Dentin Bonding Agents

CONTENTS
INTRODUCTION
ROLE OF ADHESIVE DENTISTRY
CONCEPT OF ADHESION
ENAMEL ADHESION
DENTINE ADHESION
CHALLENGES IN DENTINE
ADHESION

ENAMEL BONDING
STEPS FOR ENAMEL BONDING
MECHANISM INVOLVED
DENTINE BONDING
CONDITIONING OF DENTINE
PRIMING OF DENTINE

DENTINE BONDING AGENTS

CLASSIFICATION
GENERATIONS OF BONDING AGENTS
FIRST GENERATION
SECOND GENERATION
THIRD GENERATIONS
FOURTH GENERATION
FIFTH GENERATION
SIXTH GENERATION
SEVENTH GENERATION
ROLE OF MICROLEAKAGE
BIOCOMPATIBILITY
ANTIBACTERIAL PROPERTY
CLINICAL FACTORS IN DENTINE ADHESION
NEWER CLINICAL INDICATIONS OF DENTINE
ADHESIVES
DESENSITISATION
ADHESIVE AMALGAM RESTORATIONS
INDIRECT ADHESIVE RESTORATIONS

FAILURES IN DENTINEBONDING
SUMMARY
BIBLIOGRAPHY
 INTRODUCTION
There is much interest and activity in dentistry today with dentin bonding
agents.
In the modern society, aesthetics has become a major concern for every
individual .Thus most of us desire for a perfect set of teeth.

Therefore, teeth that have been deformed or ravaged by dental diseases

need to be restored to their natural form and colour.
Moreover, the classic concepts of tooth preparation advocated in the early
1900s have changed dramatically.
Now more focus is laid upon conservative approach to the tooth
preparation.

Therefore the introduction of adhesive restorative materials has reduced

the need for an extensive tooth preparation.

In order to successfully accomplish this, dentin bonding systems have

been introduced which bond the composite resin to the tooth structure.
DEFINITION
Adhesion is derived from Latin meaning "a state in which two surfaces are
held together by interfacial forces like valence forces or interlocking forces
or both".

(The American Society for Testing and Materials)

Thus for the process of adhesion to occur , we need to understand therole of
following components:

ADHESIVE

ADHEREND

ADHESIVE STRENGTH
 ADHESIVE is defined as a material , frequently a viscous fluid that
joins two substrates together by solidifying , resisting separation &
transferring a load from one surface to the other.

ADHEREND is defined the surface to which an adhesive adheres.

ADHESIVE STRENGTH is the measure of the load-bearing capacity of an
adhesive joint.
Therefore the development of resin based restorative material has opened
new vistas to a more conservative approach to caries management.
MECHANISM OF ADHESION:

MECHANICAL

ADSORPTION COMBINATION

DIFFUSION
INDICATIONS FOR ADHESIVE DENTISTRY

Restoration of class 1,2,3,4,5,6 carious lesions

Change the shape & colour of anterior teeth(using full or partial veneer )
Seal pits and fissures
Bond orthodontic brackets
Desensitize exposed root surfaces
Bond amalgam restorations to tooth
Bond fractured segments of anterior teeth.
Bond pre-fabricated fibre or metal posts and cast posts.
Seal root canals during endodontic therapy.
ENAMEL ADHESION
 In 1955,Michael Buonocore described a clinical technique that used a diluted phosphoric acid to
etch the enamel surface to provide retention of unfilled, self-cured acrylic resins.

 The resin would mechanically lock to the microscopically roughened enamel surface, forming
small "tags" as it flowed into the 10-µm to 40-µm deep enamel microporosities and then
polymerized.

 The first clinical use of this technique was the placement of pit and fissure sealants.

