Fig 8 - uploaded by Jorge Perdigao
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(A) Resin-impregnated smear plug (SP) upon treatment with a self-etching primer. The demineralized dentin is marked with an asterisk. (B) Same self-etching material as in (A), but the adhesive has now been applied (dentin dissolved away). Note the smear plugs embedded in the resin tag necks (SP).
Source publication
The traditional principles of operative dentistry have been challenged since Dr. Buonocore introduced the aid-etch technique in 1955. In spite of the numerous changes in clinical protocols and adhesive techniques, adhesion to dentin remains difficult. The importance of micromechanical bonding to dentin has been recognized over the last decade. Rese...
Context in source publication
Context 1
... adhesives that treat the dentin and enamel surface with a nonrinsing solution of acidic monomers in water (also known as self-etching primers). These bonding systems do not remove the smear layer ( Fig. 8) but make it permeable to the monomers subsequently applied. [12] Dentin adhesives that include an acid gel to treat the dentin and enamel (generally 30-40% phosphoric acid) for 15 to 30 seconds. Opening of the dentinal tubules and removal of the dentin smear layer by acid etching [17] (Fig. 9) have led to significant improvements in ...
Similar publications
To investigate the interaction of six experimental and commercial bonding systems with dentin in vivo.
One-Step, Clearfil Liner Bond 2, OptiBond, Permagen with 10% phosphoric acid, Permagen with 35% phosphoric acid, and Prime & Bond were applied in standard Class I occlusal cavities in premolars scheduled for extraction for orthodontic reasons, com...
Citations
... 21,28 Kullanılan bonding ajan ne olursa olsun (total etch/self-etch) DME'nin restorasyonun bağlanma gücünü azalttığına dair bir kanıt yoktur. 44,45 Başarısızlıklar esas olarak kompozit restorasyon ara yüzünden ziyade dentin-kompozitte meydana gelmektedir. 44 ...
... Newer self-etching systems combine the etchant, primer and adhesive in one container [12]. As they etch, they also infiltrate the exposed collagen with hydrophilic monomers, where they copolymerize with the placed adhesive resin to the same depth in the dentin [13]. The result is the formation of a hybridized complex; a hybridized smear layer and hybrid layer which thickness is related to the aggressiveness of the self-etching agent [13]. ...
... As they etch, they also infiltrate the exposed collagen with hydrophilic monomers, where they copolymerize with the placed adhesive resin to the same depth in the dentin [13]. The result is the formation of a hybridized complex; a hybridized smear layer and hybrid layer which thickness is related to the aggressiveness of the self-etching agent [13]. With these systems the smear layer is a bonding substrate. ...
... Adhesion to dentin is considered more complex than adhesion to enamel due to its organic component and the presence of a smear layer that obstructs the entrance of the dentinal tubules, decreasing their permeability to adhesive systems and liners. The smear layer should be treated or eliminated, depending on the different bonding strategies and characteristics of the materials to be used [2]. Glass ionomers can chemically bond to dentin due the ion exchange layer at the interface formed by continuous diffuse of aluminum, silicon, fluorine, and strontium when present in the parent glass ionomer, and calcium and phosphorus from dentin [3]. ...
Background: The aim of this study was to evaluate the adaptation of a resin-modified glass ionomer to the internal walls of dentin with different conditioning systems, with or without the application of silver diamine fluoride (SDF) and potassium iodide (KI). Methods: Cervical standardized cavities were prepared on the buccal and lingual sides of 15 extracted molars. Molars were then sectioned longitudinally in a buccolingual direction, obtaining two samples from each tooth with two cavities each (60 samples). Samples were randomly divided into three groups (n = 20). Each group was divided into two subgroups. One subgroup did not receive dentin conditioning, one was conditioned with 25% polyacrylic acid—10 s (PA), and one with 37% orthophosphoric acid—5 s (OPA). In the other subgroup, dentine was treated with SDF/KI and not conditioned or conditioned with PA or OPA. All cavities were filled with Riva Light Cure® (RLC). The adaptation of the RLC to the cavity walls was evaluated by SEM at 100× magnification. The area of maximum interfacial gap was magnified at 1000× to measure its size. Kruskal–Wallis and Mann–Whitney U test were used for comparison. A significance level of α = 0.05 was used. Results: No significant differences in the percentage of well-adapted samples were found in subgroups when SDF/KI was used, regardless of whether conditioner was used or not and whether PA or OPA was used (p > 0.05). Regardless of the gap size, dentin treatment with SDF/KI did not negatively influence ionomer adaptation to dentin walls significantly (p > 0.05), except for the subgroup conditioned with OPA (p < 0.05). Furthermore, it improved the adaptation in the axial wall of the subgroup without dentin conditioning (p < 0.05). Conclusion: According to the results of the present in vitro study, the use of SDF/KI did not affect RLC adaptation to the cavity walls. Subsequent use of a conditioner worsens the adaptation of the material to the cavity walls.
