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Pre-treatment ( cont.)
Adhesive resin (bonding
agent)
 Consists of viscous hydrophobic monomer
(Bis-GMA or UDMA) diluted with monomers
of higher hydrophilicity and lower viscosity, such
as HEMA.
 The major role of low viscosity adhesive resin is
the stabilization of the hybrid layer and
formation of resin tags and copolymerize with
the composite resin.

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The smear layer is removed and
dentinal tubules are opened

10/14/08 C= composite, H= hybrid layer, D= dentin

3
 Hybrid layer, the resin tags
penetrating the cut dentinal
tubules.
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 Be aware:
 Hybrid layer is the structure formed in dental
hard tissues ( E,D, C.) by demineralization of
the surface and subsurface, followed by
infiltration of monomers and subsequent
polymerization. Adhesive resins (unfilled or
semi-filled) can be light and / or autocuring.
Autocuring type exhibit slow polymerization.
For light – curing bonding agents, it is
recommended that the adhesive resin be
polymerized prior to the application of the
restorative resin.
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 In this way :
 Adhesive resin is not displaced.

 Adequate light intensity is available to

sufficiently cure and stabilize the

resin- tooth bond to counteract
polymerization shrinkage of the resin
composite.

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 (A) Prepared cavity. (B) The smear layer is dissolved. (C) The acid and
the dissolved smear layer are washed away using a water- air spray.
(D) Formation of hybrid layer.

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10/14/08 8
 Nanoleakage:
(nano sized porosities
within the hybrid layer)
The causes for such defect may be:
 incomplete resin infiltration
 inadequate polymerization of primer before
application of bonding resin.
 Polymerization shrinkage of maturing primer
resin.
 These defects may cause bond failures.
 More recent primers, include a chemical or
photopolymerization initiator so that these
monomers can be polymerized in situ.

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 Bonding agent
 Because O2 inhibits resin polymerization, an
O2 inhibited layer of about 15µm will always
be formed on top of the adhesive resin, even
after light curing . This O2 inhibited layer
offers sufficient double methyl methacrylate
(MMA) bonds for copolymerization of the
adhesive resin with the restorative resin.

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 Bonding agent
 Brush thinning is preferred over air thinning of
the adhesive resin film to prevent the film
thickness from being reduced to such an extent
that the air-inhibited layer permeates the resin,
resulting in low bond strength. A sufficiently
thick resin layer may absorb, by elastic
accommodations, the stress induced by
polymerization contraction of resin composite.

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10/14/08 12
  Dentin bonding systems originated with
3-component designs – conditioner
(etchant), primer, and bonding agents.
While this produced a very consistent
result, there was more and more interest
in reducing the number of components
to shorten the clinical procedure. The
transition to 2-components and now
1-component has covered about 8
years.
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 Self-Etching Adh

Re-Designing
E + nP + B  E + nBonding
PB or nEP +Systems
B  EPB
Self-Etching Primer

US Companies Japanese Companies

1=
ETCHANT
=1

2=
PRIMER
BONDING AGENT =2

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  Bonding systems that utilized
phosphoric acid are called (total etch)
and are represented by the standard
3-component and the first 2-component
types. Other bonding systems rely on
acid monomers to accomplish the same
thing (self-etching primers and self-
etching adhesives).

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  One of the interesting accusations of
1-component systems is that they are
so hydrophilic that they allow water in
the dentin to penetrate through to their
surfaces if left very long before the
composite is placed – thereby defeating
the bonding step. This is still being
investigated.

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 Most recent innovations are directed toward a
simplified application technique of adhesive
systems:
 Total–etch technique: which means

simultaneous acid etching of enamel and dentin.

Be aware:
 It is not desirable to dry the enamel
excessively when the total – etch technique is
used, because this would desiccate the exposed
dentin  postoperative sensitivity and impair the
bond to dentin.

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 In total etch technique, we are dealing with
the problem of handling these two different
substrates (E and D). We need an effective
etching pattern in enamel, but we have to
treat the dentin carefully with weaker
etchants to avoid chemical harm to the
collagen fibers. In this case, the application
of the etching gel should start in enamel and
expanded up to 30 sec. then the acid should
be applied to dentin for another 15 sec.

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  Self-etching primers or condiprimer (slightly
acidic primer) that was an aqueous solution of
20% of phenyl-p in 30% HEMA for bonding to
enamel and dentin simultaneously. It is applied
and dispersed with air without rinsing, the
dissolved calcium phosphates are entrapped in
the bonding resin layer.
 The combination of etching & priming steps:
 Reduce the working time,
 Eliminate the washing out of the acidic gel and,
 Eliminate the risk of collagen collapse.

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  However, the self-etching primer
solution also has some disadvantages,
e.g.
 The solution must be refreshed

continuously because its liquid

formulation cannot be controlled where
it is placed, and
 Often the residual smear layer

remained in between adhesive material

and dentin.
 Also, the effectiveness of self-etching

primer system on properly etching the

enamel was less predictable than the
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 One – bottle
adhesives
 The function of the primer and that of
the adhesive resin were combined into
one liquid that is applied after etching
enamel and dentin simultaneously with
phosphoric acid.

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 Packing of composite
resin restoration:
 Bulk – packing
 Incremental packing

Direct application with

a carpule system

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 Bulk-packing:
 Applied in one increment. It is suitable for
chemically curable composites: because the
degree of polymerization is not affected by the
bulk of the restoration, and conversion occurs
throughout the whole mix at the same time and
to the same degree.
 It may be employed with light curd composites
in small cavities. This technique makes no
compensation for polymerization shrinkage.