 The formation of resin micro tags within the enamel surface is the basis of RESIN-ENAMEL
ADHESION.
 The steps involved are:
Acid etching transforms smooth enamel into an irregular surface & increases its free surface
energy

Application of a fluid resin based material to the irregular etched surface , facilitates
penetration of the resin into the surface aided by capillary action

Monomers in the material are polymerised and the material becomes interlocked with the
enamel surface.
 ETCH PATTERN

Enamel etching leads to the following types of micro morphological

patterns:

TYPE 1 ETCH PATTERN-dissolution of prism cores without involvement of

prism peripheries.
TYPE 2 ETCH PATTERN-PERIPHERAL ENAMEL IS DISSOLVED , but
the cores are left intact.
TYPE 3 ETCH PATTERN-it is less distinct than the other two patterns.
 ETCHANT CONCENTRATION
Buonocore used 30-40% phosphoric acid.

Currently,37% phosphoric acid in gel form is used.

Silverstone found that the application of 30-40% phosphoric acid resulted
in a very retentive enamel surface.
>40% - Calcium salts are less dissolved - ETCH patterns with
poorer definition.

<27% - Formation of dicalcium phosphate dihydrate -

cannot be easily removed by rinsing.
 ETCH TIME

Currently, an etching time of 15 seconds is used.

An etching time of 60 seconds originally was recommended for

permanent enamel using 30-40% phosphoric acid.

However , studies show that a 15 second etch resulted in a similar

surface roughness as that provided by a 60 second etch.
Phosphoric acid is said to be a more aggressive acid,so alternative etchants have
been suggested:
EDTA (24%; ph=7)
Citric acid
Tannic acid
Maleic acid
Polyacrylic acid

ALTERNATE ETCHANT SYSTEMS:

Lasers
Air abrasion-Al2O3 particles
 LASERS

Adhesion to dental hard tissues after Er:YAG laser etching is inferior to that
obtained after conventional acid etching.

Enamel and dentin surfaces prepared by Er:YAG laser etching show

extensive subsurface fissuring that is unfavorable to adhesion.

(J Prosthet Dent 2000;84:280-8.)

Adhesion to laser-ablated or laser-etched dentin and enamel was inferior

to that of conventional rotary preparation and acid etching.

( Dental Materials (2005) 21, 616–624)

Figure 1 Scanning electron microscopic images of dentin: (A)
rotary-prepared and acid-etched (3500!),
(B) laser-prepared (9000!), and (C) laser-prepared and then acid-
etched (3500!).

(Fig. 1A) revealed a smoothsurface with tubule orifices

devoid of smear plugs.
The intertubular dentin is undisturbed.

In contrast, SEM of a cross-section of

laser-ablated, laser-etched dentin showed a highly
irregular surface and fissuring. Areas of poor hybridization
between composite and dentin suggest poor hybridization,
or no hybridization.

Laser-prepared dentin revealed surface scaling and

flaking, along with peritubular cuffing (Fig. 1B). Acid-
etching after
laser ablation appeared to decrease some of the surface
scaling and flaking (Fig. 1C).
Figure 3 Separation of resin adhesive and
unaffected subsurface dentin from laser-
ablated, then acid-etched dentin.

Laser ablated,acid-etched dentin

demonstrated areas of detachment
From both the resin adhesive and the
unaffected subsurface dentin (Fig. 3).
SEM photographs of 37% orthophosphoric acid, 10% maleic
acid, and Er,Cr:YSGG hydrokinetic laser-treated enamel are
shown in Figure 4.

The enamel surface etched with 2 acid solutions and a laser

system showed different results according to Silverstone’s10
etching patterns.

• The 37% orthophosphoric acid removed the periphery core

material but left the prism core relatively unaffected (type II),
producing a very rough enamel surface.
• The 10% maleic acid treatment resulted in preferential
removal of prism core material and left the periphery intact
(type I).
• Er,Cr:YSGG hydrokinetic laser treated enamel showed a
more random etching pattern in which adjacent areas of tooth
surface correspond to types I and II, mixed with regions where
the pattern could not be related to prism structure. There was
no recrystallization or melting observed
BOND STRENGTH

Shear bond strength of composite to phosphoric acid etched enamel

exceeded 20 Mpa.

According to studies,a minimum of 17-21MPa of bond strength is needed

to prevent the disruption of the bond between the tooth and composite.
 DENTIN ADHESION

Bonding to dentin is challenging & difficult.

