Limitations

Composite Shrinkage Post Operative Sensitivity Clinical Longevity

Basic Concepts of Adhesion

Mechanical adhesion Diffusion adhesion Adsorption adhesion Electrostatic adhesion
Involved

in metal bonding

Basic Concepts of Adhesion

* Mechanical adhesion

Bonding to Enamel
Rods made up of millions of crystals crystal orientation within a rod varies in a regular pattern.

Penetration of resin into tooth to form tags

*Adsorption adhesion

Chemical bonding to HA or collagen Ionic,covalent, hydrogen van der Waals Precipitation of substances onto tooth surface that resins can attach to (mechanical or chemical)

Diffusion adhesion

Enamel is Anisotropic
isotropic - same in all directions anisotropic - depends on direction

Properties of enamel
very hard, high compressive strength
Composite (isotropic)

low tensile strength

Enamel (anisotropic)

Bonding to enamel
Stronger bonding to rod ends Weaker bonding to sides of rods

etching gel

Etching Patterns

Type II pattern

Type I pattern

Histologic effects of etching

Etches about 10 m of surface and penetrates 25-75 m Increases surface area about 2000 times
Primarily Mechanical Bonding

Acid strength and etch time

37% phosphoric acid works well (Silverstone 1984)
Best

definition of pattern

15-60 sec etch times result in similar roughnesses

Contamination of etched Enamel

saliva or sulcular fluid contamination decreases bond strengths to enamel HA absorbs proteins very efficiently not removed by rinsing alone must re-etch to remove (10-15 sec)

Challenges in Dentin Bonding

2 6

Dentin Bonding
92

Dentin Structure and Organization

dentin is not uniformly mineralized

50 vol% HA (less mineral) 25 vol% collagen 25 vol% water includes tubules-(more water)

Enamel

peritubular dentin is more mineralized than intertubular dentin

tubule density changes with location

More holes and more hole area as pulp is approached

Dentin changes with time

Sclerotic dentin -more mineralless collagen

Dentin covered by Smear Layer

adherent layer of tooth debris, saliva and bacteria covers surface and plugs tubules to reduces dentin permeability weak cohesion and adhesion (cannot be removed with air/water syringe)
Smear layer

Smear layer and Bonding

interferes with resin bonding newer dentin bonding systems (DBS)

Smear plugs

remove alter

smear layer (total-etch)

smear layer (self-etch)

Stresses generated on tooth during composite Shrinkage

Composite shrinks

Factors that affect shrinkage stresses

cavity volume cavity configuration extension of cavity to DEJ enamel quality dentin quality bond strengths of adhesive material composition and structure

1.2 - 4.5 % by volume 0.2-1.9% linear 2.8 - 7.3 MPa force Depends on how well it is bonded

Shrinkage results in stress on tooth

Shrinkage stresses nearly exceed strength of enamel

enamel 10 MPa UTS

White Lines ?

Enamel Cracks
Result from shrinkage stress 50X

20X

CRA Newsletter (1999):23(5-6) 1-4

700X

From what?
Adept Report (2000):6(3) 1-16

Finishing stresses? Polymerization stresses?

CRA Newsletter (1999):23(5-6) 1-4

Cavity configuration and its role in stress generation

C-Factor
What is it?

Ratio of bonded surface/free surface High C-Factor = high shrinkage stress Low C-Factor =low shrinkage stress

What clinical implications?

Reduce C-Factor and you reduce shrinkage stress Reduce shrinkage stress and you improve margin integrity

Incremental Buildup reduces C-Factor

Controlling Stress by Layering

Multilayer technique Layer 3 Layer 2 Layer 1

Maximize gingival seal Lutz, Krejci, Oldenburg 1986

Current Dentin Bonding Systems Available

3 step total-etch technique 2 step total-etch technique 2 step self-etch technique 1 step self-etch technique

Total-Etch 3 step Technique

Step 1: Total etch (35% H 3PO4) Smear layer removed Surface dentin demineralized Dentin vulnerable to desiccation Step 2: Hydrophilic Primer applied Re-wets dentin Establishes Hybrid layer Step 3: Adhesive Composite placement

Limitations: Too many steps dentin moisture variable some sensitivity reported

Total-Etch 2 step Technique

Step 1: Total etch (35% H 3PO4) Smear layer removed Surface dentin demineralized Dentin vulnerable to desiccation Step 2: Primer/Adhesive mixture applied Re-wets dentin (not as effective) Establishes Hybrid layer Composite placement

Total-Etch Techniques more likely results in Post Operative Sensitivity

Both direct and indirect Biting pressure

Central location 0-30% 8-12%

Thermal sensitive less

Limitations: Too many steps dentin moisture variable most sensitivity reported

Ways to minimize post-op sensitivity when using totaletch techniques

Do Not desiccate dentin

Self-Etching 2 Step Technique

Step 1: Apply Self-Etching Primers

Keep dentin moist Water, Gluma, dentin primers, multiple adhesive layers,

Smear layer modified Surface dentin demineralized Hybrid layer developed More Complete seal and better penetration

Rewet with wetting agent

Step 2: Apply Adhesive

RMGI liner or base prior to etching

Composite placement Lower sensitivity reported Concerns about stability Seal does not appear to be as good

Self-Etching 1 Step Technique

Step 1: Apply Self-Etching Primer/Adhesive mixture

New Clinical Applications of Dentin Adhesives

Desensitization Adhesive amalgams Indirect adhesive restorations

Smear layer modified Surface dentin demineralized

Hybrid layer developed Composite placement Lower sensitivity reported Concerns about stability Seal does not appear to be as good