CHAPTER 5

Dr Majed AlGhamdi
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Definition of Adhesion
"the state in which two surfaces are held together by interfacial forces which may consist of valence forces or interlocking forces or both.
The word adhesion comes from the Latin adhaerere ("to stick to").

An adhesive material :
Viscous fluid, that joins two substrates together and solidifies, and therefore is able to transfer a load from one surface to the other.

Adhesion or adhesive strength:

The measure of the load-bearing capacity of an adhesive joint .

Bonding of resins structure is a result of four possible mechanisms:

1. Mechanical-penetration of resin and formation of resin tags within the tooth surface. 2. Diffusion-precipitation of substances on the tooth surfaces to which resin monomers can bond mechanically or chemically. 3. Adsorption-chemical bonding to the inorganic components ( hydroxyapatite ) or organic components (mainly Type I collagen) of tooth structure. 4. A combination of the previous three mechanisms.

TRENDS IN RESTORATIVE DENTISTRY

The classic concepts of tooth preparation advocated in the early 1900s have changed drastically over the last 20 years. New philosophy has resulted in: more conservative approach to tooth preparation (basic concepts of retention form, resistance form of the remaining tooth structure). Bonding techniques conservative tooth preparations less reliance on macromechanical retention less removal of unsupported enamel.
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Adhesive restorative techniques are currently used to:

1.Change the shape and the color of anterior teeth. 2. Restore Classes I, II, III, IV, V, and VI carious or traumatic defects. 3. Restore teeth with amalgam using an adhesive technique. 4. Provide retention for metallic crowns or for porcelain fusedto-metal crowns. 5. Bond all-ceramic restorations . 6. Bond indirect resin-based restorations. 7. Provide foundation for crowns. 8. Desensitize exposed root surfaces. 9. Bond prefabricated and cast post.
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ENAMEL ADHESION
Enamel is a highly mineralized tissue composed of more than 90% (by volume) hydroxyapatite. Acid etching transforms smooth enamel into irregular surface. Enamel etching:result in 3 different micromorphology pattern.. Type I pattern ..involves the dissolution of prism cores without dissolution of prism peripheries. Type II pattern ..opposite of Type I, the peripheral enamel is dissolved ,cores left intact. Type III pattern .. Areas resemble other pattern and areas tomography is not related to enamel prism morphology.
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ADVANTAGES OF ENAMEL ADHESION

Shear bond strengths of composite to etched Enamel =20 Mpa. Provide adequate retention . Cusp reinforcement after tooth preparation Reinforce remaining Enamel and Dentin , less susceptible to fracture.

ENAMEL ADHESION ..con

An etching time of 60 sec was originally recommended for permanent enamel using 30% to 40% phosphoric acid. One study concluded that shorter etch times resulted in lower bond strengths . Other studies using scanning electron microscopy (SEM) showed that a 15-second etch resulted in a similar surface roughness and similar bond strengths . Clinically, reduced etching times do not appear to diminish the retention of pit-and-fissure sealants.

DENTIN ADHESION
Adhesive materials can interact with dentin in different waysmechanically, chemically, or both. Researchers now believe that dentin adhesion relies primarily on the penetration of adhesive monomers into the filigree of collagen fibers left exposed by acid etching.

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CHALLENGES IN DENTIN BONDING

Dentin contains a substantial proportion of water and organic material, primarily Type I collagen .
Dentin contains a dense network of tubules that connect the pulp with the dentin-enamel junction . The tubules are lined by a cuff of hypermineralized dentin called peritubular dentin. The less-mineralized intertubular dentin contains collagen fibrils with the characteristic collagen banding
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 Whenever tooth structure is prepared with a bur or other instrument, residual organic and inorganic components form a "smear layer" of debris on the surface . The smear layer fills the orifices of dentin tubules (forming smear plugs and decreases dentin permeability by up to 86%) . smear layer: is composited of hydroxyapatite and altered denatured collagen. This altered collagen may even acquire a gelatinized consistency as a result of the friction and heat created by the preparation procedure.
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Enamel
Organic2%

Dentin

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DEVELOPMENT OF DENTIN BONDING SYSTEMS

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First-Generation Dentin Adhesives

The development of the surface-active comonomer NPG GMA comonomer could chelate with calcium on the tooth surface to generate water-resistant chemical bonds of resin to dentinal calcium dentin bond strengths 2 to 3 Mpa. Based on Carbon-13 NMR analysis, it appears that no ionic bonding actually develops between NPG-GMA and hydroxyapatite.

