ENAMEL ETCHANTS & DENTINE CONDITIONERS

Purpose of enamel etching: Enamel etching modifies the surface structure of the enamel which is smooth and have low bond strength and improve mechanical bonding and that ensures sealing of marginal edge where previously oral fluids would leak between microscopic gaps. Action of enamel etching: 37% Phosphoric acid removes organic pellicle and smear layer, dissolves outer 5-10 m of enamel, creating microporosities by exposing and roughening prism ends, increasing surface area energy and lowering the resin contact angle, to allow resins to form inter- and intracrystallite tags. Selective dissolution of prisms, producing different patterns that are associated with enamel porosity and thought to be determined by etching times. Poor correlation between the depth of porosity and the strength of the resin-enamel bond. The effectiveness of the enamel etching depends on etching time, type of enamel, type of etchant and rinsing time Other types of enamel etchant: 10% phosphoric acid gel , 10% maleic acid, 2.5% nitric acid, citric acid and oxalic acid. Air abrasion - bond strengths of air-abraded enamel are said to be around 50% of acid -etched enamel Laser produce a rough porous surface but said to be more shallow so may affect ability to form strong resin tags. Also does not produce a smear layer. Advantages: Improves resin-enamel bond, strengthening adhesive properties of restoration Helps create a seal to prevent marginal leakage Thixotropic nature of gels give greater control during application Disadvantages: Need a dry working environment Viscosity of gels thought to affect etching quality as less uniformity of wetting enamel surface Self-etching adhesives do not necessarily clear the smear layer well so retention strength can be compromised Aprismatic, one-directional primary enamel may prevent effective etching and reduce formation of sufficient resin tags Lower strength require much longer etching times which is not convenient in dental setting Dentine Conditioning Purpose of Dentine Conditioning Bonding to dentine is much harder than enamel as dentine is a also comprises of organic material and fluids. Dentine conditioning alters the structure of dentine and removes the smear layer to give a site for micromechanical and chemical bonding to an adhesive. Dentine conditioners used Acids or calcium chelators - 30-40% phosphoric acid gel, EDTA, maleic, Nitric, tannic, citric acids with varying concentrations. Polyacrylic acid conditioners, used for GIC restorations provides clean dentine surfaces but does not substantially demineralize. The Smear Layer of Dentine Adherent layer of debris on the tooth surface

Granular substructure but appears generally amorphous. The dentine tubule orifices are obstructed by smear plugs which may extend to a depth of 1-10m. A mix of fragmented/denatured collagen and crushed hydroxyapatite, microbials, salivary proteins Constituents and thickness of the smear layer depends on tissue removal technique, tissue type and depth of cavity. Inherently weak bond to dentine and brittle nature.

Action of Dentine Conditioners The more acidic and aggressive the conditioner, the more completely the smear layer and plugs are removed. Stronger acids also demineralize superficial dentine, removing smear plugs up to 1-5 m. Demineralization of intertubular dentine exposes a microporous collagen scaffold that is resin-permeable. Demineralisation of peritubular dentine causes the tubuli orifices widen and form a funnel-shaped structure that has exposed collagen fibrils that are circularly orientated making it extra retentive. Advantages/Disadvantages Allow for minimally invasive techniques as the need for large mechanical undercuts for filling retention is obviated. Susceptibility of collagen scaffold collapse when dried, thus impeding proper infiltration of the collagen with resin monomers. Etching for too long or with too strong an acid etchant over etching causes deep demineralization or denaturation of the collagen network, leading to less than optimal resin impregnation porous zone in hybrid layer decreased durability of the resin-dentine bond Removal of smear layer could induce tooth sensitivity. Possible access of bacteria toward pulp and induce pulpal irritation due to open dentine tubuli. Dentinal fluid release from tubules compromise primer and bonding agents due to its water content. Acid may cause irritation and damage to pulp. Design of an enamel etchant Originally, acid etchants to the form of a free flowing solution but these proved difficult to control during placement. These problems lead to the development of gel etchants which have small amounts of microfiller or cellulose added to thicken them. These gels flow under pressure however under their own weight they remain stationary. Many acids have been investigated as etchants but phosphoric acid at 37% e,g ProOptionsTM Gel Etch, 35% and 10% is most commonly used as it produces the most reliable etching patterns. 2% Benzalkonium chloride could be added as an antimicrobial. Dyes could be added to improve visibility of etchant in the mouth.