Adhesive Dentistry
Adhesive Dentistry
Adhesive Dentistry
by
DR. FAMUREWA B.A. O.A.U.T.H.C.,ILE-IFE.
11/30/2011
OUTLINE
INTRODUCTION
HISTORICAL MILESTONES DEFINITION OF TERMINOLOGIES TYPES OF ADHESION IN DENTISTRY FACTORS AFFECTING ADHESION
11/30/2011
OUTLINE
ADHESION TO ENAMEL
ACID ETCHING EFFECTS OF ACID ETCHING PATTERN OF ACID ETCHING
11/30/2011
OUTLINE
ADHESION TO DENTINE
BARRIERS TO DENTINE ADHESION EVOLUTION OF DENTIN BONDING AGENTS(DBA) CLASSIFICATION OF DBAs. IDEAL REQUIREMENTS OF DBAs CLINICAL INDICATIONS OF DBAs
11/30/2011
INTRODUCTION
ADHESIVE DENTISTRY HAS REVOLUTIONIZED RESTORATIVE DENTAL PRACTICE FOR THE PAST 45 YEARS. IMPROVED ADHESIVE MATERIALS HAVE MADE RESIN-BASED COMPOSITE RESTORATIONS MORE RELIABLE & DURABLE.
11/30/2011
INTRODUCTION
THE OBJECTIVE OF THIS PRESENTATION IS TO:
REVIEW THE EVOLUTION OF DBAs DISCUSS THE COMPOSITION & EFFECTIVENESS OF VARIOUS DBAs HIGHLIGHT CURRENT DENTAL ADHESIVES WITH THEIR CLINICAL USAGES
11/30/2011
HISTORICAL MILESTONES
1955- M. BUONOCORE ACID ETCHED ENAMEL WITH PHOSPHORIC ACID. LATE 1960s- HE SUGGESTED THAT IT WAS THE FORMATION OF RESIN TAGS THAT CAUSED ADHESION OF RESIN TO ETCHED ENAMEL 1982- NAKABAYASHI et al REPORTED THE FORMATION OF HYBRID LAYER.
11/30/2011
Adhesion can be defined as the state in which two surfaces are held together by interfacial forces which may consist of valence forces or interlocking forces or both. An adhesive is usually a viscous fluid material that joins two substrates together ,it solidifies and transfers a load from one surface to the other. Adhesive strength is the measure of the load bearing capacity of an adhesive joint.
11/30/2011
11/30/2011
Bonding of resins to tooth structure is a result of four possible mechanisms: 1. Mechanical- penetration of resin and formation of resin tags within the tooth structure. 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 component(hydroxylapatite) or organic components(type I collagen). 4. A combination of the previous three mechanisms
11/30/2011 DR. FAMUREWA B.A. 10
Failure of Adhesive joints occur as a result of combined breakdown in three locations: Cohesive failure in the substrate Cohesive failure within the adhesive Adhesive failure, at the interface of substrate and adhesive.
11/30/2011
11
11/30/2011
12
Surface energy
For adhesion the surfaces must be attracted to one another at their interface . The energy at the surface is the surface energy, this is because at the surface the atoms are not equally attracted in all directions. The increase in surface energy per unit area of the surface is referred as surface energy or surface tension. When primary bonding is involved the adhesion is called as chemisorption and when physical forces are involved these are due to Vander waals forces.
11/30/2011 DR. FAMUREWA B.A. 13
Wetting
It is difficult to force two solid surfaces to adhere when placed in apposition if the surface molecules of the attracting substances are separated by distances greater than 0.7 nm then the adhesion is negligible. The method to overcome this is to use a fluid that flows into the irregularities to provide contact. This is called wetting. Wetting is influenced by the cleanliness of the surface. The extent to which an adhesive wets the surface of an adherend may be determined by the contact angle between the adhesive and the adherend.
11/30/2011
14
Contact angle.
A) when contact angle is 0 the liquid contacts the surface completely and spreads freely and good adhesion.
Adhesion to Enamel Enamel etching and high surface energy. Clean etched field without moisture and saliva. Bond strengths 20-25 MPa.
