adhesives
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Enamel and Dentin AdhesivesKraig S. Vandewalle, Col, USAF, DC
Official Disclaimer The opinions expressed in this presentation are those of the author and do not necessarily reflect the official position of the US Air Force or the Department of Defense (DOD). Devices or materials appearing in this presentation are used as examples of currently available products/technologies and do not imply an endorsement by the author and/or the USAF/DOD.
Overview Principles of adhesion Principles of bonding Historical development Classifications Features Conclusions
Advantages of Adhesion Help offset polymerization shrinkage reduce marginal leakage staining sensitivity caries
Adhesion conservation of tooth structure internal splinting
Esthetic restorations
Indications for Adhesion Direct resin composite restorations caries, fractures, reshaping, masking
Bond all-ceramic restorations veneers, inlays, onlays, crowns
Bond amalgam Resin-retained fixed-partial dentures
Indications for Adhesion Pit and fissure sealants Orthodontic brackets Treat dentinal hypersensitivity Core build-ups Repair fractured porcelain and composite
Basic Mechanism of Adhesion(resin-based) Exchange process replacement of minerals from hard tissue
by resin monomers micromechanically interlocked
Primarily mechanical retentive interlocking
Variations in Tooth Structure Enamel more predictable bonding more homogeneous structure higher inorganic content higher surface energy
Dentin less predictable bonding higher variability higher organic contentVan Meerbeek in: Summitt, Fund Oper Dent 2001
Enamel Composition Primarily inorganic hydroxyapatiteBy volume
Organic 2% Water 12%
Inorganic 86% Van Meerbeek in: Summitt, Fund Oper Dent 2001
Enamel Bonding Developed by Buonocore-1955 Etching various acids traditionally phosphoric acid
creates micropores 5 50 microns deep
increases surface energy increases wettabilityVan Meerbeek in: Summitt, Fund Oper Dent 2001
Surface Wetting Tooth surface contamination saliva, smear layer
Clean surface increase surface energy decrease contact angleVan Meerbeek in: Summitt, Fund Oper Dent 2001
Enamel Bonding Low-viscosity monomers examples Bis-GMA UDMA TEGDMA HEMA
Predictably high bond strengths > 20 MPaVan Meerbeek in: Summitt, Fund Oper Dent 2001
Dentin Structure Dentin composition Dentinal tubules Changes in dentin structure Smear layer Dentinal wetness
Dentin CompositionInorganic 50% Organic 25%
By volume
Water 25%
Van Meerbeek in: Summitt, Fund Oper Dent 2001
Dentinal Tubules Radiate from pulp Largest near pulp 2.5 microns at pulp 0.8 microns at DEJ
Concentrated near pulp 45,000/mm2 at pulp 20,000/mm2 at DEJVan Meerbeek in: Summitt, Fund Oper Dent 2001
Tubule Composition Peritubular dentin surrounds tubule hypermineralized
Intertubular dentin between tubules less mineralized
Odontoblastic process Dentinal fluidVan Meerbeek in: Summitt, Fund Oper Dent 2001
Changes in Dentin Structure Sclerotic normal aging abrasion erosion
Hypermineralization Less receptive to bonding
Reparative caries dental proceduresVan Meerbeek in: Summitt, Fund Oper Dent 2001
Smear Layer Produced by instrumentation Composition cut dentin debris bacteria
Reduces dentin permeability 86%Van Meerbeek in: Summitt, Fund Oper Dent 2001
Smear Layer Thickness 0.5 - 5.0 microns
Will not wash off Weak bond to tooth 2 3 MPa
Very soluble weak acidsVan Meerbeek in: Summitt, Fund Oper Dent 2001
Dentinal Wetness Increases dentinal depth removal of smear layer
Historically, more difficult to bond
Van Meerbeek in: Summitt, Fund Oper Dent 2001
Dentin Bonding Development seven generations chronologic
Classification
Van Meerbeek in: Summitt, Fund Oper Dent 2001
First Generation(1950-1970s) Hydrophobic monomers Very low bond strengths 2 to 3 MPa
First commercial dentinal adhesive
Cervident - SS White (1965)
