Principles of Adhesion

Dr.Ghada Maghaireh

Background 1950s: Michael Buoncore found that applying acid to teeth render the tooth surface more receptive to adhesion. 1960s: First commercial restorative resin composite. 1970s: Introduction of the acid-etch technique in clinical practice. Etching of the enamel surface by phosphoric acid to which resins can bond. Since then, more improvement in restorative composites along with improvements in bonding agents. Adhesion Adhesion: Adhaerere to add or to stick. Adhesion or bonding is the attachment of one substance to another. Adhesive or bonding agent: the material that is applied to the surface of substances to join them together. (i.e. tooth surface and resin composite). Factors Affecting Adhesion to Tooth Tissue Compositional and structural aspects of enamel and dentin. Changes in dentinal structure. The smear layer. Internal and external dentinal wetness. Compositional and Structural Aspects of Enamel and Dentin Enamel has high inorganic content (88% by volume). Enamel is homogenous in structure and composition irrespective of its depth and location. Dentin has less inorganic content(50% by volume) and more water (25%). Dentinal tissue is heterogeneous.

Dentin is a vital and dynamic tissue. Dentinal tubules size and number increases from the DEJ to the pulp side. Dentinal fluid is under a constant outward pressure from the pulp. The Smear Layer Any debris, calcific in nature, produced by reduction or instrumentation of dentin, enamel or cementum. The thickness of the smear layer vary from 0.5 to 5 m. This layer of debris has a great influence on any adhesive bond formed between the cut tooth and the restorative material. The smear layer can be removed by ethyl-enediaminetetraacetic acid (EDTA), and by acidic conditioners (citric, polyacyclic, lactic and phosphoric acids). Although smear layer occlude the dentinal tubules, it is porous and allow small amount if dentinal fluids to pass through . Internal and External Dentinal Wetness Remove of the smear layer creates wet bonding surface on which dentinal fluids exudes from the dentinal tubules. This wet environment affects adhesion, because water competes by hydrolysis for all the adhesion sites on the hard tissues. Bond strength of several adhesive systems decrease as the depth of the preparation increased because dentinal wetness is greater. External humidity or environmental humidity can also affect the bond strength. Wetting of the Adhesive Adhesive systems must sufficiently wet the tooth surface: have a viscosity that is low enough to penetrate the micro porosities and be able to displace the moisture and air during the bonding process. HEMA (2-hydroxyethyl methacrylate) is a surface active agent that enhance the wettability of the adhesive resins.

Enamel Acid -Etching Techniques Enamel etching transform the smooth enamel surface to an irregular high surface-free energy. Acid etching remove 10m of the enamel surface and creates a microporous layer from 5 to 50 m deep. The enamel bonding agent wet the etched enamel surface and pass through the microporosities. The bond between the bonding agent and the enamel is micromechanical. The bond between the bonding agent and resin composite is chemical. Enamel Etching Patterns Two types of resin tags: Macrotags: Form circularly between enamel prism peripheries. Microtags: Form at the cores of enamel prisms. Enamel Bonding Agents Based on bis-GMA or urethane dimethacrylate (UDMA). Diluted with a lower viscosity and higher hydrophilicity monomers such as (TEG-DMA) and (HEMA). Etching with Phosphoric Acid Phosphoric acid 30% to 40%. Etching time is not less than 15 seconds. Washing time 5 to 10 seconds. Acid gel is preferred over liquid.

Adhesion to Dentin Development of Resin Dentin Adhesives First generation adhesives: Very weak bond Only 2 to 3 MPa This bonding agent bonded to enamel and dentin by chelation to calcium Second generation adhesives: Moderate bond strength 5 to 6 MPa Primary bonding was to the smear layer Third-Generation Adhesives: Early 1980s. Removal of the smear layer. Total etch concept. Scotchbond 2. Fourth-Generation Adhesives: Early to mid 1990s. Multiple dentin adhesives. Treatment of dentin by primer ( make dentin more receptive to adhesion). Application of low viscosity adhesive resin. Adhesive system replace bonding agent. Fifth-Generation Adhesives: Simpler adhesive system than fourth-generation Bond strength is comparable to fourth-generation adhesives One-bottle adhesive (primer + adhesive)

Sixth-Generation Adhesives: Slightly acidic primers or self-etching adhesives. Possibility of single-dose package. No post conditioning rinsing.