Adhesion to dentin occurs by mechanical method,chemical or both.

But the main method is by penetration of adhesive monomers into collagen

fibrils which are exposed post acid etching.
Structural differences exist between enamel & dentin.

Therefore the following reasons account for challenges faced in dentin

adhesion:
STRUCTURE OF DENTIN
SMEAR LAYER
STRESSES AT RESIN-DENTIN INTERFACE
STRUCTURE OF DENTIN

Enamel contains 90% of hydroxyapatite crystals whereas dentin has only

50% and the rest is constituted by water(25%) and type I collagen(25% by
volume).

Dentinal tubules exert pressure of 25-30mmHg, thus creating decreased

stability of bond between composite resin and dentin.

The number of dentinal tubules decreases from about 45000 near the pulp
to 20000 near DEJ
Also the tubule diameter decreases from 2.37µm to 0.63µm near DEJ.
Adhesion can also be affected by remaining dentin thickness(RDT) as
bond strength is greater for superficial dentin and its lesser for deeper
dentin
WHAT IS SMEAR LAYER?

It is the residual organic or inorganic components formed when a tooth is

prepared using a bur or other instrument.
(Sturdevant’s Art & Science of operative dentistry,4th edition)

It is 1-10 µm thick .
 COMPOSITION OF SMEAR LAYER:

According to SEM studies done by Shulien TM(1988),it consists of:

 Small particles of mineralized collagen matrix
 Inorganic tooth preparation
 Saliva
 Blood
 Bacteria

According to branstroem,the organic component consisted of coagulated

proteins from collagen denatured by frictional heat of cutting.
 Therefore optimal bonding can occur by:

A. Removal of smear layer by using etch and rinse adhesives.

B. Incorporation of smear layer into bonding layer by self-etch adhesives

Complete removal of smear layer increases the dentin permeability by 90%.
DENTINE BONDING AGENTS

It is defined as ”a thin layer of resin applied between conditioned dentin and resin
matrix of a composite.”
The term dentine bonding agents is no longer relevant as current bond agents bond to
enamel and dentine.

Due to acid –etching ,micro leakage or loss of retention is not a hazard at the resin-
enamel interface but its encountered at the resin-dentine interface.
Due to the differences in the composition of enamel and dentine,developing agents
that will adhere to dentine was challenging due to the following reasons:

The high water content interferes with bonding.

Presence of a smear layer on the dentine surface.
Therefore the bonding agent should be hydrophilic to displace the water
,permitting it to penetrate the porosities in dentine and react with the
inorganic/organic components.

But, restorative resins are hydrophobic, therefore the bonding agent should
contain both hydrophilic and hydrophobic components.

The hydrophilic part bonds with either calcium or collagen whereas the
hydrophobic part bonds with the restorative resin.
 CONDITIONING OF DENTIN

It is the etching of dentin surface with acids or calcium chelators.

So, when acid is applied to it, dissolution of hydroxyapatite crystals in
intertubular dentin and outer surface of peritubular dentin occurs

Ultimately, the smear layer gets removed and collagen fibrils are exposed.
Materials used are: 37% phosphoric acid
nitric acid
citric acid
EDTA(ethylene diamine tetra-acetic acid)
DURATION OF ETCHING ON DENTIN

Ideal duration is 15-20 seconds.

Increased duration: greater collapse

of collagen due to denaturation.
Decreased monomer infiltration.

Decreased duration: insufficient

depth of etching.
PRIMING OF DENTIN

It is the process of applying primers to the etched/conditioned dentin

surface to improve the diffusion of the adhesive resin into moist and
demineralized dentin

Primer solution is a mixture of monomers with hydrophilic and hydrophobic

components dissolved in organic solvent

Priming agents are HEMA(hydroxyethyl methacrylate) and 4-META(4-

methacryloxyethyl trimellitae anhydride)
 Mechanism of dentine bonding

Acid washing / rinsing

Removes smear layer
Dissolves HA

Drying shrinks remaining

Collagen polymer molecules
Rehydration / priming
Swells collagen
Mechanism of dentine bonding

