Principles of bonding and adhesives in dentistry

Dental materials

What is adhesion?
The force that binds two dissimilar materials together when they are brought into intimate contact In dentistry, bonding refers to the process of attaching a restorative material to tooth structure by adhesion

Basic principles in the bonding process

Surface preparation to remove plaque & debris Acid etching with phosphoric acid, to remove mineral, create porosity, wettability Bonding agent applied and flows to fill the porosities and create resin tags (micromechanical retention) Resin applied and bonds chemically to underlying bonding agent (primary bonding)
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Adhesion
For proper adhesion to occur, intimate contact between the adhesive and the substrate is needed. This intimate contact is affected by: Wettability of the substrate surface The viscosity of adhesive The morphology or surface roughness,

Factors affecting adhesion

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Wettability and surface energy

low surface energy (solid)

High surface energy

liquid

liquid

solid

solid

Surface energy: the attraction of atoms to a surface (directed inward). In liquids, it is called surface tension
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2. 3. 4. 5.

Viscosity of bonding agent Interpenetration (formation of hybrid zone) Micromechanical interlocking Chemical bonding

Isolation

Enamel etching
Introduced by Michael Buonocore in 1950s Etching time: 10-30 seconds (around 15 seconds) Primary teeth and fluoride treated teeth require more time Etched enamel looks frosty white when dried Etching produces a rough surface (pits) into which resin flows and forms resin tags = micromechanical retention
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Enamel etching
Resin tags may penetrate to a depth of 10-20 microns in etched enamel The depth of penetration depends on:
Etching time Rinsing time

These two actors determine how effective etching was, and how well debris were removed from enamel surface

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Enamel etching
Without etching, bonding is weakened and this leads to microleakage In amalgam corrosion products may seal any spaces between cavity and restoration, in GIC the release of fluoride provides protection but in composite, good bonding is essential.

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Enamel etching
Liquid or gel (the gel is made by adding colloidal silica to the acid) phosphoric acid 30-50% (usually 37%).

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Procedure
Acid etch is applied using a brush or, if acid is supplied in disposable syringes, the acid maybe applied directly out of the syringe tip Etchant is applied for 15 seconds, or longer is mentioned previously
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Before etching

Acid etching gel

After etching
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Procedure continue,
Rinsing is done with water for 20 seconds then dried well. It should have a frosty white appearance Enamel should be kept clean and contaminant free (saliva, blood, etc) If contamination occurs enamel should be reetched for 10 seconds

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Enamel bonding
In the past, etching and bonding involved only enamel. Currently, total etch technique is done, and bonding agents are applied to both enamel and dentine. Bonding agents used for enamel bonding were made from resin combined with diluents to lower viscosity. (Bis-GMA + TEGDMA)

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Dentine etching and bonding

What makes dentine a challenge when it comes to adhesive bonding:
Dentine is a living tissue (50% HA, 30% collagen, 20% fluid) Tubular nature of dentine (dentinal fluid) Branching patterns in tubules, may enhance retention Smear layer presence Possible side effects on the pulp
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Dentine etching
1979 etching was done for dentine as well as enamel using 37% phosphoric acid. Research proved enhanced bonding (total etch technique) Over etching will remove more mineral than needed and open up tubules, and expose more collagen, making dentine more difficult to coat with bonding agent Over etching dentine leads to weaker bond and sensitivity Over drying should be avoided to prevent collapse of collagen and occluding tubules

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Another study showed how resin tags from bonding agents in dentine infiltrated a surface layer of collagen in demineralized dentine to form the HYBRID LAYER

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Bonding agents
Several years ago, it was believed that bonding to dentine can be achieved by chemical bonding between resin and either collagen or mineral content of dentine. Molecules designed for these purposes had the following presentation: M-R-X: M is a methacrylate group, R is a spacer such as hydrocarbon chain (ensure mobility of M group when X is immobilized), an X is a functional group that can bond to calcium in HA (usually an acidic group)

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Generations of bonding agents

First generation (1950s): based on silane coupling agents model. Based on M-R-X model:
M=methacrylate group R= hydrocarbon group X= glycerolphosphoric acid dimethacrylate

Success rate was low, due to high polymerization shrinkage and high CTE in unfilled resins used in those time
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Bonding agents
Second generation ( late 60s early 70s): similar concept to first generation agents. Low success rate. Attempts were made to deal with the smear layer Third generation agents: same as the previous generation, however attempts were made to modify or remove the smear layer which consists of:

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Bonding agents
Smear layer: it is weakly bonded t dentine
Dentine particles Bacteria Salivary constituents.

Procedure in 3rd generation agents:

Application of dentine conditioner (HEMA, or 2% nitric acid, or maleic acid) Application of primer (dentine bonding agent based on MR-X) Application of adhesive (unfilled resin) Placement of resin composite
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Bonding agents
Fourth generation: procedure,
Total etch technique for enamel and dentine, dentine conditioned for 15 seconds. Rinsing with water follows, then gentle drying without desiccating dentine to prevent collapse of collagen fibers Rinse to remove etchant and demineralized debris Dry to ensure enamel is etched Slightly moisten dentine Absorb excess water with cotton Apply hydrophilic primer (contains resin that polymerizes within collagen and a solvent that evaporates to ensure drying of tooth surface). Apply adhesive (bonding resin) then cure Composite applied and cured
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Bonding agents
Fifth generation agents: fewer steps, better results. Rely on micromechanical retention involving:
Penetration into partially opened dentinal tubules Formation of hybrid layer (hydrophilic monomer penetrate and polymerize to form interpenetrating network with collagen fibrils

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Generations of bonding agents

Fifth generation bonding agents:
Etching is achieved using phosphoric acid. Priming and bonding is combined in one step.

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Self-etching primers
Acidic groups are added to etch tooth surface No need for rinsing and drying May not be effective on unprepared enamel

Self priming adhesive: most commonly used now

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Fifth generation agents:
Self etching primers applied then dried Followed by bonding agent application
UniFil bond from GC Corp.

Adper SE scotchbond adhesive 32 (self etch primer and adhesive

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Bonding

Bonding agent

Curing

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Microleakage
Occurs when the restoration does not completely seal the surrounding margins of the cavity preparation Possible outcomes of microleakage? What contributes to microleakage?

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Factors that prevent good bonding

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Measurements of bond strength

Tests used:
Shear bond strength Tensile bond strength

Data were variable due to variability of tooth surface, and different testing methods
Microtensile and microshear bond strength: less variability.

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Amalgam bonding
Older amalgam restorations leak less due to corrosion products Technique:
Cavity preparation then isolation Etching of enamel and dentine to remove smear layer Primer applied and cured Self-cure bonding resin applied then amalgam is applied
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Clinical applications of bonding

Porcelain bonding and repair involves:
Sandblasting Special etchant (hydrofluoric acid) Silane applied for 30 seconds then dried to evaporate solvent (leaving a layer of vinyl that bonds resin to adhesive) Bonding agent applied Composite applied

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Pit and fissure sealants

Filled and unfilled resins GIC Success depends on good wetting, intimate contact through etching which will also ensure longevity of the sealant. PRR: minimal cavity preparation, resin composite placement, sealant placement on top.
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Glass ionomer cements bonding

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Thank you
Reference, Philips science of dental materials, Chapter 14 Dental materials, clinical application for dental assistants and dental hygienists, pages: 44 (dentine etching),48-50 (microleakage, factors that prevent good bonding, porcelain, amalgam bonding) Chapter 5
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