claimed chemical bond to calcium
retention only 50% at 6 months
Class 5Harris, J Prosthet Dent 1974
Second Generation(late 70s to mid 80s) Phosphorous-ester monomers
enhanced surface wetting claimed chemical bond to calcium smear layer predominately intact
fear of etching dentin
Low bond strengths 5 to 6 MPa
Retention 70% at 1 year Class 5Van Meerbeek in: Summitt, Fund Oper Dent 2001
Third Generation(mid-80s) Mechanism of action mildly acidic hydrophilic monomer modified/altered smear layer
Moderate bond strengths Improved short / long term success
Van Meerbeek in: Summitt, Fund Oper Dent 2001
Fourth Generation(early 1990s) Multi-step condition dentin remove smear layer
primer adhesive
High bond strengths Retention 98 to 100 % at 3 yrs Class 5Van Meerbeek in: Summitt, Fund Oper Dent 2001
Fifth Generation(late 1990s) Attempt to simplify reduce number of bottles combined primer and adhesive
High bond strengths
Van Meerbeek in: Summitt, Fund Oper Dent 2001
Sixth Generation(late 1990s) Combined conditioner and primer moderate bond strengths
Combined conditioner, primer and adhesive lower bond strengths
Van Meerbeek, Oper Dent 2003 Click here for abstract
Seventh Generation(most recent) All-in-one adhesives combined conditioner, primer and adhesive one-step
No mixing Low bond strengthsVan Meerbeek, Oper Dent 2003 Click here for abstract
Currently Available Generations Fourth Generation Three-step Etch & rinse
Fifth Generation Two-step Etch & rinse
Sixth Generation Two-step Self-etch One-step Self-etch mix
Seventh Generation One-step Self-etch no mix
Classification of Newer Systems Interaction with tooth surface Number of clinical application steps 1) Etch & rinse (i.e., total-etch) 2) Self-etch 3) Resin-modified glass ionomerVan Meerbeek, Oper Dent 2003 Click here for abstract
Adhesive Categories Etch & Rinse Three-Step conditioner, primer, adhesive
Two-Step conditioner, (primer & adhesive)
Self-Etch Two-Step (conditioner & primer), adhesive
One-Step (conditioner & primer & adhesive)
Glass Ionomer Two-Step conditioner, resin-modified glass-ionomer mixture
Etch & Rinse (Three-Step) Conditioner Primer Adhesive resin Examples Scotchbond Multi-Purpose Optibond FL
Conditioner Chemical alteration of surface acids
phosphoric, citric, maleic, nitric
Removes dentinal smear layer exposes collagen fibrils
Simultaneous enamel etch Rinse keep moistVan Meerbeek in: Summitt, Fund Oper Dent 2001
Primer Hydrophilic monomers dissolved in acetone, alcohol, or water
Displaces water Promotes infiltration into collagen Lightly air dry drive off solvents, water
Transforms hydrophilic to hydrophobicVan Meerbeek in: Summitt, Fund Oper Dent 2001
Primer Bifunctional monomer Link hydrophilic collagen hydrophobic resin
Example HEMA
CH3 H2C=C-C-O-CH2-CH2-OH O
Adhesive Resin Unfilled or lightly-filled monomers equivalent to enamel bonding Bis-GMA, UDMA, TEGDMA
Stabilize the hybrid layer fills up remaining pores
Resin tags Links primer to composite resinVan Meerbeek in: Summitt, Fund Oper Dent 2001
Hybrid Layer Conditioner demineralizes dentin Interdiffused with low-viscosity monomer displaces water bifunctional
Resin mechanically interlocks collagenVan Meerbeek in: Summitt, Fund Oper Dent 2001
Etch & Rinse (Two-Step) Conditioner Combined primer and adhesive higher technique sensitivity higher solvent-to-monomer ratio risk of applying too thin
apply multiple layers
Examples Single Bond Optibond Solo Plus Prime & Bond NTHashimoto, Oper Dent 2004 Click here for abstract
Pros/Cons of Etch & Rinse Separate acid etch good enamel etch pattern
Potential to over-etch dentin except sclerotic dentin
Post-conditioning rinse necessary sensitive to level of dentin wetness
Multiple long-term clinical studies availableVan Meerbeek, Oper Dent 2003 Click here for abstract
Dentin WetnessEtch & Rinse
