Resin-Dentine Bonding

Bonding
Need to provide a reliable, long term seal to enamel
and dentine

When to use Dentine Bonding Agents:

Aesthetics eg shallow abrasion lesions, veneers
Inadequate space for a lining eg erosion pits
Gingival margin with exposed dentine
Concerns
Desensitisation of dentine
Constantly changing materials
?Adequate enamel etch
Bonding to dentine (& enamel)
Three elements:- Effect of cavity design
1. Etching. An acidic agent removes the smear Usefulness of in-vitro testing
layer, opens & widens the dentine tubules, and ?Substrate – caries-affected/sclerotic dentine
partially demineralises the dentine & enamel. Nanoleakage – overwet/overdry dentine
The acid is applied to enamel & agitated for 15s, then – hybrid layer deterioration
enamel & dentine for 15s, then rinsed off.
“new adhesives are continually being introduced to
2. A priming agent is applied to enamel & dentine – the dental profession, unfortunately, often without
it penetrates the demineralised collagen network. A sufficient clinical validation”
primer is a methacrylate monomer dissolved in a
Van Meerbeek B et al; Oper Dent 2003; 28: 215-35
solvent (ethanol, acetone, water) containing both
hydrophilic and hydrophobic components – a “clinical trials must run much longer than 2 years to
bifunctional molecule that bonds to both dentine properly evaluate performance”
and resin. Donovan TE et al: J Prosthet Dent 2013; 110: 161-210
The primer is dried onto the enamel & dentine.
Multiple layers are often required. Adequate enamel etching?
Self-etch adhesives have higher concentrations of
3. A bonding resin penetrates the primed collagen acidic resin monomers that enable these adhesives
network, the dentine tubules and enamel to etch through thick smear layers and bond to the
microporosities. The resin is polymerised and forms underlying structure.
a “hybrid” layer of resin intermingled with collagen Tay FR , Pashley DH; Dent Mater 2001; 17: 296-308
bundles & tag penetration
Acidity (pH) of self-etch primers/adhesives
Phosphoric acid 0.1
“The simpler the clinical procedure is the lower the
Adper Prompt L-Pop 0.4
number of possible application errors.” 1-st SE
iBond 1.6
Finger W, Fritz U; Am J Dent 1996; 206-10 AdhesSE 1.4 2-st SE
Clearfil SE Bond 1.9
Types of DBA’s Prime&Bond NT 2.2
E&R
Etch + prime + bond SBMP (3M-ESPE) Single Bond 4.7
OptiBond FL (Kerr) ETCH
& Van Meerbeek B et al; Oper Dent 2003; 28: 215-
Etch + prime/bond Single Bond (3M) RINSE 35
OptiBond Solo Plus (Kerr)
Effect of cavity design
Self-etch primer + bond Clearfil SE Configuration or C-factor: ratio of bonded to
Bond(Kuraray) unbonded surfaces. Higher the C-factor the lower
AdheSE (Ivoclar) SELF- the conservation of adhesion.
ETCH
Self-etching adhesive Scotchbond Universal – Conservation of adhesion +
(3M ESPE) 5/ 5/1= 5 4/2=2 3/3=1 2/4=0.5 1/5=0.2
iBond (Heraeus)
 Feilzer AJ Degree of conversion:
J Dent Res 1987; 66: 1636-9 “ …a substantial amount of monomers remained
unpolymerized within the hybrid layer.”
E&R 2stSE 1stSE
Adhesive layer 85% 82% 55%
Hybrid layer 59% 70% 45%
... laboratory-measured bond strengths are not a Water interferes with the polymerization process.
good predictor of retention or seal of restorations ...
Santini A, Miletic V; Eur J Oral Sci 2008; 116: 177-83
Erickson RL E; J Esthet Dent 1994; 6: 227-44

“laboratory methods provide little more than

screening tools for evaluating adhesives and that Hybrid layer deterioration
long-term clinical studies are the only valid “Single-step adhesives behave as permeable
predictors of performance.” membranes after polymerization.”
Calcium and phosphate ions dissolved in the
Donovan, TE et al: J Prosthet Dent 2013; 110: 161-210 polymerized acidic adhesive attract water:
“Laboratory tests use ideal dentine from extracted  Water blisters
teeth, which does not reflect the clinical reality.  Water trees
Clinical studies are the ultimate test for any dentine  Decreased bond strengths
adhesive.”
Tay F, Pashley D; J Canad Dent Assoc 2003; 69: 726-31
Perdigao J; Dent Clin North Am 2002; 46: 277-301

