Dental Adhesives in Clinical Practice
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Questions and Answers

What is the primary mechanism by which dental adhesives create a strong bond to tooth structure?

  • Micromechanical interlocking of the adhesive into demineralized tooth surface (correct)
  • Chemical bonding through covalent bonds between the adhesive and tooth structure
  • Electrostatic attraction between the adhesive and the tooth surface
  • Physical interlocking of the adhesive into the grooves and irregularities of the tooth surface
  • Which of the following is NOT a characteristic of a desirable dental adhesive?

  • Compatibility with tooth tissues and restorative materials
  • Ability to create a strong bond to both enamel and dentin
  • High bond strength
  • Fast setting time, allowing for rapid restoration completion (correct)
  • Which of the following is NOT a common indication for adhesive dentistry?

  • Performing periodontal splints
  • Securing orthodontic brackets to teeth
  • Bonding indirect restorations, such as crowns and bridges
  • Replacing missing teeth with implants (correct)
  • Conservative restorations of class I, II, III, IV, V, and VI carious lesions
  • According to Van Meerbeek's classification, what are the three main categories of dental adhesives?

    <p>Etch-and-rinse, self-etch, and glass ionomer adhesives (C)</p> Signup and view all the answers

    What is the principal challenge when bonding to dentin compared to enamel?

    <p>Dentin contains more collagen than enamel, making it more difficult to create a strong bond (B)</p> Signup and view all the answers

    What is the main reason why bonding to dental tissues is considered a sensitive challenge for dentists?

    <p>The significant differences in structure and composition between different dental substrates (C)</p> Signup and view all the answers

    What is the term used to describe the process of creating a resin-infiltrated hybrid layer within the demineralized tooth structure?

    <p>Hybridization (C)</p> Signup and view all the answers

    What is the main reason why dentists often prefer to use adhesives that are hydrolytically stable?

    <p>To prevent the adhesive from breaking down in the presence of moisture (C)</p> Signup and view all the answers

    What is the primary reason for the evolution of adhesive dentistry?

    <p>Use of tooth-colored restorative materials is frequently requested by patients. (B)</p> Signup and view all the answers

    Which of the following is NOT a benefit of adhesion in dentistry?

    <p>Increased risk of tooth fracture due to stress concentration at the interface. (C)</p> Signup and view all the answers

    What is the term used to describe the degree of spreading of a liquid on a solid surface?

    <p>Wetting (C)</p> Signup and view all the answers

    Which scenario results in the maximum adhesion between an adhesive and adherend?

    <p>Contact angle of 0 or 180 degrees (B)</p> Signup and view all the answers

    How does adhesion improve tooth conservation?

    <p>By reducing the need for tooth preparation. (A)</p> Signup and view all the answers

    What is the primary reason for the reduction in microleakage at the tooth/restoration interface due to adhesion?

    <p>The creation of a gap-free bond between the tooth and restoration. (A)</p> Signup and view all the answers

    What is the key characteristic of a successful adhesive joint?

    <p>A gap-free bond between the adhesive and adherend. (A)</p> Signup and view all the answers

    Which of the following is NOT a benefit of adhesive dentistry in terms of esthetics?

    <p>Increased use of amalgam restorations. (C)</p> Signup and view all the answers

    Which of the following is not a method of conditioning enamel for resin bonding?

    <p>Thermal conditioners (D)</p> Signup and view all the answers

    Which of the following chemical conditioners is most widely used for etching enamel?

    <p>Phosphoric acid (A)</p> Signup and view all the answers

    What is the primary objective of conditioning enamel before bonding resin?

    <p>To improve the adhesion of the resin to the enamel (C)</p> Signup and view all the answers

    Which of the following is a benefit of using laser conditioning for enamel?

    <p>Occlusion of dentinal tubules, leading to desensitization (A)</p> Signup and view all the answers

    What is the primary function of microtags in resin bonding to enamel?

    <p>Contributing significantly to the retention of the resin to enamel (C)</p> Signup and view all the answers

    Why is EDTA not considered an ideal etchant for enamel?

    <p>It can cause a decrease in resin bond strength to enamel. (A)</p> Signup and view all the answers

    Which of the following is a potential application of air abrasion in resin bonding?