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Second-Generation Dentin Adhesives

In 1978, the Clearfil Bond System F (Kuraray, Osaka, Japan) was introduced in Japan . Generally recognized as the first product of the second generation of dentin adhesives a phosphate-ester material (phenyl-P and HEMA in ethanol). Mechanism of action was based on the polar interaction between negatively charged phosphate groups in the resin and the positively charged calcium in the smear layer .

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The smear layer was the weakest link in the system because of its relatively loose attachment to the dentin surface. Examination of both sides of failed bonds revealed the presence of smear layer debris . bonding did occur was due to interaction with calcium ions

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Third-Generation Dentin Adhesives

New Bond in 1984 Kuraray introduced Clearfil The concept of phosphoric acid-etching of dentin before application of a phosphate ester-type bonding agent was introduced by Fusayama and others in 1979. This new phosphate-based material contained HEMA and a ten-carbon molecule known as10-MDP, which includes a long hydrophobic and a short hydrophilic component.' Most other third-generation materials were designed not to remove the entire smear layer, bur rather to modify it and allow penetration of acidic monomers such as Phenyl-P or PENTA.

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 Treatment of the smear layer with acidic primers was proposed using an aqueous solution of 2.5% malefic acid,55% HEMA, and a trace of methacrylic acid (Scotchbond 2 [3M ESPE, St. Paul, Minnesota]) Scotchbond 2 the first dentin bonding system to receive "provisional and "full acceptance" from the American Dental Association (ADA) in 1987 .

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Current Options for Resin-Dentin Bonding

Fourth-Generation DentinAdhesives. (Total etch technique) Fifth-Generation Dentin Adhesives (One-Bottle ,Total Etch Adhesive) Self-Etching Dentin Adhesive Systems Self-etching primers (SEPs)

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Fourth-Generation DentinAdhesives.
(Total etch technique)
1990 s ,remain popular today. Originate in Japan. Lab. Shear strength 17 -30 MPa (1) an acid etching gel(phosphoric acid ) that is rinsed off; (2) primers that are reactive hydrophilic monomers in ethanol, acetone, and/or water. (3) an unfilled or filled fluid bonding agent(Bis-GMA). bonded to the underlying dentin substrate. Ex:
All-Bond 2 OptiBond FL Scotchbond MultiPurpose (3M ESPE, St. Paul, Minnesota), are basically
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Composite Dentin Adhesive Hybrid Layer

Bonding of resin to dentin, using a "total-etch" technique.

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Removal of the smear layer via acidetching

Partial or total removal of the smear layer and demineralization of the underlying dentin. Demineralizing intertubular and peritubular dentin, open the dentin tubules and expose a dense filigree of collagen fibers increase the microporosity of the intertubular dentin Dentin is demineralized: up to 7.5 um, depending on the type of acid application time concentration
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Scanning electron micrograph of a smear plug blocking the entrance of a dentinal tubule. SP, Smear plug.
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The adhesive system / Substrates

have a low surface tension and the substrate must have a high surface free energy for adequate interfacial contact. Substrates are characterized as having low or high surface energy. Dentin consists of two distinct substrates: 1. high-surface energy (hydroxyapatite). 2. low surface energy (collagen). Thus, after etching with acidic

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Fifth-Generation Dentin Adhesives

(One-Bottle ,Total Etch Adhesive)
One-Bottle combine the primer and bonding into a single solution

adhesive systems (the fourth- and fifth-generation materials described in the previous section) based on the total-etch philosophy have proved successful both in vitro and in vivo . easier to apply. Reduce the number of steps needed . Application time . Laboratory bond strengths usually vary from 17 MPa to 30 MPa, which are very close to the values commonly obtained on enamel.
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Self-Etching Dentin Adhesive Systems

The first systems based on this philosophy included acidic etchants with a lower concentration than the traditional 30% to 40% phosphoric acid.

Some studies ; indicated that low-concentration etchants (such as 2.5% nitric,10% citric, 10% phosphoric, or 10% maleic ) are as effective as 30% to 40% phosphoric acid when applied to enamel for 15 seconds.

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 other studies have shown that such low-concentration acids have lower enamel bond strengths than conventional 30% to 40% phosphoric acid

The long-term clinical consequences of etching enamel with these low-concentration acids are not yet known.

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Self-etching primers (SEPs)

Introduced in Japan. include a phosphonated resin molecule that performs two functions simultaneously etching and priming of dentin and enamel. self-etching primers are not rinsed off. bond strengths of 20 to 28 MPa

The bonding mechanism of SEPs based on the simultaneous etching and priming of enamel and dentin without rinsing, forming a continuum in the substrate and incorporating smear plugs into the resin tags.
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Bonding to dentin using a self-etching primer.

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ADVANTAGE OF THIS SYSTEM

Simplifying the bonding technique, Elimination of rinsing and drying steps. reduces the possibility of overwetting or overdrying.