Monomer polymerisation
And collagen entanglement

Monomer penetration
 CLASSIFICATION
1. HISTORICAL STRATEGIES
 FIRST GENERATION(1965)
 SECOND GENERATION(1978)
 THIRD GENERATION(1984)
2. CURRENT STRATEGIES
 ETCH & RINSE ADESIVES
i. THREE STEP-ETCH &RINSE ADHESIVE(FOURTH GENERATION)
ii. TWO STEP –ETCH & RINSE ADHESIVE(FIFTH GENERATION)
 SELF ETCH ADHESIVES
 TWO COMPONENT –SELF ETCH ADHESIVE(SIXTH GENERATION)
o TWO STEP-TWO COMPONENT –SELF ETCH ADHESIVE
o ONE STEP –TWO COMPONENT - SELF ETCHADHESIVE
 SINGLE COMPONENT-ONE STEP-SELF ETCH ADHESIVE(SEVENTH
GENERATION)
 Current strategies

ETCH & RINSE ADESIVES SELF ETCH ADHESIVES

THREE STEP-ETCH &RINSE ADHESIVE TWO STEP –ETCH & RINSE ADHESIVE
(FOURTH GENERATION) (FIFTH GENERATION)

TWO COMPONENT –SELF ETCH ADHESIVE SINGLE COMPONENT-

ADHESIVE(SEVENTH
( SIXTH GENERATION ) ( SEVENTH GENERATION)

TWO STEP-TWO COMPONENT –SELF ETCH ADHESIVE

ONE STEP –TWO COMPONENT - SELF ETCH ADHESIVE
BASED ON MODERN ADHESION STRATEGY:
Van Meerbek et al(2001) suggested a classification based on adhesion strategy.

TOTAL ETCH SELF ETCH

TWO STEP MILD

THREE STEPADHESIVES MODERATE
INTERMEDIARY STRONG

TYPE OF ADHESIVE STEPS INVOLVED

THREE STEP ADHESIVE:FOURTH GENERATION

ETCH AND RINSE
ADHESIVES TWO STEP ADHESIVE:FIFTH GENERATION
TWO STEP ADHESIVE:SIXTH GENERATION
SELF ETCH ADHESIVES
ONE STEP ADHESIVE:SEVENTH GENERATION
 BASED ON THE TREATMENT OF SMEAR LAYER:

 Smear layer modifying

 Smear layer removal
 Smear layer dissolving
DECADE BONDING AGENT FEATURES

1960s FIRST GENERATION • DENTIN ETCHING WAS CONTRAINDICATED

1970s SECOND GENERATION • ADHESION WAS TO SMEAR LAYER
• WEAK BOND STRENGTH
1980s THIRD GENERATION • ETCHING ENAMEL & DENTIN
• PRIMING-A SECOND STEP WAS DONE
• BETTER BOND STRENGTH
EARLY 1990s FOURTH GENERATION • TOTAL ETCH CONCEPT WAS INTRODUCED
• WET BONDING & HYBRID LAYER CONCEPTS
INTRODUCED
• MULTIPLE TECHNIQUE SENSITIVE CLINICAL STEPS

MID 1990s FIFTH GENERATION • PRIMER & ADHESIVE COMBINED IN ONE BOTTLE
• HIGHER BOND STRENGTHS

LATE 1990s SIXTH GENERATION • INTRODUCTION OF SELF-ETCHING PRIMERS

• POST OPERATIVE SENSITIVITY WAS REDUCED
• LOWER BOND STRENGTHS

EARLY 2000s SEVENTH GENERATION • ALL IN ONE/ONE STEP BOND CONCEPT

INTRODUCED
• BOND STRENGTH LOWER THAN 4TH & 5TH
GENERATIONS
 Most products use a three-component system consisting of a conditioner, primer, and
adhesive.

