Principles of bonding and adhesives in dentistry:

So what is the adhesion ?? The force that binds two dissimilar materials together when they are brought into intimate contact Adhesion represent the bond .. and how they adhere to each other In dentistry bonding refers to the process of attaching a restorative material to tooth structure by adhesion ""Fe 6b al asnan kef bn7ke 3n madaeh btlta98 be madeh o5ra 3am bn7ke 3an pressure btlta98 be enamel &dentin kef al 7ashwah r7 tmsak bl sen w ma t6l3 mno "" There are many ways of adhesion the crown retend to the tooth (prepared tooth ) like the amalgam inside the cavity if u want retention to the surface of the tooth we are talking about composite and glass ionomer cement some principle preparation should be done to remove any plaque and debris .. any contaminant on the surface could interfere with good bonding so the surface has to be clean and at the same time u will improve the wettability . Ur bonding agent(filling) will flow better . It will cover a larger surface area and if we have a large surface area between the surface and the filling we will have better bonding force

""kol ma za6 8oot tmasook al 7ashwah fe al sen kol ma zad 8oot elte9a8o feeh ,,, "" as simple as that . in case of composite we need to prepare the surface , make it rough and in the same time clean . So we use phosphoric acid "la andaf al sa67 ele bdha tege 3alah al 7ashwa" >> phosphoric acid will remove any debris or opaque any remnant of perpetration of the enamel &dentin to create pores and the roughness of the surface and increase the wettability so anything U place on the top it will flow much better . after that when the bonding agent is on the surface the composite will stick with it with the enamel and dentin . if we didnt prepare the surface well with phosphoric acid .. it will contaminant with saliva, blood , etc minimize the bonding force Remember ..(In Arabic ) "" al-3amlyh kolha 56wt ..eza 5rbt wa7da al ba8e kolo b5rb :D al sa67 ndef bl acid etching .. bndef bonding agent bd5ool bl Micro- pores bmsak feha bnfs al w2t resin bmsk bl bonding agent w b9er al taraboo6 ma ben al 7ashwa wl enamel & dentin."" Clean surface (by etching) >> add bonding agent >>> resin attach bonding agent >>> contamination between bonding , enamel , dentin .

#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) we need clean surface , viscosity of the filling(bonding agent) is Important we dont the material to be too viscose otherwise it will not flow well and the morphology of the surface is Important a rough surface provide better adhesion than the smooth surface . How this rough surface is created ?? By the phosphoric acid which will remove part of the minerals in the enamel and dentin . When it remove part of the minerals in the enamel &dentin >>> and also it will remove part of the mineral in the dentinal tubules .. open them >> create this micro-pores Without the roughness there will be no good bonding

The intimate contact is affected by :

# wettability of the surface #the viscosity of adhesive #morphology\ surface roughness Now.. ** wettability ( retune to slide # 5 ) Wettability depend on the surface energy (Surface energy is the attraction of atoms to a surface (directed inward) In liquids, it is called surface tension)

Look to the slide in the right pic the wettability is poor , the liquid form droplet

but in the left one .. the liquid flows better and able to wet the surface more.

SoOo

Low contact angel >>> stronger bond High contact angel >>> poor wettability and bonding (( al sa2l ele 3am n7ke 3ano is the bonding agent adr eno entasher 3a surface w egmad 3a rough surface )) In case of composite its sensitive U need to be careful with Isolation preventing any contamination of saliva or blood cause by etching and bonding and then ur composite material is applied. Isolation done in many ways . By cotton rows , rubber dam placement ( isolate the tooth of the rest of the cavity in some gingival or cusped preparation which will push the gingival

away , control bleeding and it will make the model cavity clear to the dentist ) Now in amalgam restoration U have to be careful to find amalgam to Ur cavity u dont place access amalgam on the outer tooth surface . Coz it will break of under load , which will cause deficiency in ur filling and micro-leakage . ""Hl2 ento 3am tdarabo demonstration lma t3malo amalgam aw ay 7ashwah 7ododha lazm tkoon nhayt al cavity ay goz2 zyadh 3a al surface bsoholah mmkn enkaser m3 mroor al wa8at . Ma fe she esnedoo w esbb "Micro-leakage " U should find ur filling to ur cavity preparation no More no less

Clinical preparation :

First . They didnt start using phosphoric acid and etching enamel & dentin they went through steps

Earlier bonding and etching they didnt produce good demonstration so they start to prove it through the years until they came with the material or technique we use today "" 3amalyah ma btblsh mn awalha kwaes lma e5tar3oo madeh aw eblsho esta3meloha btbdah bemowa9aft 3'er gaedah fa b6wro bl madeh shway shway . "" SoOo they start with enamel etching they were afraid of using dentin etching coz it contain tubules, fluid , it does not have enough minerals like enamel so it's not important to etching . Later on . They discover etching of enamel and dentin or what we called " Total Etching " # total etching is much better than etching enamel alone .

Enamel Etching :
its average is 15 sec. and it could reach up to 30 sec. its fine to do some roughness of the surface . for primary teeth and fluoride treated teeth it's a little bit difficult coz of roughness of the surface , remove part of minerals and to create a good surface for bonding sooo it need longer etching time **Fluoride treated teeth have Florid apatite so it need more etching time

"" mathaln lma eroo7 al mareed la 3nd al Dr. w e7o6lo fluoride Gel mmkn etkoon a89a eshway mn al asnan al 3adeyh >> so need more time "" ** In primary teeth its more irregular than permanent teeth >> so it need more etching time

Now etch enamel look frosty ( chalk ) white coz some of the

#Etching time: 10-30 seconds (around 15 seconds) #Primary teeth and fluoride treated teeth require more time #Etched enamel looks frosty white when dried

mineral was lost . SoOo after the etching enamel wash and dry it U will notice that the surface of the enamel is frosty ( like snow ) """ that will tell u that it was etched from its surface color """
" .... . ... " ... SoOo ..

