Dentin Bonding Agents
Transcript of Dentin Bonding Agents
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Adhesion and Dentin bonding agents
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Contents HistoryAdhesion - types
- factors affectingIdeal requirementsAdhesion to enamel Bonding to dentin and its problemsConditioning of dentinPrimersSmear layerHybrid layerClassification of dentin bonding agentsConclusion
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Introduction
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History –
1955 - Buonocore acid etching with phosphoric acid
1956 - Buonocore developed the first dentin bonding agents.
1957 - Bowen gave BISGMA resin system
1982 - Bowen, Cobb and Rapson developed multilayer adhesive system
Nakabayashi reported the presence of hybrid layer
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Adhesion – latin - to stick
It is the force or the intermolecular attraction that exists between molecules of two unlike substances when placed in intimate contact with each other.
Adhesive Adherend
Types of adhesion –
1. Chemical - based on primary valence forces – covalent, ionic, metallic bonds2. Physical - based on secondary forces – Van der Waals forces,
hydrogen bonds, dispersion forces( specially when surfaces are smooth and polished )
3. Mechanical - based on penetration of one material into another at microscopic level. ( when surfaces are rough )
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Factors affecting adhesion –
1. Surface energy –
2. Wetting -
3. Contact angle -
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Adhesion to enamel – mainly by micromechanical method
Acid etchingThe procedure that leads to removal of smear layer and increase the microscopic roughness by removal of prismatic and the interprismatic mineral crystals.
Effects of acid etching –
1. Removes residual pellicle2. Creates a porous layer of depth 5 – 10 microns3. Increases wettability4. Increases surface area5. Increases surface energy
Bond strength to acid conditioned enamel 16 – 21 M Pa.
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Various etchants used –
1. Phosphoric acid – as liquid or gel
)
2. Sulphuric acid 2 %
3. Phosphoric acid 10 %
4. Maleic acid 10 %
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5. Nitric acid 2.5 %
6. Oxalic acid
7. Citric acid
Teeth requiring longer application - acid resistant teeth
( with high F content)
primary teeth. ( more aprismatic )
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Patterns of etching –
Type 1 – Most common.Preferential removal of enamel prism cores & periphery intact.
Type 2 - Reverse of type 1. Periphery removed and cores intact.
Type 3 – Etching pattern less distinct. Both types 1 & 2 present.
Macrotags – resin tags formed at periphery of enamel rods ( between prisms )
Microtags - smaller tags formed at end of rod where individual hydroxyapatite crystal has been dissolved.
More important because of greater number and surface area.
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Problems in bonding to dentin –
Presence of 30% organic material
Random arrangement of hydroxyapatite crystals in the organic matrix.
Tubular nature of dentin that permits fluid flow, adversely affects bonding.
Sclerosed dentin is difficult to penetrate as peritubular dentin becomes and wider.
Permeability of dentin differs at various sites.
Variation in arrangement of tubules & their shape.
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Ideal requirements of dentin bonding agents:
1. Provide high bond strength to dentin that should be present immediately after placement and that should be permanent.
2. Provide bond strength to dentin similar to that of enamel.
3. Show biocompatibility to dental tissue including the pulp.
4. Minimize microleakage at the margins of the restorations.
5. Prevent recurrent caries and marginal staining.
6. Be easy to use and minimally technique sensitive.
7. Possess a good shelf life.
8. Be compatible with a wide range of resins.
9. In addition it should be non toxic and non sensitizing to the operators or patients.
10. Bonding agents should seal the tooth surfaces from oral fluids.
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SMEAR LAYER
Suggested by Skinner (1961)
Coined by Boyde et al (1963)It is a thin layer of grinded debris left on tooth during tooth preparation.Thickness – 12 micron metersCompositionDenatured collagen Hydroxyapetite & cutting debris.
Of 2 types : - Superficial – loosely adherent smear layer - Deep – tightly packed smear plug
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Smear plugs-Thickness 1-5 microns metersPrevents bacterial invasion but does not prevent diffusion of bacterial toxins into the pulp .Decreases dentinal permeability
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Composition of dentin bonding agents
ConditionersPrimersAdhesivesInitiators and acceleratorsFillersOther ingredients.