After conditioning dentin dentin must be wet prevent collagen collapse
Too little water collagen collapse
Ineffective resin penetration Leads to nanoleakageSano, Oper Dent 1995 Click here for abstract
Wet Bonding Acetone and ethanol based primers displace remaining water carry monomers into collagen gently air-dried leaving monomers behind
Examples One-Step Prime & Bond NTKanca, Quintessence Int 1992 Click here for abstract
Effect of Dentin WetnessOne-Step (Bisco)16 14 12 10 8 6 4 2 0 moist dry 1 sec dry 5 secs dry 5 secs + rewet Bond Strength (MPa)
Perdigao, Am J Dent 1998 Click here for abstract
Overwet Phenomena Too much water not completely displaced
Phase separation blister and globule formation
Tay, Dent Mater 1996 Click here for abstract
Disadvantages to Wet Bonding Cannot check for enamel frosted etch Technique sensitivity not too wet or too dry
Solvents evaporate from bottle may reduce monomer penetration
Van Meerbeek in: Summitt, Fund Oper Dent 2001
Dry Bonding Water-based primers effective on wet or dry dentin self-rewetting effect re-expand collapsed collagen
Permits check of frosted enamel Examples Scotchbond Multi-Purpose OptibondVan Meerbeek in: Summitt, Fund Oper Dent 2001
Class V Clinical StudiesEtch & Rinse Three-Step Scotchbond MP (3M ESPE) 100% retention at 3 yrs Van Meerbeek, Quint Int 1996
98-100% retention at 3 yrs Trevino, J Dent Res 1996
100% retention at 2 yrs Alhadny, Am J Dent 1996
Class V Clinical StudiesEtch & Rinse Two-Step Optibond Solo (Kerr) 93.3% retention at 3 yrs Swift, JADA 2001
Prime & Bond 2.1 (Caulk) 89.4% retention at 3 yrs Swift, JADA 2001
Laboratory StudyThree-Step vs Two-Step Etch & RinseShear Bond Strength30 25 20Two-Step Three-Step
MPa
15 10 5 0 Opti Opti FL Solo+ Single Bond MP + Excite SyntacPecora, J Prosthet Dent 2002 Click here for abstract
Laboratory StudyThree-step vs Two-step Etch & RinseMicrotensile Bond Strength
60 50 40 uTBS 30 20 10 0
24 hr 4 yr Single Bond Scotchbond Optibond MP Solo Optibond FL
De Munck, J Dent Res 2003 Click here for abstract
Adhesive Categories Etch & Rinse Three-Step conditioner, primer, adhesive
Two-Step conditioner, (primer & adhesive)
Self-Etch Two-Step (conditioner & primer), adhesive
One-Step (conditioner & primer & adhesive)
Glass Ionomer Two-Step conditioner, resin-modified glass-ionomer mixture
Self-Etch ComponentsAcidic monomersMDP Di-HEMA-Phosphate MA 154 Phenyl-P MAC-10 4-MET(A) BisGMA UDMA TEGDMA GDMA HEMA usually water based
Crosslinking monomersSolvent
Self-Etch (Two-Step) Combined conditioner and primer Adhesive resin Examples Clearfil SE AdheSE
Click here for table of self-etching adhesives
Self-Etch (One-Step) Combined conditioner primer adhesive
Examples Prompt L-Pop One-up Bond F Touch and Bond iBond Xeno IIIClick here for table of self-etching adhesives
Pros/Cons of Self-Etch Good dentin conditioning simultaneous infiltration depth of demineralization
Possible reduction in post-op sensitivity?? No post-conditioning rinse not sensitive to level of dentin wetness
Reduced application timeHara, Am J Dent 1999
Clinical Studies(Post-Operative Sensitivity) Class 1 or 2 composite restorations Clearfil SE self-etch
Prime & Bond NT etch & rinse
Tested for post-op sensitivity No difference Baseline, 2 weeks, 6 weeks, 6 months Perdigao, JADA 2003 Click here for abstract
Baseline, 2 weeks Perdigao, Quint Int 2004 Click here for abstract
80
Seconds
100
120
20Self-Etch
40
60
0
Application Time
Source: USAF DECS N=3
Pr om pt LPo Xe p n O ne o I II -u p B on C le d ar fil SE A dh eS E iB on d Ex c Si ng ite Pr im le e& Bo n B on d d N T Ty ria n O PQ pt ib 1 Sc on d ot ch So lo bo nd M PEtch&Rinse
Pros/Cons of Self-Etch Limited clinical indications Limited clinical data Relatively lower bond strengths Many require refrigeration
Van Meerbeek, Oper Dent 2003 Click here for abstract
Shear Bond Strength to DentinEtch&Rinse
50 40MPa
Self-Etch