The etch & rinse adhesives produced higher bond There are two aspects to the degradation of the
strengths to normal and caries affected dentine than hydrid layer:
self-etching systems. 1. Hydrolytic degradation by water sorption,
biodegradation of Bis-GMA & depolymerisation of
Ceballos L et al; J Dent 2003; 31: 469-77 resin by microbes.
2. Thinning /disappearance of the collagen fibrils
Bond to caries affected dentine (MPa)
Using etch & rinse and self-etch systems: 1. Degradation …
Normal Caries affected “the adhesive dentine interface is a porous collagen
Prime & Bond NT (E&R) 56 41 web infiltrated mainly by hydrolytically unstable
Single Bond (E&R) 44 36 HEMA.”
ClearFil SE Bond (SE) 36 22
Prompt L-Pop (SE) 18 13 HEMA is a hydrophilic monomer that penetrates
etched dentine more effectively than Bis-GMA.
Ceballos L et al.; J Dent 2003; 31: 469-77
However, HEMA is unstable in aqueous
Sclerotic dentine environments and will degrade when exposed to
“lower micro-tensile bond strengths were found in oral fluids.
sclerotic lesions.” Wang Y et al; J Dent Res 2003; 82: 141-5
“ … was attributed to the obliteration of dentinal
tubules with sclerotic castes and the presence of an This results in chemical degradation & washout of
acid-resistant hyper-mineralised layer.” the resin leaving porosities in the hybrid layer.
Tay FR, Pashley D; J Dent 2004; 32: 173-96 Sano H et al; J Dent Res 1999; 78: 906-11

Nanoleakage Biodegradation of Bis-GMA by salivary esterases is

Submicron-sized porous zones beneath or within a clinically relevant process that progressively
hybrid layers. Due to: compromises the integrity of the restoration-
 Etch & rinse systems – disparity between depth adhesive interface, as well as the resin composite,
of demineralization and monomer diffusion with time.
 Self-etching systems – residual water within the Shokati B et al; J Biomed Mater Res 2010; 94B: 230-7
adhesive.
Tay FR et al; J Dent Res 2002; 81: 556-60
 Polymers contained in composite resins have
been shown to host & nurture aerobic & anaerobic
Overwet/overdry dentine
organisms.
With the etch & rinse DBA’s …
 Additionally, these microbes are capable of
“ ... a delicate balance exists in the amount of
depolymerising & digesting polymers, creating
moisture required for keeping the demineralized
pockets & channels within the resin.
collagen stable ... ”
Tay FR et al; Am J Dent 1996; 9: 43-8
 Matasa CG. Am J Orthod Dentofac. Orthop. 1995; 108: 132- De Munck J et al; J Dent Res 2005; 84: 118-32
41 De Munck J et al; J Dent Res 2012; 91; 351-7
Etch & rinse technique
“ S. mutans has esterase activities at levels that
- ensure adequate isolation
degrade composites and adhesives… This finding
- etch enamel for 15 sec, then dentine & enamel
suggests that the resin-dentin interface could be
for 15 sec + agitate while etching
compromised by oral bacteria that contribute to the
- wash 20s & leave dentine “just moist”
progression of secondary caries.”
- apply 2% CHX for 1min, wash and dry
Bourbia M et al; J Dent Res 2013; 989-94 - apply & agitate primer on enamel & dentine, &
dry
2. Thinning/disappearance of collagen fibrils … - completely evaporate solvent
Auto-degradation of collagen occurs in resin- - use multiple primer coats
infiltrated dentine by the action of host-derived - apply a thin layer of bonding agent (2 coats if
matrix metalloproteinases (MMP’s). low viscosity) & cure (check curing intensity)
- avoid contamination & place CR
Mazzoni et al; Biomaterials 2006 27: 4470-6
A/Prof. Elizabeth Martin
…. acids contained in etch & rinse and self-etch May 2014
bonding agents can activate MMP’s in dentine.
This results in the breakdown and loss of collagen
fibres of the hybrid zone via collagenase and
gelatinase activity.

Nishitani Y et al; Eur J Oral Sci 2006; 114: 160-66

2% CHX was more effective than 0.2% in

preventing loss of microtensile bond strength over
time (6mnth compared with immediate testing), in
vitro as a result of MMP activity.

Campos EA et al, J Dent 2009; 37: 108-14

In–vivo bond strengths measured after 14 months in

function showed a 38% reduction without 2% CHX
treatment.
Immed.(MPa) 14mth (MPa)
Control 29.3 19.0
CHX 32.7 32.2

Carrilho MRO et al; J Dent Res 2007; 86: 529-33

“The addition of chlorhexidine to a two-step self-

etching adhesive primer (Clearfil SE Bond Primer)
has no adverse effect on the immediate resin-
dentine bond strength...”.

Zhou J et al, J Adhes Dent 2009; 12: 27-31

“Clearly the durability of the resin-dentin bond is

more complex than previously thought.”

Nishitani Y et al; Eur J Oral Sci 2006; 114: 160-66

The 3-step etch & rinse adhesives are the best

performing and are regarded as the “gold
standard”.
The 2-step self etch adhesives form the second-best
performing group.

These adhesives appear to be most resistant to

hydrolytic degradation as they provide a separate,
more hydrophobic resin layer as the final
application step.