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 Bulk-packing:
 The mixed material may be transported
and pressed into the preparation using a
gold-plated or Teflon-tipped plastic
instrument or by using injection technique
that prevent air–entrapment. The matrix is
then tightened around the restoration and
held for 3min avoiding moisture
contamination.

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 Incremental
packing
 Involve packing of the restoration in successive small
increments (no thicker than 2mm), each is pressed into
place and is light cured for 20-40 sec.

Be-aware:
 The initial increments must be thin to copolymerize
adequately to the bonding resin.
 This technique Partly compensate for polymerization
shrinkage (reduce but does not eliminate the problem)

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 Carving:
 Gold – plated or Teflon – tipped carving instruments
are used to overcome composite stickiness.
 Be aware:
 Bonding agent is a better lubricant for preventing
composite resin from sticking to the plastic instrument.
 Care must be taken to maintain the carving in a
direction towards the margins to avoid disturbing
peripheral apposition of enamel surface.
 The VLC systems allow the dentist unlimited working
time for carving and reproduction of lost tooth form
and contour.

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 Contouring a composite surface with
a particular composite spatula

The surface of composite can be

processed with fine brushes
before polymerization.

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 Polymerization:
 Three different induction systems for
polymerization of resin-based
restorative may be employed, namely
VL curable, the chemical cure and the
combined dual-cure systems.

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 Advantage 0f VLC:
1- Command first
polymerization
 The working time with this system is
under full control of the restorative
dentist. This provides the time he
needs for contouring and reproduction
of correct anatomy. This will decrease
the amount of finishing required.
Furthermore, quick polymerization
prevents possibilities for moisture
contamination.

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 Advantage of VLC:
2- No air inclusion
 V.L.C. composites are non-mixable single
component systems. Therefore, there
would be no chance for air-inclusion that
inhibits polymerization and causes:
 Development of soft spots.
 Loss of surface hardness.
 Decrease in density.
 Discoloration tendency.

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 Advantage of VLC:
3-Controled polymerization
shrinkage:
 Polymerizing VLC composites shrink
towards the curing light i.e. away from the
interface with substrate enamel and dentin
surfaces. This results in gapping which
invites leakage. Therefore, reflecting
plastic wedges are placed at the gingival
end of class II to overcome this problem.

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 Advantage of VLC
4- Longer shelf time
5- Superior color
stability:
 These systems utilize the more stable
and color-fast aliphatic tertiary amines for
activation of polymerization.

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 Advantage of VLC:
6- Improved wear
resistance
 The surface of VLC restorations will be
in direct proximity to the light source,
and thus will exhibit maximum
conversion with improvement in wear
resistances.

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 Disadvantages of
VLC:
 1- Depth-dependent cure:-
The degree of conversion of VLC
composites is depth-dependent.
However, incremental condensation
serves to overcome such problem.
 2- Eye hazards.

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 CURING LIGHT TYPES
• Quartz-Tungsten-Halogen (QTH) Lights
> Continuous output -- normal intensity
> Continuous output -- high intensity
> Staged output (stepped, ramped, …)
• Plasma Arc Curing (PAC) Lights
• Argon-Laser Curing (Laser) Lights
• Light-Emitting Diode (LED) Lights

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 Characteristics of Light
 Visible light
 400-700 nm
 Most composites sensitive
 400-520 nm (blue)
 Photo-initiator in resin
 absorbs photon energy
 combines with activator
 amine
 creating free radicals
 initiates polymerization

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  Be aware:
 Degree of conversion depending on:
 The energy intensity of the light  higher 
more conversion.
 The distance from the light source.
 The exposure time.

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 Polymerization shrinkage
and its clinical
significance:
 Autocured composite polymerizes toward the
center of the mass, while VLC composite
polymerizes toward the light source. Stresses
arising from polymerization shrinkage may
produce defects in the composite-tooth bond,
leading to bond failure, marginal leakage
associated with postoperative sensitivity and
may produce discoloration of margin and/or
current caries.

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 Polymerization
shrinkage and its
clinical significance:
 There have been many efforts at reducing the
polymerization shrinkage:
 Incremental condensation technique.
 The lamination (sandwish) technique with glass-
ionomer cement.
 The use of resin inlay.
 Use of improved adhesive system
 Application of flowable composite over the
hybridized dentin (as a liner).
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 Finishing and
polishing
 Chemically cured restorations may be
finished 24 hours after polymerization to
allow for more advanced conversion with
development of maximum surface
hardness.
 VLC composites are finished immediately
following polymerization.

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 Sof-Lex finishing
strips and polishing
disc

Diamond-coated metal wedges

To remove proximal overhangs
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 Final finish of gingival
margin

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 Finishing and
polishing

Scalpel blade can be

used for trimming the
margins. Composite sealer seals microscopic
defects arise during finishing and
Polishing.
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 Finishing procedures
include:-
 Removal of gross excess and marginal finish.
 Disc contouring.
 Paste polishing.
 A no.12 scalpel blade is useful for removal of gross
excess from margins. Finishing can be performed with
12- bladed carbide burs, diamond points, abrasive discs
(sof-Lex disc) and finishing strips (to smooth the gingival
proximal surfaces).
 Polishing is done with a very fine abrasive polishing
paste applied with a soft rubber tips. Finishing and
polishing are completed in a moist field to prevent
overheating of the restorations.

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 Finishing
procedures
 Glaze materials, sealers, non-filled
resin, may be applied to composite
surface and visible light cured to seal
microscopic defects (which arise during
finishing and polishing) and provide
smooth surface. However, they are soft
material that may abrade in 6 months.

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10/14/08
THANK YOU 48