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Questions and Answers
What is the primary characteristic of aggressive self-etch systems?
What is the primary characteristic of aggressive self-etch systems?
- They require selective etching of enamel.
- They provide excellent bond strengths to dentin.
- They are only suitable for use on direct composites.
- They do not require selective etching of enamel. (correct)
What is one method to address the issue of dentin permeability in adhesive systems?
What is one method to address the issue of dentin permeability in adhesive systems?
- Applying a layer of traditional varnish.
- Using a thicker layer of the same adhesive.
- Selecting a more aggressive adhesive system.
- Adding an extra coat of a hydrophobic bonding layer. (correct)
Why are universal adhesives termed as such?
Why are universal adhesives termed as such?
- They are applicable only for direct restorations.
- They can only bond dentin.
- They bond only with enamel.
- They can bond to various substrates besides dentin. (correct)
Which category of self-etching primers tends to provide poorer enamel bonds?
Which category of self-etching primers tends to provide poorer enamel bonds?
What is the recommended adhesive system for restoring tooth # 11?
What is the recommended adhesive system for restoring tooth # 11?
What is the primary function of the etchant in a three-step total etch adhesive system?
What is the primary function of the etchant in a three-step total etch adhesive system?
Which statement best describes the composition of the bonding agent in the three-step total etch system?
Which statement best describes the composition of the bonding agent in the three-step total etch system?
What is the result of opening the tubules in dentin during the etching process?
What is the result of opening the tubules in dentin during the etching process?
Which of the following is an example of a bonding agent used in the current strategies for adhesion?
Which of the following is an example of a bonding agent used in the current strategies for adhesion?
During the bonding process, what does the primer do in the three-step total etch system?
During the bonding process, what does the primer do in the three-step total etch system?
What is primarily exposed by the etching step in the three-step total etch adhesive system?
What is primarily exposed by the etching step in the three-step total etch adhesive system?
What is the main purpose of the hybrid layer formed during the adhesion process?
What is the main purpose of the hybrid layer formed during the adhesion process?
Which property of dentin is improved by the bonding process involving primer and bonding agents?
Which property of dentin is improved by the bonding process involving primer and bonding agents?
What is a primary drawback of the total etch system?
What is a primary drawback of the total etch system?
How can excess water from rinsing the etching gel be effectively removed?
How can excess water from rinsing the etching gel be effectively removed?
Which of the following is NOT an advantage of two-step self etching adhesives over total etch systems?
Which of the following is NOT an advantage of two-step self etching adhesives over total etch systems?
What is the primary function of resin tags formed in dentinal tubules?
What is the primary function of resin tags formed in dentinal tubules?
Which method is included in the self etching adhesive types?
Which method is included in the self etching adhesive types?
In self etching systems, what is a critical aspect that is retained?
In self etching systems, what is a critical aspect that is retained?
Which adhesive product is an example of a two-step etch-and-rinse system?
Which adhesive product is an example of a two-step etch-and-rinse system?
What effect does excessively wet dentin have on the bonding process?
What effect does excessively wet dentin have on the bonding process?
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Study Notes
Adhesion to Dentin
- Contemporary Adhesive Systems are categorized into three main types
- Three-Step Total Etch System (Etch and Rinse) involves etching, priming, and bonding
- Two-Step Etch and Rinse System (E + [PB]) simplifies the process by combining primer and bonding agents
- Self Etching Adhesives include two-step and one-step (or all-in-one) systems
Three-Step Etch and Rinse (E + P + B)
- Etchant (E):
- Removes the smear layer from dentin
- Exposes intertubular and peritubular collagen
- Opens dentinal tubules in a funnel configuration (up to 7.5 μm)
- Decreases surface free energy of dentin
- Primer (P):
- Contains bifunctional molecules (hydrophilic and hydrophobic)
- Envelops the external surface of collagen fibrils
- Re-establishes surface free energy compatible with hydrophobic restorative materials
- Bonding Agent (B):
- Consists of hydrophobic monomers like Bis-GMA and a small percentage of hydrophilic monomers like HEMA
- Co-polymerizes with primer molecules
- Penetrates and polymerizes into inter-fibrillar spaces, forming the hybrid layer (resin-dentin interdiffusion zone)
- Penetrates and polymerizes in open dentinal tubules, forming resin tags
Two-Step Etch and Rinse (E + [PB])
- Rationale: Simplifies the bonding procedure
- Examples: One-Step Plus, Prime & Bond NT, Adper Single Bond Plus, OptiBond SOLO Plus
Drawbacks of Total Etch Systems
- Moisture Sensitivity:
- Excessive Dryness: Collagen fiber network collapses, hindering resin monomer penetration
- Excessive Wetness: Pooled moisture dilutes the primer, reducing its effectiveness
Moist Bonding
- Excess water after rinsing etching gel can be removed using:
- Damp cotton pellet
- High-volume suction
- Disposable brush
- Laboratory tissue paper
Self Etching Adhesives
- Non-rinsing conditioners/self-priming etchants
- Types:
- Two-step self etching adhesive (2 bottle):
- One-step self etching adhesive (1 bottle or all in one):
Two-Step Self Etching Adhesives
- Main advantages compared to total-etch systems:
- Simplified technique (less technique-sensitive)
- Elimination of rinsing and drying steps: Reduces the risk of over-wetting or over-drying
- Do not remove the smear layer completely: Results in less post-operative sensitivity
One-Step Self-Etch Systems (All-in-One or Single Bottle)
- All components in one bottle
- Semi-permeable membranes: Do not form a hermetic seal for vital deep dentin due to transudation of dentinal fluid
- Solutions:
- Extra coat of hydrophobic bonding layer
- Thin layer of flowable composite liner
Self Etching Adhesive (SEPs) Classification by pH
- Mild and Ultramild SEPs: Excellent dentin bond strengths but poorer enamel bonds
- Aggressive self-etch systems: Excellent enamel bonds and no need for selective enamel etching
Universal Adhesives
- Bond to various substrates; dentin, indirect ceramic, resin-based restorations (crowns, inlays, onlays, veneers)
- Mild or ultra-mild one-step self-etching adhesive
- Selective enamel etching is mandatory
Case Discussion
- Class II Preparation in Tooth #16:
- The specific bonding system choice is not provided in the text. It is crucial to consider the specific characteristics of the preparation, the available bonding systems, and the manufacturer's recommendations for making an informed decision.
- Restoring Tooth #11:
- The specific bonding system choice is not provided in the text. It is crucial to consider the specific characteristics of the preparation, the available bonding systems, and the manufacturer's recommendations for making an informed decision.
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