Etching produces a rough surface (pits) into which resin flows and forms resin tags (( micromechanical retention )) >> after the enamel is etch we applied the bonding agent and it will flow to the Micro-pores and create resin tag What is resin tag ??? LOOk at the pic . This is electron Microscopic Pic. there as an etch surface of dentin and a layer of bonding agent and it flow to the micropores and create these extension ( like arms inside dentin) and we called them resin tag (they are made of the bonding agent ) . But after its cured U will not be able to remove it coz the penetration of bonding agent in the dental tubules is resin tag they are the bases for the retention (composite ) .

When we create this dentinal tubules with acid then U remove it then u applied the bonding agent flow into these micro-pores then U cured it . And end up with finger-like extension and it's called resin tag . In between composite and dentin a hybrid layer that is made of bonding agent that has one arm attach to teeth( dentin) the other part attach to composite . "" Hybrid layer . btmsak bsha3'letan mo5talefat tamamn btmsk al sen mn geha w al 7ashwah mn geha o5ra "" its imp. For bonding . How far there resin tag penetrate ??? Resin tags may penetrate to a depth of 10-20 microns in etched enamel it depend on etching time and rinsing time U need to etch to recommended time 10-30 sec and U need to rinse probably and remove any remnants of the acid if u dont rinse .. part of the acid will remain and it will prevent penetration of the bonding agent . "" bnt5ala9 mn ba8ayah al acid 3shan ma ed5ol w eshbookm3 dentin and the enamel "" .

#These two factors determine how effective etching was, and how well debris were removed from enamel surface >> coz they will affect the penetration of resin tag . slide 12 Now in amalgam the story is different, we are talking about mechanical retention. Sometimes even if there is a space created between amalgam and enamel & dentine, because there is no chemical bonding or micromechanical bonding, after a while the amalgam will start to corrode due to contact with acid, sulfide and oxygen inside the patient mouth. This corrosion means that part of the amalgam will start to break down or dissolve. Now the products of this corrosion will flow into the dentinal tubules and will seal any space between amalgam and enamel & dentine. So it will minimize the micro-leakage actually. It's harmful to the filling but it will seal any space between amalgam and enamel & dentine. In GIC the bond is chemical ( good chemical adhesion ),but in composite nothing can compensate the bad bonding, if it does not bond properly due to bad acid etching or bad bonding procedure, micro-leakage will occur, and nothing will counter it. So microleakage will happen so it will cause sensitivity, cariesetc

In the other hand, in amalgam fillings, corrosion products will seal any space, so it will minimize the sensitivity or microleakage. SoOo . #In GIC: there is chemical bond with enamel and dentine ( ) #In amalgam: the products of the corrosion will seal the microleakage. #In composite: if there is no good acid etching, so there will be no good bonding, micro-leakage will occurs and nothing will close it.

Enamel etching
Done by the phosphoric acid which is applied using a brush or a syringe tip.

(Slide 13) this is an etched enamel surface, you can see the micropores on the surface of the enamel. Bonding agent will flow on these pores and attach its self to it. It is either liquid or gel (the gel is made by adding colloidal silica to the acid) phosphoric acid 30-50% (usually 37%). how did they come up with this percentage ?? they tried different percentages, they examined the bond strength of the material with the enamel & dentine, and see which is better, which one gives you the better bond strength.

They attach a filling to the enamel & dentine and try to separate them, so the stronger the material bond to the surface, the higher the force you need to separate them.

(slide 14) this is the acid etching, blue or green in color, a gel is provided, a liquid also can be available, but the gel is better because it will not flow everywhere and it's easier to control it . Etching enamel is applied for 15 seconds, then Rinse it, wash it and dry it.

(Slide 15) when you etch the tooth, then you dry it, it will have a frosty white appearance. the acid (the gel) is usually provided with tubes ( disposable tips) so you can use one for one tooth and then throw it away, or you can squeeze some of the gel out, and apply it to the brush.

We rinse it for around 20 seconds, usually we rinse double the time we etch, Ya3ni we etch for 10 sec and we rinse for 20 sec, but you need rinse at least for 20 sec to ensure that you have removed all the acid. We use the water to rinse, but also we need to use some force to make sure that the surface is clean so we use water with air. If

it's contaminated with saliva or blood you need to re-etch it again. Summary ::: # 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 re-etched for 10 seconds .

Enamel Bonding
Previously, etching and bonding involved only enamel. Currently, total etch technique is done, and bonding agents are applied to both enamel and dentine which provide a better bonding strength with the restorative material . Dentin is different from enamel, it's a different tissue, and it contains minerals, collagen, dentinal tubules, fluids, nerve endings or extensions of the nerve that extend into the pulp. It's a living tissue so you need to be careful when you etch it or deal with it. For example, when you etch the dentine, then dry it, you have to not over dry it, if you over dry dentine, collagen fibers will collapse into the micro tubules and close it. You have to etch the dentine for less than 15 sec, and after you dry it, you have to get a wet piece of cotton and wet its surface again. # 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.

SoOo . over etching and over drying will weaken the bond and cause sensitivity to the patient.

(Slide 21) this is the hybrid layer (bonding agent), it sticks to the tooth micromechanically and the composite attached to the hybrid layer chemically since both of them are made of resin.

(Slide 22) this is an example of etched dentine, so you can see collagen fibers, and you can see the micro tubules, so if you over dry it, the collagen fibers will collapse into this space and close it. So the bonding agent will not bond to it. # etching permanent teeth different than etching primary one cause of it morphology .

We will continue next time because they have a meeting in this room so you have to leave.

Done

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