    <p>Removing demineralized and discolored tooth tissues (B)</p> Signup and view all the answers

    Which of the following is not a characteristic of macrotags in resin bonding?

    <p>They are the result of resin infiltration into tiny etch pits. (B)</p> Signup and view all the answers

    Flashcards

    Adhesive Dentistry

    A field focused on bonding restorative materials to teeth using adhesive techniques.

    Minimum Intervention

    A dental approach that replaces only lost or diseased tooth tissue.

    Long-term Retention

    The ability of adhesive restorations to remain stable over time.

    Microleakage

    The seepage of fluids and bacteria between the tooth and restoration.

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    Contact Angle

    The angle formed by the adhesive with the adherend, indicating adhesion quality.

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    Gap-Free Adhesive Joint

    An adhesive connection without any gaps, vital for effective bonding.

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    Esthetic Restorative Dentistry

    Restorative dentistry focused on achieving aesthetic results.

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    Bonding Indirect Restorations

    The process of securing indirect restorations using adhesive techniques.

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    Bond Strength

    Measure of adhesive's capability to resist debonding under stress.

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    Types of Dental Adhesives

    Classified into etch-and-rinse, self-etch, and glass ionomer adhesives.

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    Hybridization

    Micro-mechanical interlocking by resin infiltration into demineralized substrate.

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    Indications for Adhesive Dentistry

    Applications like restorations, shape change, and bonding indirect restorations.

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    Bonding Challenges

    Difficulty in achieving reliable bond strength due to different dental substrates.

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    Hydrolytic Stability

    The ability to resist degradation in a moist oral environment.

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    Microporosities

    Small pores exposed in enamel and dentin for better adhesive bonding.

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    Exchange Process in Adhesion

    Involves removing calcium phosphate to expose microporosities for resin bonding.

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    Resin Tags

    Structures formed from resin polymerization that enhance bond strength.

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    Macrotags

    Larger resin tags filling space around enamel prisms.

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    Microtags

    Smaller resin tags formed inside etch pits of enamel.

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    Enamel Conditioning

    Process of preparing enamel for bonding, involving cleaning and creating microporosities.

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    Chemical Conditioners

    Acids used to etch enamel, enhancing bond strength.

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    EDTA

    A chelating agent that weakly decalcifies enamel but offers low bond strength.

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    Laser Treatment

    Physical conditioning technique that alters surface by thermal changes, enhancing bonding.

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    Air Abrasion

    Mechanical conditioning that uses aluminum oxide particles to clean enamel and dentin.

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    Study Notes

    Adhesion to Dental Tooth Tissues

    • Adhesive dentistry is rapidly evolving, driven by patients' desires for tooth-colored restorations that are both functional and aesthetically pleasing.
    • Conservative dentistry now prioritizes minimally invasive or minimum intervention techniques, replacing only lost or diseased tissue with a restorative material directly bonded to the remaining sound tissue.

    Advantages and Clinical Significance of Adhesion

    • Adhesion allows for stable and long-term restorations.
    • It efficiently transmits and distributes functional stresses across the bonded interface, creating a unified tooth-restoration unit.
    • It maximizes tooth conservation, reducing the need to remove healthy tooth structure.
    • Micro leakage at the tooth/restoration interface is minimized, reducing postoperative hypersensitivity, marginal staining, and recurrent caries.
    • Esthetic restorative dentistry is expanded to encompass correcting tooth dimensions and color, bonding indirect resin-based restorations, and repairing and creating highly esthetic, "invisible" direct restorations.

    Requirements for Adhesion

    • For effective bonding, the adhesive or adherent must flow readily over the adherend to produce good wetting.
    • Wetting, the degree of spreading of a liquid on a solid surface, is measured by the contact angle.
    • The contact angle is the angle formed by the adhesive and adherend at their interface.
    • Optimal adhesion is achieved with a contact angle of 0 or 180 degrees.
    • Moderate adhesion occurs with angles less than 90 degrees.
    • Poor adhesion is associated with angles greater than 90 degrees.