1. CONDITIONER (CLEANSER, ETCHANT) –

 weak organic acid (e.g., maleic acid),
 a low concentration of a stronger inorganic acid (e.g., phosphoric or nitric acid)
 a chelating agent (e.g., EDTA).
 MAIN ACTIONS:

 Alters or removes the smear layer.

 demineralizes peritubular and intertubular dentin

 exposes collagen fibrils --demineralizes up to a depth of 7.5 microns.

 peritubular dentin is etched more deeply than the intertubular dentin

increases dentin permeability.
PRIMER

bifunctional monomer in a volatile solvent such as acetone or alcohol

examples of HEMA (hydroxyethyl methacrylate),

NMSA (N-methacryloyl-5- aminosalicylic acid),
NPG (N-phenylglycine),
PMDM (pyromellitic diethylmethacrylate), and
4-META (4- methacryloxyethyl trimellitate anhydride).
MAIN ACTIONS:

Links the hydrophilic dentin to the hydrophobic adhesive resin

Promotes infiltration of demineralized peritubular and intertubular dentin

increases wettability of the conditioned dentin surface

 ADHESIVE (BONDING RESIN):

It is an unfilled or partially-filled resin; may contain some component of the primer (e.g.,
HEMA) in an attempt to promote increased bond strength.

MAIN ACTIONS:

 Combines with the primer s monomers to form a resin-reinforced hybrid layer ( resin-dentin
interdiffusion zone ) 1 to 5 microns thick.

 Forms resin tags to seal the dentin tubules

CLASSIFICATIONS
1st generation dentin adhesives

 These contained N-phenylglycine and glycidyl methacrylate (NPG-GMA).

 NPG-GMA is a bifunctional molecule

 This means that one end of this molecule bonds to dentin while the other
bonds (polymerizes) to composite resin.

 Bond strength - 1 to 3 MPa.

 First commercially available was CERVIDENT.

Chelation with calcium on the tooth surface to generate water resistant

chemical bonds of resin to dentinal
Agents used in this generation:
NPG-GMA.
Glycerophosphoric acid dimethacrylate.( GPA- DMA).
Cyanoacrylates
Polyurethanes.
DISADVANTAGES
Low bond strengths of only 2-3 MPa. Hydrolysis of GPA-DMA
in oral environment.
Difficulty in bulk polymerization of cyanoacrylates. Instability of
NPG-GMA in solution.
2nd generation adhesives

 Phosphate ester dentin bonding agents were introduced containing phenyl-

P & HEMA in ethanol.

 Its mechanism of action was based on polar interactions between

negatively charged phosphate groups in resin and positively charged Ca
ion in the smear layer.

 Bond strength: 1- 5 Mpa

 Examples:
Clearfil bond system F. Bondlite ( Kerr).
Prisma Universal Bond( Johnson and Johnson).

DISADVANTAGES
Low bond strength of 1-10 Mpa
Hydrolysis of the bonds between phosphonate esters and dentin
Poor clinical performance:

Bond achieved limited by cohesive failure in smear layer or

break at the smear layer dentin surface.
Resins were devoid of hydrophilic groups, large contact angles
on intrinsically moist surfaces, did not wet the dentin well.
 3rd Generation

 Three step systems.

 PHOSPHATE BASED (HEMA+10 MDP)
 Required either removal, modification or dissolution of the smear layer.
Dentin etching (Introduced by Fusuyama)

Primer application

Application of an unfilled resin.

 Bond strength: 3-8 mpa

 Eg: Scotch bond 2
 4th Generation- Early 1990s

•Total etch concept/Moist Bonding

•Hybrid layer Nakabayashi 1982
Impregnation of resin into partially decalcified dentin followed by
polymerization created a resin reinforced
Advantages:
Good Bond strength: 17-25 Mpa.
No reduction in bond strength when applied to moist surface. Can bond to
mineralized tissue as well as metal, amalgam,
composite and porcelain

Disadvantages:
Multiple steps: Technique sensitive.
Unless the primer and adhesive are applied consecutively, the overlying composite
resin will not bond to the surface.

Agents used in this generation

All bond 2( Bisco Dental) Amalgam- bond(

Parkell) Clearfil Liner Bond( Kuraray) Imperva
Bond( Shofu Dental) Optibond( Kerr)
Scotch bond multipurpose( 3M Dental)
 5th Generation- Mid 1990s

Totally removes smear layer

Based on Total etch concept 2 step system

• Etching

• Priming + Bonding

Moist bonding techni

que
Advantag
Good bond strength.
es:
Time saving and relatively simpler to use.
Some agents have incorporated fluoride and elastomeric components to
improve marginal integrity.