11/30/2011
16
Acid Etching
Before the introduction of acid etching the use of bonding agents and leakage of oral fluids within the microscopic space between the prepared teeth and restorative materials was of greater concern for resin composites. The first meaningful proof of intra-oral adhesion was reported in 1955 by MICHEAL BUONOCORE, who etched the enamel with acids and then placed the restorative resin which formed resin tags when penetrated into the roughened surface created by the acid. This was the effective method to improve the mechanical bonding and to ensure sealed interfacial gaps.
11/30/2011
17
Phosphoric acid 30-50% (most commonly used at a conc. Of 37% ) Citirc acid Maleic acid Oxalic acid Polyacrylic acid. Pyruvic acid Procedure Available as gel ( colloidical silica is added) or liquid form. Applied onto the tooth surface with brushes or when available in the form syringe it is expressed onto surface. Etching time is -15 sec. Rinse the tooth. If any contamination occurs procedure is to be repeated.
11/30/2011 DR. FAMUREWA B.A. 18
11/30/2011
19
11/30/2011
20
11/30/2011
21
TYPE
- Mixed
11/30/2011
22
Dentine Adhesion
Adhesive materials can interact with dentine in different ways( Chemically, mechanically or both). Unlike bonding to enamel, dentine bonding poses peculiar challenges: Dentine contains a substantial amount of water(25%) and 25%organic material ( type I collagen ). Network of dentine tubules connecting the pulp to the dentine-enamel junction.
11/30/2011 DR. FAMUREWA B.A. 23
11/30/2011
24
Network of dentine tubules connecting the pulp to the dentine-enamel junction. Dentinal tubules enclose cellular extensions from the odontoblast and is also fluid filled. Smear layer which is a residual organic and inorganic debris of cut tooth tissue forms a layer over dentine and also plugs the tubules. Presently ,Dentine adhesion relies on micromechanical bonding achieved by the penetration of adhesive monomers into the fibrils of collagen fibres left exposed by acid etching.
11/30/2011 DR. FAMUREWA B.A. 25
Dentine Bonding
Bonding to dentine is achieved through several processes which may be carried out in one or several steps hence the preference for the term systems rather than agents. Adhesion to dentine has been more elusive because dentine is more biologically active and is complex in composition and morphological structure.
11/30/2011 DR. FAMUREWA B.A. 26
Dentine Bonding
Dentine has a much higher organic content than enamel. Composition of dentine expressed in volume percent is 45% inorganic content, 33% organic compounds and 22% chiefly water.
11/30/2011
27
Smear Layer
Cutting processes can produce smear layers on any material. Dentine smear layer contains hydroxyapatite crystals and partially denatured collagen and is generally 1-5 microns thick.
11/30/2011
29
Immediate application and curing of a dentine bonding agent will prevent this wetting. The bonding agent penetrates the dentinal tubule, etched intertubular and peritubular dentine to form a resin impregnated dentine known as the interdiffusion zone or hybrid layer.
11/30/2011 DR. FAMUREWA B.A. 31
Adhesion depends on chelation between the bonding agent and calcium ions in the smear layer and dentine surface as well as mechanical entanglement with the dentine surface.
11/30/2011 DR. FAMUREWA B.A. 32
11/30/2011
34
11/30/2011
37
11/30/2011
38
11/30/2011
39
11/30/2011
40
11/30/2011
41
First Generation
Buonocore in 1956 demonstrated the use of glycerophosphoric acid dimethacrylate- containing resin to bond to acid etched dentine through the calcium ions of hydroxyapatite. Bowen in 1965 showed that NPG-GMA, a bifunctional molecule would bond to dentine after it had been treated with glycerophosphoric acid. The bond strengths exhibited by this systems were very low, about 1-3 MPa. Example is CERVIDENT.
11/30/2011 DR. FAMUREWA B.A. 42
Second Generation
Introduced in the late 1970s, the majority of these incorporated halophosphorous esters of unfilled resins such as BIS-GMA or HEMA. Bonding mechanism was through ionic bond to calcium by chlorophosphate groups. Dentine was not etched hence much of the adhesion was to the smear layer, which is weakly attached to the dentine. Bond strength ranges from 1 6.8 MPa. E.g. Scotchbond 1, Prisma Universal Bond, Bondlite, Dentin Adhesit.