    A Successful Adhesive Joint

    • A successful adhesive joint is gap-free.
    • It exhibits sufficient bond strength to resist debonding from polymerization shrinkage stresses or functional stresses. Bond strength is the adhesive's capacity to resist debonding.
    • It must be compatible with both tooth tissues and the restorative material.
    • It is dimensionally and hydrolytically stable in the complex oral environment, ensuring long-term bond durability.

    Classification of Dental Adhesives

    • Dental adhesives are categorized based on their adhesion strategy :
      • etch-and-rinse adhesives
      • self-etch adhesives
      • resin-modified glass ionomers
    • All three adhesive types utilize a hybridization mechanism of micro-mechanical interlocking involving resin infiltration into the demineralized substrate. The result is a hybrid layer bonded to dentin.
    • Visualization of the different adhesive systems are included with the description.

    Indications for Adhesive Dentistry

    • Conservative restorations of carious or non-carious lesions (classes I–VI).
    • Reshaping and/or recoloring anterior teeth.
    • Repairing fractured teeth.
    • Bonding indirect restorations (e.g., crowns, inlays).
    • Sealing pits and fissures.
    • Bonding orthodontic brackets.
    • Providing periodontal splints.
    • Restoring damaged restorations.

    Fundamental Principles of Adhesion to Tooth Substrate

    • Adhesion to tooth tissue is based on exchanging inorganic tooth material for synthetic resin through two phases.
    • The first phase involves removing calcium phosphate contents to expose micro porosities in enamel and dentin surfaces.
    • The second phase, hybridization, involves polymerizing the resin within the created surface micro porosities.
    • Micromechanical interlocking occurs due to this process, primarily via diffusion.

    Challenges in Bonding to Dental Substrates

    • Bonding to dental tissues is challenging due to the differences in substrates. Enamel bonding is relatively simple, dentin bonding is significantly more challenging.

    Resin/Enamel Interface

    • Adhesive resin, drawn within the created etched enamel surface by capillary attraction, envelops individual hydroxyapatite crystals and polymerizes in situ.
    • Two types of resin tags form:
      • Macrotags fill the spaces around enamel prisms.
      • Microtags result from resin infiltration and polymerization within enamel etch pits. They contribute most to enamel retention.

    Resin/Enamel Interface: Conditioning Enamel

    • Objectives: Removing organic pellicle, smear layer, and creating enamel micro-porosities.
    • Increasing enamel surface energy to enhance bonding with restorative resin.
    • Objectives, and the methods for completing the objectives is included.

    Resin/Enamel Interface: Methods (Chemical Conditioning)

    • Commonly used chemical conditioners for enamel include:
    • Phosphoric acid 37% (most widely used etchant, used for 20-30 seconds).
    • Nitric Acid
    • Citric acid
    • Maleic Acid
    • Oxalic Acid.
    • EDTA and HCL are less commonly used and may be problematic
    • Specific concentrations and application times are presented.

    Resin/Enamel Interface: Methods (Physical Conditioning [Laser])

    • Laser-based physical conditioning method altering the substrate surface by microscopic explosions improves the adhesion.
    • This leads to a decreased organic fraction and a sensitized dentin surface.

    Resin/Enamel Interface: Methods (Mechanical Conditioning [Air Abrasion])

    • Air abrasion using aluminum oxide particles of differing sizes and velocities removes the demineralized and discolored areas. This method may be useful for self-etch adhesives.

    Factors Affecting Successful Acid Etching

    Numerous different factors were noted, including:

    • Acid type
    • Acid concentration
    • Etching time
    • Etchant form
    • Rinsing time
    • Activation methods
    • Tooth type
    • Enamel conditions

    Patterns of Etching

    • Three enamel etching patterns are observed:
      • Type I: preferential removal of enamel prism cores.
      • Type II: preferential removal of prism peripheries.
      • Type III: does not relate to prism morphology, showing mixed etching patterns.

    Clinical Features of Etching

    • The etched surface will appear white-frosted (chalky white).

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    Description

    This quiz explores the principles and challenges of dental adhesives used in adhesive dentistry. It covers concepts such as bonding mechanisms, classifications, and the properties of effective adhesives. Test your knowledge on how dental adhesives interact with tooth structures and their clinical applications.

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