Podcast
Questions and Answers
What characteristic do self-etching primers (SEPs) generally exhibit?
What characteristic do self-etching primers (SEPs) generally exhibit?
Which type of self-etching system typically provides excellent bond strengths to dentin?
Which type of self-etching system typically provides excellent bond strengths to dentin?
What is a necessary step when using universal adhesives?
What is a necessary step when using universal adhesives?
In which scenario would it be best to use a composite restoration?
In which scenario would it be best to use a composite restoration?
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What issue is associated with using polymerized adhesives in dentistry?
What issue is associated with using polymerized adhesives in dentistry?
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What is a significant advantage of two-step self etching adhesives over total etch systems?
What is a significant advantage of two-step self etching adhesives over total etch systems?
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What can happen if excess water remains after rinsing the etching gel?
What can happen if excess water remains after rinsing the etching gel?
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Which of the following is a drawback of the total etch system?
Which of the following is a drawback of the total etch system?
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Which method can be used to remove excess water after rinsing the etching gel?
Which method can be used to remove excess water after rinsing the etching gel?
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What describes self etching adhesives?
What describes self etching adhesives?
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What is one common characteristic of one-step self-etch systems?
What is one common characteristic of one-step self-etch systems?
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What is the primary purpose of the three-step total etch system in adhesion?
What is the primary purpose of the three-step total etch system in adhesion?
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Which component of the three-step total etch system is responsible for opening the tubules in dentin?
Which component of the three-step total etch system is responsible for opening the tubules in dentin?
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What happens when the dentin surface is excessively dried during bonding?
What happens when the dentin surface is excessively dried during bonding?
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What is one of the main benefits of a moist bonding technique?
What is one of the main benefits of a moist bonding technique?
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What type of molecules are included in the primer of the three-step total etch system?
What type of molecules are included in the primer of the three-step total etch system?
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What is the role of Bis-GMA in bonding to dentin?
What is the role of Bis-GMA in bonding to dentin?
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Why is the surface free energy of dentin decreased during the adhesion process?
Why is the surface free energy of dentin decreased during the adhesion process?
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Which of the following examples represents a product utilized in the bonding process?
Which of the following examples represents a product utilized in the bonding process?
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What is one benefit of co-polymerizing hydrophilic monomers with the primer molecules?
What is one benefit of co-polymerizing hydrophilic monomers with the primer molecules?
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What characteristic is essential in the bonding agent for effective adhesion to dentin?
What characteristic is essential in the bonding agent for effective adhesion to dentin?
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Study Notes
Enamel and Dentin Adhesion (2)
- Batterjee Medical College, a college for Science and Technology, is responsible for the presentation.
- The presenter is Dr. Rehab Alwakeb, from the Operative Dentistry Division.
- The presentation is based on Chapter 4, page 114 of the "Art and Science of Operative Dentistry" 6th edition.
Learning Objectives (ILOs)
- I: Differentiate between current strategies for resin adhesion to dentin.
- II: Discuss (with justification) the selection of the adhesive system appropriate for a prepared cavity.
Current Strategies for Adhesion of Resins to Dentin
- Contemporary adhesive systems include:
- Etch-and-rinse systems (three-step)
- Two-step systems
- Self-etch systems (single-step, two-step)
Classification of Contemporary Adhesive Systems
- Diagrams illustrate the different steps and components (etchant, primer, bond resin, etc) of each system.
Three-Step Total Etch System
- The process involves acid-etching, rinsing, and then applying primer & adhesive.
- This creates etched dentin exposed collagen fibres.
- A composite is then applied.
- Formation of a hybrid layer & resin-tags results from this procedure.
Etchant, Primer, and Bonding Agent
- Etchant (E): Removes smear layer, exposes intertubular and peritubular collagen, and creates an accessible/decreased surface free energy.
- Primer (P): Includes bifunctional molecules (hydrophilic and hydrophobic), envelops external surface of collagen fibers and re-establishes free energy levels.
- Bonding agent (B): Contains hydrophobic monomers - Bis-GMA and hydrophillic monomers - HEMA, which then co-polymerize with the primer to create resin tags & hybrid layers that infiltrate into the intertubular spaces.
Two-Step Etch-and-Rinse (E+PB) System
- Rationale: Simplifies bonding procedure.
- Examples:
- One-Step Plus (Bisco)
- Prime & Bond NT (Dentsply Caulk)
- Adper Single Bond Plus (3M ESPE)
- OptiBond SOLO Plus
Drawbacks of Total Etch System
- Excessive Drying: Removing moisture via air drying during the rinsing phase results in collagen fiber network collapse, and prevents resin monomers from penetrating into the dentin.
- Excessive Wetting: Pooled moisture (excess water) dilutes the primer, resulting in reduced effectiveness.
Methods for Removing Excess Water After Rinsing
- Damp cotton pellet
- High-volume suction
- Disposable brush
- Laboratory tissue paper
Self-Etching Adhesives
- Described as non-rinsing conditioners.
- Two-types:
- Two-step self-etching adhesives
- One-step self-etching adhesives
2-Step Self-Etching Adhesives
- These systems do not necessitate rinsing
- The systems comprise self-etching primer, followed by application of adhesive & composite.
- No rinsing is needed.
Advantages of Self-Etching Adhesives Compared to Total Etch Systems
- Simplified Technique: Less technique sensitive
- No rinsing/drying steps
- Less post-operative sensitivity
One-Step Self-Etch Systems
- Contain all components in one bottle.
- Act as semi-permeable membranes.
- Do not provide an airtight seal for the vital deep dentin.
Overcoming Problems with Self-Etch Systems
- Use a hydrophobic binding layer on top of the self-etch system.
- Apply a thin layer of composite flowable liner.
SEP Classification
- SEPs (self-etch primers) are categorized by pH level:
- Mild and ultra-mild
- Moderate
- Aggressive
Universal Adhesives
- Bond to various substrates in addition to dentin
- Indirect ceramics, and resin-based restorations
- Considered moderate/mild self-etching.
- Enamel etching is mandatory.
Case-Based Discussion
- A 40-year-old patient seeks treatment for food collecting in tooth #47, which exhibits severe occlusal caries and displays hard discolored dentin on the pulpal floor.
- Composite restoration is the treatment of choice.
Clinical Questions
- Several patient cases are presented for which the best adhesive system must be identified and defended.
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Description
This quiz covers the current strategies for resin adhesion to dentin based on Chapter 4 of the 'Art and Science of Operative Dentistry'. It focuses on differentiating among various adhesive systems and discussing their selection for cavity preparation. Ideal for students studying operative dentistry.