11/30/2011 DR. FAMUREWA B.A. 43
Dentine bonding follows three main processes 1. Acid etching (conditioning):Application of acid to dentine results in partial or total removal of the smear layer and demineralization of the underlying dentine to open dentine tubules and expose collagen fibres A wide range of organic (maleic, tartaric, citric, EDTA, acidic monomers), polymeric( polyacrylic acid), and mineral ( hydrochloric, hydrofluoric) acids have been investigated as etchants but phosphoric acid (30-40%) solutions and gels produce the most reliable etching.
11/30/2011 DR. FAMUREWA B.A. 46
SMEAL LAYER
11/30/2011
47
2. Priming: Primers are hydrophilic molecules usually carried in a solvent. Acidic primers containing carboxylic acid groups are used in self etching bonding agents. Solvents used in primers are acetone, ethanol-water, or water. Some are solvent free. Primers permeate the collagen fibrils and the tubules to increase their surface energy and render them receptive to the hydrophobic adhesive.
11/30/2011 DR. FAMUREWA B.A. 48
Ethanol/water
Evaporates less quickly; less sensitive to wetness of dentine Slow evaporation, not sensitive to wetness of dentine No drying, single coat
DR. FAMUREWA B.A.
Water
Long drying time; water can interfare with adhesive if not removed Higher film thickness
49
Solvent-free
11/30/2011
3. Bonding: this requires the placement of adhesives which are generally hydrophobic dimethacrylate oligomers that are compatible with monomers used in the primer and composite. It is applied to the etched and primed tooth surface and cured. When primer and bonding resins are applied to etched dentine they penetrate the intertubular dentin forming a resin-dentine interdiffusion zone called the HYBRID layer.
11/30/2011 DR. FAMUREWA B.A. 50
This three step adhesion process marked the commencement of the Fourth generation bonding systems ( Type 1 adhesives) and the basic principle for dentine bonding presently. Subsequent generations are designed to simplify the process by reducing the number of clinical stages required. This shortens chairside time and reduces procedural errors.
11/30/2011
51
The 5th generation-Mid 1990s This combines the primer and adhesive in one bottle and 30-40% phosphoric acid as etchant thus reducing the stages from 3 to 2 (PRESENTLY AVAILABLE @ O.A.U.T.H.C.). Bond strenght-20-25MPa. Unit-Dose packaging was introduced. Examples are Single bond, Excite, Gluma Comfort Bond e.t.c
11/30/2011
53
These includes self etching primers where the etchant and primer are in one bottle and adhesive resin in another bottle. Manipulation is easy , show good bond strength to dentin but not to enamel Etching and rinsing not required Primer applied first then adhesive. ACIDIC PRIMER ADHESIVE:- Methacrylated phosphates SOLVENT:- Water Eg:- SE bond, XENO, Linear Bond II Bond strenght-18-23Mpa Some are Fluoride releasing e.g FL-BOND II
11/30/2011 DR. FAMUREWA B.A. 54
4th-7th generation
11/30/2011
57
Bonding of all direct composite resin restoration,both anterior& posterior including pit & fissure sealants Bonding of indirect composite resin restorations( inlays, onlays and veneers). For bonding ceramic veneers & crowns Bonding of amalgam restorations Management of dentin hypersensitivity Luting post and core restorations Bonding of orthodontic brackets Repair ed porcelain, amalgam & resin restoration Treatment of erosion, abrasion & abfraction
11/30/2011 DR. FAMUREWA B.A. 58
CONCLUSION
DENTIN(ENAMEL & DENTIN) BONDING AGENTS HAVE MADE REMARKABLE PROGRESS FROM THE NO ETCH ERA OF BUONOCORE TILL DATE. COST OF THIS MATERIALS & TECHNIQUE SENSITIVITY STILL REMAIN A CHALLENGE TO THEIR EFFECTIVE USE .
11/30/2011
59
REFERENCES
RESTORATIVE DENTAL MATERIALS(11th Edition) EDITED BY CRAIG R.C. & POWERS J.M. STURDEVANTS ART & SCIENCE OF OPERATIVE DENTISTRY(4th Edition) EDITED BY ROBERTSON T.M. et al. G.KUGEL, M. FERRARI. The science of bonding: from first to sixth generation. JADA 2000 FACULTY OF DENTAL SURGERY(NPMCN) UPDATE LECTURE BY D.C. UMESI-KOLEOSO & I.C.ADEGBULUGBE
11/30/2011 DR. FAMUREWA B.A. 60
Thank you !!
11/30/2011
61