Disadvantages:
•They lack many of the components to perform multisubstrate
bonding.

Post operative sensitivity

(most common in situations that magnify effects of composite
polymerization shrinkage.)
 6th Generation- Early 2000s
Primer and etchant are combined in one step.( Self etching primers)

•Contains phosphate derivatives of hydrophilic monomer such as

phenyl-P.
•It also contains 50% HEMA or other hydrophilic monomer, so they
both etch and primer the dentin
Type I Two step/ Non rinsing conditioner/ Self etch primer systems
Type II One step/ Self etching adhesives/ All in one
systems(Requires mixing)
Examples: Clearfil® SF Bond (Kurarray) Simplicity™
(Apex),
ADVANTAGES:
No need to acid etch with phosphoric acid. No post conditioning
rinsing required.

Reduced post operative sensitivity

Simultaneous demineralization and resin infiltration.
Less sensitive to degree of wetness and dryness. Low technique
sensitivity

DISADVANTAGES

Less effective bonding of enamel

Initial bond might deteriorate with aging, which could lead to premature
failures.

Bonding to Sclerotic and caries affected dentin might be problematic May inhibit set of self

cure or dual cure resin materials.

 7th Generation- 2003

The system is quite similar to the 6th generation but a desensitizing agent
was added to overcome the problem of hypersensitivity .

•It is a, single-component, no-mix, one-step application dental adhesive with an etchant,

adhesive, desensitizer, and photo-initiator

•They combine conditioning, priming & application of adhesive resin but unlike 6th gen don’t
require mixing.

Contains both hydrophilic &hydrophobic components.

Disadvantages

•complex nature of mixed solutions - more prone to phase separation &

formation of droplets within adhesive layer.

•Lack of Polymerization-thin film

Examples:

•iBond™ (Heraeus)
•Xeno® IV (Dentsply)
•G-Bond™ (GC)
•Complete (Cosmedent)
•OptiBond® All-In-One (Kerr)
Bond Strength 17-25Mpa 20-25Mpa 18-25Mpa 20-30 Mpa
 Comparison of the performance of current self- etch adhesives
with the etch and rinse approach

Etch and rinse Self-etch

Hybridization of Difficult to Easy to perform durable :primarily for mild
dentin perform but stable self etch adhesives
and durable over
time when done
properly
Bond to enamel and excellent Fairly good and clinically acceptable :can be improved
marginal integrity on by additional phosphoric acid etching
enamel

Postoperative Good chance for this Less chances of this, but not impossible
sensitivity ,especially with
overetching or
overdrying of the
dentin
Water solubility of Withstands Higher :some call them a
the adhesive hydrolysis fairly well semipermeable membrane”
when nano- leakage
is absent

Color stability of Good color Not that good :owing to its hydrophilicity,good
the adhesive stability ,good chance of water uptake(stains accompany the
choice for high water )in the adhesive
–end esthetic
restoration
Ease of use If operator is well Easier to use but technique sensitive
trained and potential too
errors are Most difficult is the removal of the water from
recognized the adhesive
,not difficult to
use
Classification based on the number of clinical application steps

•Etch & Rinse

Three‐Step - conditioner, primer, adhesive Two‐Step -

conditioner, (primer & adhesive)

• Self‐Etch

Two‐Step • (conditioner & primer), adhesive

One‐Step • (conditioner & primer & adhesive)
 Classification of Bonding Agents based on their effect on
smear layer:

Smear layer removing dentin bonding agents

 Used after the smear layer is completely removed using total-etch
tech(Enamel & dentin are simultaneously etched using 37% phosphoric
acid)

 Bond to dentin micromechanically by formation of resin tags & hybrid

layer.

 Examples: - Single bond

-Gluma
-Optibond Solo
 Smear layer modifying dentin bonding agents

- Aim to modify the smear layer & incorporate it in bonding process.