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Conditioning of the dentinDefined as alteration done after the creation of
dentin cutting debris, termed the smear layer, to create a surface, capable of micromechanical and chemical bonding to dentin bonding agent.
Changes after conditioning:Removal or modification of smear layerOpening of dentinal tubule orifices. Modifications in organic matterDecalcification of inorganic portion.
Can be done by -ChemicalsAcidsCalcium chelators
ThermalLasers
MechanicalAbrasion
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Acid washing / rinsingRemoves smear layerDissolves HA
Drying shrinks remainingCollagen polymer molecules
Rehydration / primingSwells collagen
Mechanism of dentine bonding
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Monomer penetration
Mechanism of dentine bonding
Monomer polymerisationAnd collagen entanglement
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1. Phosphoric acid : First dentin conditioner37% H3PO4 should be used. Use of more than 50% results in the formation of monocalcium phosphate monohydrate that is not readily soluble and would not be completely washed away.
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Calcium chelators:Chelators are used to remove the smear layer
without decalcification or significant physical changes to the underlying substrate as opposed to strong acid etchants.
EDTA:- Removes smear layer, not plugs. - It is scrubbed on the surface of the smear layer for a few seconds, then left passively for another 60 seconds followed by additional scrubbing. Disadvantage:- Removes small amount of Ca, thus causing fall in the bond strength.
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Primers
Adhesion promoting agents
Contains monomers with HYDROPHILIC properties which have affinity for exposed collagen fibrils &HYDROPHOBIC properties for copolymerization with the adhesive resin.
Monomers used are : HEMA, NPG-GMA.
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XM R
PRIMER FORMULA :
Hydrophilic part: (REACTIVE GROUP)Hydrophobic part: (Methacrylate group) R- Spacer Adhesive molecule is
bifunctional X enters into chemical union with the tooth structure M Co-polymerizes to the resin through the double bond of methacrylate R- spacer group responsible for making the molecule large enough to keep the methacrylate groups spatially located for optimal chemical reaction with composite
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The solvents used in primers
1. Acetone based primers – Advantages :
Excellent water chaser,Dries quickly
2. Ethanol based primers – Advantages :
Evaporates less quicklyLess sensitive to wetness of dentin.Good surface energy and good
penetration.3. Water based primers – Advantages :
Slow evaporationNot sensitive to wetness of
dentin. Have capacity to raise collapsed
fibers.(9%-50%)
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Hybrid layer :Nakabashi -1982
Resin reinforced zone, or resin infiltrated layer
Hybrid layer is the structure formed in dental hard tissues by demineralisation of the surface and subsurface, followed by infiltration of monomers and subsequent polymerisation. The resulting structure is neither resin or tooth but a hybrid of both.Shag carpet appearance
Appears when dentin surface after being acid etched is actively scrubbed with an acidic primer solution.
The combined mechanical and chemical action of rubbing the acid etched dentin with an acidic primer dissolves additional mineral salts while fluffing and separating the entangled collagen at the surface.
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Fillers:Most of the bonding agents are unfilled
May contain inorganic fillers 0. 5% to 40% by wt.
microfillers, or nanofillers, and submicron glass.
Advantages of nanofillers:
Prevents nanoleakage.Causes uniform thickness of adhesive
layerBetter flexibility to adhesivesBetter dissipation of forcesScatter of light is prevented.Provides radio opacity
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Classification of Dentin bonding agents
1. According to generation
2. According to adhesion strategy (number of clinical applications)
3. According to treatment of smear layer. 4. According to mode of curing
5. According to Ph
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I. On the basis of generations:
First Generation: By Bowen in 1965
Agents used: NPG GMA
Mechanism of adhesion: Chelation of NPG GMA with calcium on the tooth
surface to generate water resistant chemical bonds
of resin to dentinal calcium.
Bond strength : 2 – 3 MPa
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Second Generation: Early 1980s
Agents used: BIS-GMA / HEMAPolyurethane based compounds
Interaction b/w negatively charged phosphate grps in the resin with positively charged calcium ions in the smear layer.
Bond strength: 1- 5 Mpa
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Third Generation: Mid 1980s
Negative effect of smear layer known by then. Thus additional step of conditioning and priming to -
remove smear layermodify smear layer
Mechanism of adhesion: Conditioner removes smear layer and
opens up the tubules.