Conditioning of Dentin Any chemical alteration of the dentinal surface by acids with the objective of removing the smear layer and simultaneously deminerlizing the dentinal surface. The deminerlization process expose the collagen fibrils and thus increase the microporosities of the intertubular dentin. Conditioners are applied to enamel and dentin (Total-etch technique). The demineralization process exposing the collagen fibrils affect the surface-free energy of dentin. Dentin Primers Primers are adhesion-promoting agents. Contain hydrophilic monomers dissolved in organic solvents such as acetone or ethanol. Those solvents are volatile and so can displace water from the dentinal surface and collagen network. This promote infiltration of the monomer of the adhesive in the nanospaces of the exposed collagen network. Primers have hydrophilic properties that have affinity to the collagen fibrils and hydrophobic properties to copolymerize with the adhesive resin. Many Modern adhesives have HEMA as a primer and contain other monomers. One-bottle adhesives: combine priming and bonding function.

Adhesive Resin Consist of hydrophobic monomers such as GMA and UDMA and hydrophilic monomers such as TEG-DMA and HEMA as wetting agent. Adhesive resin stabilize the hybrid layer and form resin extensions into dentinal tubules (resin tags). Self cured or light cured adhesive. Light cure the adhesive before the application of the resin composite. Oxygen inhibited layer on top of adhesive provide sufficient double bonds for copolymerization with the resin composite. Hybridization Hybrid layer is the area or zone of the adhesive system which micromechanically interlocks with the dentinal collagen. Resin Tag Formation Penetration of the resin to the dentinal tubules to form resin tags. Resin infiltrates even lateral tubule branches forming submicron resin tags. The contribution of formation resin tags to bond strength has been a matter of speculation. Adhesion Strategies- A Scientific Classification of Modern Adhesives Depends on the number of application steps and on their interaction with the dentinal substrate. Smear Layer-Modifying Adhesives. Smear Layer-Removing Adhesives. Smear Layer-Dissolving Adhesives.

Smear Layer-Modifying Adhesives Based on weak acidity smear layer-modifying primers. The smear layer is not removed that provides a natural barrier to the pulp. The interaction of theses adhesives with dentin is very superficial, with only limited penetration into dentin. Selective etching of enamel in a separate step. Smear Layer-Removing Adhesives Most common adhesives. Removing of the smear layer using the total-etch concept. Formation of hybrid layer and resin tags. Three-step smear layer-removing adhesives (Acid etching + dentin primer + adhesive) Two-step smear layer removing adhesives or one-bottle adhesives (Acid etching + primer & adhesive) Smear Layer-Dissolving Adhesives Smear layer dissolving adhesives or self-etching adhesives. Slightly acidic primers or self-etching adhesives. Partially demineralize the smear layer and the underlying dentin with simultaneous resin infiltration. Possibility of single-dose package. No post conditioning rinsing. Insufficient long term studies. Critical Steps in Adhesion. Isolation Dentin and pulp protection Enamel and dentin conditioning Wet Vs Dry Bonding Primer application

Adhesive resin application Restorative procedure Isolation Isolation and moisture control is very critical for the bonding procedure. Bonding to acid etched enamel requires a dry surface to allow the bonding resin to flow into the microporosities created by acid etching. Accidental contamination of the substrate with external fluids prevent effective contact between the adhesive and the bonding substrate. Salivary contamination is detrimental because salivary proteins block the microtentive porosities on the acid etched enamel and dentin and may block infiltration of the resin. Enamel and Dentin Conditioning Phosphoric acid etchant (35%) for both enamel and dentin in one application. Etching time should be for 15 seconds staring with enamel. The etchant should be thoroughly rinsed. Wet Vs Dry Bonding After acid etching enamel surface should be dried. On dentin, a certain amount of moisture is needed wet bonding. Dehydration of the acid-etched dentin surface through air drying can result in collapsing and shrinkage of the exposed collagen fibril network which can prevent resin infiltration. On the other hand the acid-etched dentin surface should not be kept too wet. Excess water should be removed with a short air blast or with a dry sponge.

Primer Application The primer should be applied for at least 15 seconds. Primer should be actively rubbed into the dentin surface with disposable brush or sponge applicator. After short and gentle air drying the primed surface should appear glossy. Adhesive Resin Application Spreading of the adhesive layer to the bonded surface should be done by a brush. The adhesive should be light cured for 20 seconds before the application of the restorative resin composite. References: Chapter #8 of The Fundamentals of Operative Dentistry.