- Based on the concept that smear layer is a natural barrier to the pulp, preventing bacterial
penetration & reduce outflow of dentinal fluid that can affect bonding.

-Removal of Only superficial smear layer and resin intermingling with deeper layers

Examples:
- Pro Bond
- Prime & Bond 2.1
- Compoglass
Smear layer dissolving dentin bonding agents

 Demineralize the smear layer & superficial dentin

without removing the smear plugs.

 “self-etching primers” & “self-etching adhesives”.

 Both enamel & dentin are simultaneously etched and
primed by acidic primers.

 Examples: -self-etching primers : ADHESE

-self-etching adhesives : Prompt-L-Pop
 RECENT ADVANCES :
UNIVERSAL ADHESIVE

In 2012, the term “universal adhesive” has been given several definitions
which are:

a) Can be used in total-etch, self-etch, and selective etch techniques;

b) Can be used with light-cure, self-cure, and dual-cure materials (without the
separate activators);
c) Can be used for both direct and indirect substrates;
d) Can bond to all dental substrates, such as dentin, enamel, metal, ceramic,
porcelain, and zirconia.
In November 2011, a new “ScotchBond Universal” was discovered.
Which needs a separate self-cure activator or a special amine-free dual-
cure cement when in use with dual-cure or self-cure materials, hence not
a truly “universal” adhesive.
In March 2012, a “All-Bond Universal” was discovered, which can be
used in:
i. total-etch, self-etch and selective etch techniques,
ii. can be used with any dual-cure, self-cure and light-cure
materials without the need of a separate activator,
iii. can also be used for both direct and indirect substrates, and
can bond with any dental substrates.

All-Bond Universal is the first truly “universal adhesive”.

 IS FUTURABOND DC-THE EIGTH
GENERATION
BONDING AGENT?
 BASED ON THE TREATMENT OF SMEAR LAYER

SMEAR LAYER SMEAR LAYER SMEAR LAYER

MODIFYING REMOVAL DISSOLVING
 SMEAR LAYER

It was first suggested by Skinner in 1961.

Coined by Boyde in 1963.

0.5-2µm thick, granular

Smear plugs…1-10µm
WHY IS THE PRESENCE OF SMEAR LAYER
DETRIMENTAL TO BONDING?

It is a weak attachment to dentin and is brittle

so it can be easily dislodged & prone to cohesive failure.

Therefore to overcome this, etch & rinse adhesive was developed.

SMEAR LAYER REMOVAL

DRAWBACK OF COMPLETE REMOVAL OF SMEAR LAYER:

Increases dentin permeability and flow of the dentinal fluid

Thus diluting the bonding agent

Examples:

IV & V generation dentin bonding agents.

SMEAR LAYER MODIFYING

Examples:

II & III generation dentin bonding agents.

Incorporation of smear layer inhibited proper bonding and resulted in loss

of bond strength.
 SMEAR LAYER DISSOLVING

Self-etching adhesives dissolve and include the smear layer in the

hybridization process.
BASED ON Ph

STRONG INTERMEDIARY MILD

(<1) (1-2) (≅ 2)
 CLINICAL APPLICATION OF SELF-ETCH
BONDING SYSTEMS

Class V composite resin restoration using a

self-etch two step system

a) Application of self-etch primer.

b) Application of adhesive.

c) Completed Class V composite resin

restoration.
ANTERIOR COMPOSITE RESTORATIONS(CLASS III,IV)
 POSTERIOR COMPOSITE RESIN RESTORATIONS

Core build up restoration with light cured composite resin using two-step self-etch
bonding system.
a) After removal of defective amalgam restoration
b) Application of self-etching primer
c) Application of adhesive
d) Completed composite restoration in molars and the premolar
RESTORATION OF PRIMARY TEETH

Self-etch adhesives are an alternative to total etch systems.

But ,the all in one adhesives should be used in combination with
compomers(polyalkenoic acid modified composite resins) & only in small
to medium sized cavities with adequate macroretention.