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6. Sixth generation Two Types of adhesive belong to 6th generation.

- Self etching Primer in one bottle and separate adhesive agent in another = 2 bottles or - Conditioner + Primer + and adhesive combined but require mixing.
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Seventh generation

The late Self etch technique. One bottle one step Single Component. No Mixing-

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ROLE OF THE HYBRID LAYER

Resin infiltration or "hybridization" of the dentinal tubules and intertubular dentin accounts for a substantial proportion of the bond of resin to dentin.

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MOIST VERSUS DRY DENTIN SURFACES

.Vital dentin is inherently wet; therefore , complete drying of dentin is difficult to achieve clinically. .Water has been considered an obstacle for attaining an effective adhesion of resins to dentin. .With that in mind, research has shifted toward development of dentin adhesives compatible with humid environments.
DR.M.ALGHAMDI
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Most newer adhesives combine hydrophilic and hydrophobic monomers in the same bottle, dissolved in an organic solvent such as ethanol or acetone. The "wet-bonding technique prevents collagen collapse that occur upon drying demineralized dentin. Such COLLAPSE may prevent the monomers from penetrating the nano channels formed by dissolution of hydroxyapatite crystals between collagen fibers
DR.M.ALGHAMDI
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-If the dentin surface is dried with air, the collagen undergoes immediate collapse and prevents resin monomers from penetrating D.T.

-The clinician must be aware that pooled moisture should not remain on the tooth, because excess water can dilute the primer and render it less effective.

DR.M.ALGHAMDI

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DR.M.ALGHAMDI

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Many clinicians, still dry the tooth preparation to check for the classic etched enamel appearance.
Rewetting the dried etched dentin with water or with aqueous rewetting agents has been demonstrated to restore bond strength and raise the collapsed collagen network to a level similar to a "wet bonding technique.

Therefore , the inclusion of both an organic solvent and water may be fundamental for the best infiltration of some adhesives into demineralized dentin and result in a less techniquesensitive procedure.

DR.M.ALGHAMDI

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Clinically, it is very difficult to either assess or standardize the ideal amount of moisture that should be left on the dentin surface before the application of the adhesive system. Ideally, water should form a uniform layer without pooling (overwet) and without dry areas (overdried). Therefore air-drying with an air-water syringe after rinsing off the etching gel is not recommended. Excess water after rinsing the etching gel can be removed with a damp cotton pellet, a disposable brush, or a tissue paper without adversely affecting bond strengths

DR.M.ALGHAMDI

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MICROLEAKAGE
Microleakage is the passage of bacteria and their toxins
between restoration margins and tooth preparation walls. The smear layer alone may be a pathway for microleakage through the nanochannels within its core. The pulpal response to restorative materials is related to the degree of marginal leakage.

DR.M.ALGHAMDI

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Dentin adhesives can prevent exposure of the pulp-dentin complex to bacteria and their toxins. Bonding the resin to a preparation with cavosurface margins in enamel is still the best way to prevent microleakage. Bacteria are able to survive and proliferate within the fluidfilled marginal gaps under composite restorations. If the restoration is sealed, bacteria will not survive.

DR.M.ALGHAMDI

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Nanoleakage: small porosities in the hybrid layer or at transition between the hybrid layer and the mineralized dentin that allow penetration of silver nitrate dye Water trees: porosities in the polymerized adhesive layer

DR.M.ALGHAMDI

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BIOCOMPATIBILITY
It is unlikely that the acid is directly responsible for any injury to the pulp.
Etchants are hypertonic. Application of a hypertonic gel could osmotically draw fluid from the dentin toward the surface and alter the exposed collagen fibers. Ideally, one would use isotonic acids as dentin etchants, to be tolerated.

DR.M.ALGHAMDI

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Dentin adhesive systems are well tolerated by the pulp-dentin complex in the absence of bacterial infection. To prevent bacteria infection, restorations must be hermetically sealed.

DR.M.ALGHAMDI

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When all margins are in enamel, polymerization shrinkage stresses at the interface are counteracted by strong enamel adhesion. Thus, marginal gaps are less likely to form, and the restoration is sealed against bacteria.

DR.M.ALGHAMDI

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Dentin adhesive systems also are used to bond fresh amalgam to existing amalgam restorations in repair procedures. The prognosis of this type of procedure is, however, unpredictable and can be unsuccessful.

The interfacial failure between fresh amalgam and old amalgam may be a result of the lack of micromechanical retention in the "old" amalgam restoration surface. Therefore dentin adhesive systems are not recommended for amalgam repair.

DR.M.ALGHAMDI

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Thank you
DR.M.ALGHAMDI
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