... Worldwide, it is acknowledged that adhesion on enamel is trustworthy and effective [38]. However, it is less so on dentin owing to substrate morphology [39], additionally impacted by the kind of adhesive [40] and the application method [41]. Another factor that must be considered is the possibility that thermo-mechanical stress conditions might hasten bond deterioration in this crucial region, which would eventually result in restoration failure [42,43]. ...
... Dentine bonding strategies dependent on dentine tissue characteristics with the extent of dentine mineralization being the most important [20,21]. The increase of primary dentine mineralization reduces the bond strength with resin composites mediated with etch and rinse or self-etch adhesives [19,22,23]. A typical example is bonding to sclerotic dentine, where the more aggressive etch and rinse adhesives demonstrated higher bond strength compared to self-etch products [24]. ...
Objectives
The aim of the study was to evaluate the mineralization and resin bonding capacity of coronal secondary dentine at various ages.
Materials and Methods
The mineral to matrix ratio (M) of mandibular incisor coronal sections classified in three age groups (I:21-40y/n=7, II: 41-60y/n=5, III: 61-80y/n=7) were measured by Fourier transform infrared microscopy (FTIRM), at incisal (MC) and pulpal (MP) secondary dentine and at primary dentine (MR). Then, the difference between MC-MP normalized by the corresponding MR was calculated (NM) per specimen. The bonding capacity of a resin composite to paired occlusal secondary and primary dentine cross-sections, mediated by a self-etch adhesive, was assessed in mandibular molars of I and III age groups (n=10/location and age) by a shear test (SBS). Statistical analysis was performed by two-way (M, SBS) and one-way (NM) ANOVA plus post-hoc tests (a=0.05).
Results
In the oldest age group (III), MC demonstrated significantly highervalues than MR. MP was significantly lower than MC, MR in all age groups, with the least differences observed in group III. No significant differences in MP were observed among age groups. NM values significantly increased with age. SBS showed insignificant differences between primary (all age groups) and secondary dentine (I group). Group III manifested the lowest SBS on secondary dentine.
Conclusions
Secondary dentine in older age groups showed higher mineralization, reducing the bonding capacity of a mild self-etch adhesive.
Clinical Relevance
Considering the highest mineralization and lowest bonding capacity of self-etch adhesives to older secondary dentine, more aggressive adhesive treatments applied selectively on the secondary dentine of deep cavities may be proposed for management of deep cavities.
... Although clinical trials are the most appropriate tools to evaluate the effectiveness of the adhesive systems, long-term clinical trials are hard to perform because of the time and rapid evolutions and changes in the adhesive systems. Therefore, laboratory studies are still commonly used to estimate the clinical behavior of dental materials (10). ...
... Sadece dentin ve sement mevcuttur. Bu durum marjinal sızdırmazlık açısından düşünülmelidir (9). Literatür kaynaklarının çoğu CMR'nin üç adımlı bir total-etch adeziv sistemi kullanılarak yürütülmesi gerektiği sonucuna varmaktadır (6,7,10). ...
Servikal Marjin Relokasyonu (CMR), diş eti dokularının altında bulunan proksimal kavite kenarlarını yükseltmek için direkt rezin kompozit materyalden oluşan bir tabakanın yerleştirilmesidir (1). Posterior dişlerdeki mine-sement sınırının altına uzanan büyük proksimal çürük defektlerine klinikte sık rastlanmaktadır. Adeziv teknolojisindeki gelişmeler ve artan estetik talepler nedeniyle, bu gibi durumlarda tedavi planı genellikle indirekt adeziv restorasyonlardır. Ancak derin servikal sınıra sahip kaviteleri restore ederken iki önemli klinik sorun ortaya çıkabilir. Biyolojik genişliğin ihlali olabilir ya da teknik operasyonel problemler görülebilir (2). Komşu yumuşak ve sert periyodontal dokular üzerinde zararlı etkilerden kaçınmak için “biyolojik genişlik” korunmalıdır (3). Restoratif sınırlarla alveol kret arasında 3 mm veya daha fazla mesafenin gerekli olduğu düşünülür (3). Teknik operasyonel problemler ise subgingival bölgelerde diş preperasyonundaki zorluklarla başlar. Ölçü alma, restorasyonun adeziv simantasyonu ve marjinlerin bitirme ve cilalama aşamalarındaki zorluklarla devam eder (4). Bahsedilen sorunların çoğu yetersiz görüş, kavitenin derin kısımlarına erişim zorluğu ve operasyon alanının imkansız veya yetersiz izolasyonu ile ilgilidir. Bu da klinik işlemler esnasında kan ve tükrük kontaminasyonuna yol açar (5).
... The peculiar structure of dentin compared to enamel and the sensitivity of the DBA application procedure render dentin a very challenging substrate for bonding [60,[74][75][76]. The presence of cementum also jeopardizes reliable adhesion [77]. ...
