
nEP +B nEPB
nEP B that the three-step etch-and-rinse adhesives remain
Self-Etching
Self-
Primer
Self-Etching
Self-
Adhesive the 'gold standard' in terms of durability.
hydrophobic

Any kind of simplification in the clinical

Hybrid
Layer
Hybrid
Layer
Hybrid
Layer
Hybrid
Layer
application procedure results in loss of bonding
effectiveness.
effectiveness
hydrophilic

Reliable Bonding No Postoperative Sensitivity

1. Store in the refrigerator and use quickly.

Only the two-step self-etch adhesives
2. Use steel or carbide burs (not diamonds) for dentin
surfaces to be bonded.
approach the gold standard and do have some
3. Apply multiple layers and agitate applicator. additional clinical benefits.
4. SEPs (and SEAs) should be “air dried” >10s, and
“not air thinned.” A critical review of the durability of adhesion to tooth tissue:
© 2004, Bayne and Thompson, UNC School of Dentistry. 3 4
5. Consider H PO etch, as well, if significant methods and results. De Munck, J. et al. Journal of Dental Research.
enamel involved in preparation surfaces.
84(2):118-32, 2005 Feb.

7
Total-etch three-step Total-etch two-step
– Clearfil New Bond (Kuraray) – Single Bond (3M)
1978* – Optibond Solo (Kerr)
– Scotchbond Multi
Multi--Purpose (3M) – Prime&Bond* and 2.1 and NT (Caulk)

– Optibond (Kerr)
– All
All--Bond 2 (Bisco) 1 2
1 2 3
prime
etch &
bond
etch prime bond

Self--etch one-
Self one-step

Prompt L-
L-Pop* (ESPE)

etch
&
prime
&
bond

ADHESIVE

PRIMER

8
 Prime and bond NT unit dose Prime and bond NT unit dose
Immediately apply generous
amounts of Prime&Bond NT Gently air dry for 5 seconds.
adhesive to thoroughly wet the Surface should have a uniform
tooth surfaces. glossy
l appearance

These surfaces should remain wet

Light cure Prime&Bond NT
for 20 seconds, which may
necessitate applying additional adhesive for 10 seconds.
adhesive.

Formation of a hard tissue barrier after pulp

cappings in humans. A systematic review
Marginal leakage, a persistent problem when
Olsson H. Petersson K. Rohlin M. International
bonding resin to dentin, can result in which of
Endodontic Journal. 39(6):429-42, 2006 Jun.
the following?
• To evaluate the evidence on the formation of a
hard tissue barrier after pulp capping in humans. A. sensitivity
171 publications; 21 studies. B. marginal staining
• The majority of studies on pulp capping using C. recurrent caries
calcium hydroxide based materials reported D. all of the above
formation of hard tissue bridging, studies on other E. none of the above
pulp capping materials such as bonding agents
presented inferior results.

Which of the following is/are true of

the etching solution?
The current consensus is that dentin bonding
agents bond primarily _______________ to
1. Is usually 37% phosphoric acid solution or
tooth structure. gel
2. Is allowed to over-etch the immediate vicinity
A. chemicallyy of the fissure
B. mechanically
3. Is applied liberally to the central fissure area
C. via hydrogen bonding but not allowed to contact other surfaces of
D. by fusion the tooth
4. Is left on the tooth for 60 seconds and then
rinsed away with water for 15 seconds.