30 20 10 0Clearfil PBNT PQ1 Excite 1-Up AdheSE Xeno III Tyrian iBond Prompt SE Bond L-Pop Source: USAF DECS Horizontal lines connect nonsig diff at 0.05 level N=10
Class V Clinical StudiesSelf-Etch Two-Step Clearfil SE Bond (Kuraray) 100% retention at 2 yrs Peumans, J Dent Res abstr #0911
93% retention at 2 yrs Turkun, J Dent 2003
Class V Clinical StudiesSelf-Etch One-Step Prompt L-Pop (3M ESPE) 65% retention at 1 yr Brackett, Oper Dent 2002
79% retention at 2 yrs van Dijken, Am J Dent 2004
Special Considerations Incompatibilities self-cure composites with simplified adhesives two-step etch & rinse one-step self-etch
Acidic monomers react with basic catalyst of overlying composite Adhesive permeability leads to superficial water blisters via water treesClick here for details
Adverse Acid-Base ReactionSimplified Adhesives
CompositeNeutral
O2 Inhibited Layer
CompositeBPO+Amine Acidic Monomers
Adhesive Primer Dentin
Dentin Two-step Etch & Rinse One-step Self-EtchSuh, 2002
Three-step Etch & Rinse Two-step Self-Etch
Water Trees Simplified adhesives Act as semi-permeable membrane Conduct fluid Osmotic blistering along the composite-adhesive interface slows self-curing of composite
Click here for details
Lindemuth 2004
Composite
Water Tree FormationHybrid Layer Trapped Moisture
Dentin
Lindemuth 2004
Hydrolytic Degradation of Resin Dentin Bond
Failure over time
Dual Cure Dual- and self-cure composites cores cements
Separate activator Examples Optibond Solo Plus Prime and Bond NT
Features Fluoride release Unit-dose
Fluoride Release Anti-caries effect? no proof of efficacy in resin-based adhesives
Examples FL-Bond One-up Bond F PQ1 Tenure Quick Optibond Solo Plus
Unit Dose Improved infection control Convenience Minimizes loss of volatile components over time Higher cost Examples Optibond Solo Plus Excite Prime and Bond NT Prompt L-Pop
Adhesive Categories Etch & Rinse Three-Step conditioner, primer, adhesive
Two-Step conditioner, (primer & adhesive)
Self-Etch Two-Step (conditioner & primer), adhesive
One-Step (conditioner & primer & adhesive)
Glass Ionomer Two-Step conditioner, resin-modified glass-ionomer mixture
Resin-modified Glass-Ionomer Weak conditioner pretreatment polyacrylic acid removes smear layer exposes collagen
Mechanical bonding hybrid layer
Chemical bonding carboxyl groups with calcium in tooth
Resin-modified Glass-Ionomer Two-step weak conditioner mix and apply glass ionomer adhesive
Fluoride release Example Fujibond LC
Pros/Cons of Resin-Modified Glass-Ionomer Chemical and mechanical bonding Fluoride release Limited clinical data Class V study Fuji Bond LC 96% retention at five years Class 5 Tyas, Oper Dent 2002
% 2015
Average Annual Failure RateClass V Restorations
Standard Deviation
10 5 01.9 %Glass Ionom er
4.8 %3-Step Etch&Rinse
4.7 %2-Step Self-Etch
6.2 %2-Step Etch&Rinse
8.1 %
1-Step Self-Etch
Peumans, Dent Mater 2005 Click here for details
Adhesive Preferences with Light-Cured Composites*Civilian Practitioners Total-etch Self-etch Other 70% 62% 3%
*Multiple responses
DPR 2005
Conclusions Etch & rinse favorable long-term data
Self-etch promising?? do not require rinsing demineralize and infiltrate to same depth
reduced technique sensitivity reduced application time potential decreased post-operative sensitivity??Van Meerbeek, Oper Dent 2003 Click here for abstract
Conclusions Trend toward simplified application reduced number of steps not necessarily better
Van Meerbeek, Oper Dent 2003
Purchasing Considerations(Federal Dental Services)
4th generation etch & rinse three-step several available
5th generation etch & rinse two-step multiple available
6th generation self-etch two-step Clearfil SE Bond
self-etch one-step ????Click here for synopsis of self-etching adhesives
Acknowledgements Dr. David Charlton Lt Col Steve Klyn
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