Operative Dentistry Chapter 4: Adhesion Concepts

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Questions and Answers

What characteristic do semi-permeable membranes exhibit regarding dentinal fluid?

They only allow air to pass through.

They prevent dentinal fluid from passing through.

They completely seal off the dentin surface.

They allow dentinal fluid to transudate across them. (correct)

Which category of self-etching adhesives generally provides excellent dentin bond strengths?

Moderate self-etch adhesives.

Selective etching adhesives.

Ultramild self-etching primers. (correct)

Aggressive self-etch systems.

What is a key requirement for using universal adhesives in dental restorations?

They can only bond to dentin.

Selective enamel etching is optional.

They must only be applied in a two-step process.

They bond to multiple substrates, requiring specific preparation. (correct)

Why is an extra coat of a hydrophobic bonding layer applied in some cases?

To increase the bond strength by compensating for transudation. Signup and view all the answers

What is the restoration of choice for a large occlusal caries in tooth # 47?

Composite restoration. Signup and view all the answers

What is the main purpose of the etchant in a three-step etch-and-rinse adhesive system?

To remove the smear layer Signup and view all the answers

Which component of the three-step etch-and-rinse system is responsible for creating a hybrid layer?

Bonding agent Signup and view all the answers

What is a characteristic of the primer in the three-step etch-and-rinse system?

It includes hydrophilic and hydrophobic monomers Signup and view all the answers

What effect does the etching process have on dentin structure?

It opens the tubules in a funnel configuration Signup and view all the answers

What is the primary function of the bonding agent in the adhesive system?

To promote compatibility with restorative materials Signup and view all the answers

What is the significance of decreasing the surface free energy of dentin during the adhesion process?

It enhances the bonding capability to resin materials Signup and view all the answers

Which of the following adhesive systems does NOT belong to the three-step etch-and-rinse category?

Self-etch adhesive systems Signup and view all the answers

What is a potential outcome of improper adhesion to dentin?

Increased likelihood of restoration failure Signup and view all the answers

What is a major drawback of the total etch system?

Immediate collapse of the collagen fiber network due to excessive dryness Signup and view all the answers

Which of the following methods can effectively remove excess water after rinsing the etching gel?

High-volume suction Signup and view all the answers

What technique is eliminated in self-etching adhesives compared to total etch systems?

Drying the dentin surface before application Signup and view all the answers

What is the benefit of a two-step self-etching adhesive over total etch systems?

Reduces technique sensitivity and simplifies application Signup and view all the answers

How do self-etching adhesives contribute to reduced postoperative sensitivity?

By retaining some of the smear layer Signup and view all the answers

Which of the following represents a type of self-etching adhesive?

One-step self-etch adhesive Signup and view all the answers

What happens to resin monomers on excessively dry dentin?

They fail to penetrate effectively Signup and view all the answers

What is a key advantage of one-step self-etch systems?

They incorporate all components in a single bottle Signup and view all the answers

Study Notes

Adhesion of Resins to Dentin

Classification of contemporary adhesive systems includes three-step total etch (etch and rinse).
The three components: Etchant (E), Primer (P), and Bonding agent (B).
Three-step system removes the smear layer, exposing intertubular and peritubular collagen.
Opening dentinal tubules enhances bonding by decreasing surface free energy up to 7.5 µm.
Examples of three-step systems include Scotch Bond MultiPurpose, All Bond 2, and Panavia 21.

Two-Step Etch-and-Rinse System

Simplifies bonding procedures compared to total etch systems.
Examples include One-Step Plus, Prime & Bond NT, Adper Single Bond Plus, and OptiBond SOLO Plus.

Drawbacks of Total Etch System

Excessive dryness can occur if dentin is air-dried, leading to collagen fiber collapse.
Excessive wetness dilutes the primer, reducing its effectiveness.

Moist Bonding

Removing excess water post-etching can be performed with damp cotton, high-volume suction, disposable brushes, or tissue without affecting bond strengths.

Self-Etching Adhesives

Classified as non-rinsing conditioners or self-priming etchants.
Types include two-step and one-step self-etching adhesives.

Advantages of Self-Etching Adhesives

Simplified techniques reduce technique sensitivity.
Elimination of rinsing prevents over-wetting or drying issues.
Less postoperative sensitivity compared to etch-and-rinse adhesives due to partial smear layer removal.

One-Step Self-Etch Systems

Incorporate all necessary components in a single bottle.
May allow transudation of dentinal fluid; solutions include adding a hydrophobic bonding layer or applying a flowable composite liner.

Categories of Self-Etching Primers (SEPs)

Classified by pH into mild, moderate, and aggressive:
- Mild and ultramild SEPs offer better dentin adhesion but weaker enamel bonds.
- Aggressive SEPs excel in bonding to enamel without selective etching.

Universal Adhesives

Bond to multiple substrates, including indirect ceramics and resin restorations.
Typically mild or ultra-mild one-step self-etching adhesives, requiring selective enamel etching.

Case-Based Discussion

Example of a 40-year-old woman with Class I tooth preparation for composite restoration in tooth #47.
Considerations for adhesive system selection for Class II preparation in tooth #16.
Factors influencing adhesive choices for restoring tooth #11, with justifications required.

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Description

This quiz explores fundamental concepts of enamel and dentin adhesion as outlined in Chapter 4 of the 6th edition of 'Art and Science of Operative Dentistry'. It involves differentiating between current strategies for resin adhesion to dentin and includes a case discussion for selecting adhesive systems based on cavity preparation. Test your understanding of operative dentistry principles and applications.