A conservative approach for restoring deep proximal lesions is to apply an increment of composite resin over the preexisting cervical margin to relocate it coronally, the so-called “deep margin elevation” (DME). A literature search for research articles referring to DME published from January 1998 until November 2021 was conducted using MEDLINE (PubMed), Ovid, Scopus, Cochrane Library and Semantic Scholar databases applying preset inclusion and exclusion criteria. Elevation material and adhesive system employed for luting seem to be significant factors concerning the marginal adaptation of the restoration. This technique does not affect bond strength, fatigue behavior, fracture resistance, failure pattern or repairability. DME and subgingival restorations are compatible with periodontal health, given that they are well-polished and refined. The available literature is limited mainly to in vitro studies. Therefore, randomized clinical trials with extended follow-up periods are necessary to clarify all aspects of the technique and ascertain its validity in clinical practice. For the time being, DME should be applied with caution respecting three criteria: capability of field isolation, the perfect seal of the cervical margin provided by the matrix, and no invasion of the connective compartment of biological width.
... The subgingival extension also poses problems on adhesive procedures, since little or no enamel is usually available in the cervical area. It is globally accepted that adhesion is stable and efficient on enamel [2], while on dentin it is less reliable due to substrate morphology [3], being also influenced by the adhesive type [4] and the application technique [5]. Another aspect that must be considered is that thermomechanical load conditions could cause premature bond degradation in this critical area, ultimately leading to restoration failure [6,7]. ...
... Table 2 reports a summary of the mechanical characteristics given to the simulated materials, which were taken from the literature [27,28] or directly provided from the manufacturers. Table 3 reports a summary of volumes, expressed as mm 3 , and elements, expressed as n°, for the different parts in different scenarios. ...
Objectives
To evaluate shear stress (SS) and normal pressure (NP) at the tooth-restoration interface of highly-filled flowable resin composite applied to deep margin elevation technique through FEM analysis generated by a microCT scan.
Methods
A reference maxillary molar with two class II cavities was prepared according to deep margin elevation protocol. A geometrical model was segmented from a micro-CT scan generating separate volumes of enamel, dentin and restorative materials. The 3D Finite Element (FE) model was subsequently built-up and an axial chewing load was simulated. Data concerning the tooth-restoration interface were analyzed in terms of SS and NP. Different materials and techniques were tested in order to evaluate the effects of the restorative material, the usage of a highly-filled flowable composite as liner and the substrate of the cervical area.
Results
Both SS and NP presented similar distribution, but showed significant differences between tested materials. Composites showed more homogeneous behavior in stress distribution compared to ceramic. The use of a highly-filled flowable composite as liner on the cervical margin significantly reduced SS and NP on the cavity floor and the cervical margin area. Lastly, stress distribution in the cavity floor area varied according to the cervical margin substrate: enamel showed a protective role in stress distribution.
Significance
Highly-filled flowable resin composites showed encouraging results when applied to deep margin elevation from an interfacial mechanical point of view. Further studies are needed to validate these data and to better define the role of cervical enamel in stress distribution.
... [8][9][10][11] It is known that during the curing of adhesive systems, there is an incomplete conversion of monomers that remain free in the dentin 12 and that, due to substrate permeability, can diffuse via the dentinal tubules to cause pulp damage. 13,14 Thus, it is essential that the polymerization process is effective, maximizing the physical-mechanical properties, favoring the clinical performance of the product, as well as reducing its possible toxic effect on dental pulp cells. 7 Due to the fact that the cytotoxicity of resinous materials is directly related to the effectiveness of the polymerization technique, 2,7 some protocols have been tested to increase the degree of conversion (DC) of monomers to polymers. ...
Objectives:
To evaluate the influence of heat application on the degree of conversion (DC) of the 3M Single Bond Universal Adhesive System, as well as its transdentinal cytotoxicity and microtensile bond strength to dentin.
Methods:
Experimental groups were established according to the time and temperature of the air jet: G1: 5 seconds-25°C; G2: 10 seconds-25°C; G3: 20 seconds-25°C; G4: 5 seconds-50°C; G5: 10 seconds-50°C; G6: 20 seconds-50°C. In control group (G7), no treatment was performed. The DC was assessed using the Fourier transform infrared spectroscopy-attenuated total reflectance (FTIR-ATR) technique. For the transdentinal cytotoxicity test, dentin discs fitted in artificial pulp chambers (APC) received the application of the adhesive system and the air jets. For the microtensile bond strength, healthy molars were restored and submitted to the microtensile test after 24 hours and 6 months, respectively.
Results:
Significant reduction in viability of Mouse Dental Papilla Cell-23 (MDPC-23), which exhibited morphological changes, was observed in all experimental groups compared to control (p<0.05). Although all tested protocols resulted in transdentinal diffusion of 2-hydroxyethyl methacrylate (HEMA), the group G6 presented the highest degree of monomeric conversion and the lowest cytotoxic effect, with higher dentin bond strength values in comparison to group G1 (p<0.05).
Conclusions:
Applying an air blast at 50°C for 20 seconds increases the DC and microtensile bond strength of the 3M Single Bond Universal Adhesive System to dentin, as well as reduces the transdentinal cytotoxicity of the material to pulp cells.