Advantages:Increased bond strengthImproved clinical performanceReduced microleakage relied on mechanical means of bonding as opposed to the less reliable chemical adhesion.
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Bond strength: 9-15 Mpa.
Disadvantages:More number of steps, thus complexTechnique sensitiveRetention decreased with time ( longevity questionable )
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Fourth generation – Universal bonding systems
Characterized by Complete removal of smear layer Total etch technique
( simultaneous etching of enamel and dentin. )
Mechanism of action Etching removes smear layer, opens the tubules upto 7.5 microns
and increases the permeability.Primer wets & penetrates the collagen meshwork and increases its
surface energy and wettability into which the resin flows.
Based on diffusion and impregnation of resin into partially decalcified dentin followed by polymerisation creating a resin reinforced layer
Hybrid layer
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AdvantagesLess technique sensitivitysimilar bond strengths to both enamel and dentin
Bond strength: 18 Mpa
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Fifth generation
Developed with aim towards reducing the total number of clinical steps. Characterized by combinations of primer and adhesive in one step.
( One bottle adhesive systems )
Mechanism of action : complex combination of micromechanical retention
Bond strength 17 – 24 MPa.
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Sixth generation: Introduced in the late 1990s.
Here the primer and etchant are combined in one step.( Self etching primers).
Available in two types –two step self etching primerssingle step self etching primers ( all in one
systems )
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Seventh Generation: One up Bond F
Fluoride releasing Self etching type Colour changing capacity (visual confirmation of complete curing) Characterized by etching, priming and bonding in a simple application with no rinsing or drying. Available in two bottles, which have to be mixed and applied to the cavity.
(A & B mixed) (Completely cured)
Yellow Pink White
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II. Classification based on the number of clinical application steps
and how they interact with tooth structure
Total etch adhesives:3 step2 step
Self etch adhesives:2 step1 step
Resin modified glass ionomer adhesives
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Total etch adhesives - Fusayama
Total etching is the simultaneous etching of enamel and dentin.
The ph of these formulations is between 2.5 to 4.5
to demineralise smear layers and etch dentin.
Hence a separate etch and rinse phase involved
Mechanism of action – ( hybrid layer formation )
Smear layer removed by etch and rinse phase,
3-5micron deep demineralization of the dentin surface.
Collagen fibrils are completely removed from hydroxyapatite
a microretentive network for micromechanical interlocking of monomers.
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3 step Total etch: ( Fourth generation of dentin bonding agent )
ConditioningPriming Application of adhesive resin
Etchant Primer Adhesive
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2 Step total etch ( Fifth generation of dentin bonding agent. )
ConditioningPrimer and adhesive
Etchant
Adhesive Primer and adhesive
Primer
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Self etch adhesives -
These adhesive systems are based on the use of non rinse acidic monomers that simultaneously condition and prime dentin and enamel.
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Self etching primer
EtchantPrimer
Adhesive
Two step self etching primer - ( sixth generation )
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Advantages : . The self etching primers are designed to be used on dry dentin. Avoids the removal of smear plugs in the dentinal tubules and
the dentin bond strengths is comparatively high.
Disadvantages : Less effective bonding of enamel. Initial bond might deteriorate with ageing, which could lead to premature failures. Bonding to sclerotic and caries affected dentin might be problematic
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All in one adhesive
EtchantPrimer Adhesive
Single step self etching primer
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Clinical uses of dentin bonding systems:
Bonding of directly placed resin based restorative materials. Bonding of indirectly placed restorative materials. Bonding of ceramic restorations. Bonding of amalgam restorations. Repair existing restorations. Sealing of pits and fissures of posterior teeth. Treatment of cervical sensitive dentine. Reattachment of fractured tooth fragment
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Advantage of single step SEPs :
Fast and easy to use.
Disadvantages:
Marginal staining and debonding may occur in some of the Systems.May not bond durably to enamel.Lack of polymerization..
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VII. According to their mode of curing:
Chemical cure:Amalgabond plus
Light cure:One bond Gluma comfort bond
Dual cure:Clearfil liner bond 2VPrime and Bond NT dual cure.
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Failures in bonding :
Can occur at various levelsbetween mineralised and demineralised dentinbetween demineralised dentin and bonding agentwithin layer of bonding agentbetween bonding agent and composite resin.
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Thank you !!