(Quintessence International, vol(8),nov-dec2013)

CORE BUILD-UP WITH LIGHT-CURED COMPOSITE RESIN:

CORE BUILD UP WITH FLOWABLE COMPOSITE….DEFECTIVE AMALGAM

RESTORATION…..TWO STEP SEA….FULL CERAMIC PARTIAL CROWN
EXAMPLE OF A SELF-ETCH TWO STEP BONDING SYSTEM
INCLUDING ACTIVATOR(ADHESE/ADHESE DC ACTIVATOR)
FOR COMBINATION WITH DUAL-CURED RESIN CEMENTS &
CORE BUILD-UP COMPOSITES
In the combined post & core technique,the same dual cured composite resin is used for adhesive
post cementation & as core material.
a.try in of FRC post.
b.application of self-etch primer-adhesive into root canal using endo-microbrush.
c.adhesively cemented FRC post with composite core build-up.

A
TREATMENT OF CERVICAL DENTIN HYPERSENSITIVITY

PREVENTION OF ROOT SURFACE CARIES

ADHESIVE CEMENTATION OF INDIRECT RESTORATION

 MICROLEAKAGE

DEFINITION
It is the passage of bacteria and their toxins between restoration
margins and tooth preparation walls

MECHANISM OF ACTION:

The presence of gaps at the resin-dentin interface leads to ingress of

bacteria.
Therefore bonding the resin to a preparation with cavosurface margins in
enamel is the best way to prevent microleakage.

Bacteria are able to survive & proliferate within the fluid filled marginal
gaps, thus leading to secondary caries.
 NANOLEAKAGE

It is the small porosities in the hybrid layer or at the transition between the
hybrid layer and the dentin that allow the passage of particles of silver
nitrate dye.

Penetration of ammoniacal silver nitrate results in two patterns:

Spotted pattern-in the hybrid layer of self-etch adhesives due to incomplete

resin infiltration.
Reticular pattern-that occurs in the adhesive layer due to incomplete
removal of water from the bonding area.
 NANOLEAKAGE UNDER ELECTRON MICROSCOPE.

Spotted pattern in the hybrid layer formed by one-step self-etch adhesive

Reticular pattern and water trees in adhesive layer formed by self etch adhesive
 CLINICAL FACTORS AFFECTING ADHESION

Flow of saliva and/or blood contamination

Moisture contamination from handpiece or air water syringe
Oil contamination of handpieces or air-water syringes
Fluoride content of teeth
Location and size of dentinal tubules
Presence of plaque,calculus,extrinsic stains or debris
Presence of bases or liners on prepared teeth
Tooth dehydration
Presence of residual intermediary cements
 BONDING TO AMALGAM

Bonding of amalgam restoration to tooth is still a debatable topic.

The use of adhesive systems beneath amalgam restoration reduces or

prevents microleakage, makes cavosurface angle less susceptible to
demineralization when compared to varnish.

There is reduction in sensitivity and more conservative cavity preparation

can be achieved when amalgam is bonded to tooth.
 CONCLUSION

In today’s era, numerous improvements in materials and

procedures have been made to meet the growing aesthetic
demands of the patients.
In all the aesthetic restorations a bonding step is involved
to ensure durability and reliability.
Thus the ideal bonding system should be biocompatible,
bond perfectly to enamel and dentin, have sufficient
strength to resist to failure as a result of masticatory forces,
have mechanical properties close to those of tooth, and be
resistant to degradation in oral environment and easy to
use.
 BIBLIOGRAPHY
STURDEVANT'S ART & SCIENCE OF DENTISTRY-4TH, 5TH & 6TH
EDITION
PHILLIPS-SCIENCE OF DENTAL MATERIALS...11TH EDITION

TOOTH COLORED RESTORATIVES-PRINCIPLES AND

TECHNIQUES..9TH EDITION
PICKARD'S MANUAL OF OPERATIVE DENTISTRY...8TH EDITION

TEXTBOOK OF OPERATIVE DENTISTRY-SUMEETHA

SANDHU..1ST EDITION
MATERIALS USED IN DENTISTRY….S.MAHALAXMI
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