Operative Dentistry 7_Adhesion_Part3_DES300_F2023 PDF

Operative Dentistry Adhesive Dentistry III Kostis Giannakopoulos, DDS, PhD Assistant Professor, Department of Dentistry 14-11-2023 Enamel adhesion  HYBRID D LAYER B A DENTIN COMPOSITE  Solvents...

Operative Dentistry Adhesive Dentistry III Kostis Giannakopoulos, DDS, PhD Assistant Professor, Department of Dentistry 14-11-2023 Enamel adhesion  HYBRID D LAYER B A DENTIN COMPOSITE  Solvents The carrier of the bonding Acetone agent to dentin Ethanol Highly hydrophilic Water  Three-Step Etch-and-Rinse 1. Phosphoric acid approximately 35% that is rinsed. 2. A primer containing reactive hydrophilic monomers in ethanol, acetone, or water. 3. A non solvated unfilled or filled resin bonding agent. Contains hydrophobic monomers such as Bis-GMA, frequently combined with hydrophilic molecules such as HEMA.  Two step etch and rinse adhesive systems (5th generation) Advantages Disadvantages Good immediate bonding. Acidic and hydrophilic. Ease of use. No Hap to protect the Low cost. collagen. Faster degradation. Incompatibility with self cure resins. Light cure only.  Self-Etch Approach No etching and no rinsing. Smear layer is not removed. More superficial interaction with dentin (depending on the pH of the Adhesive). HAp preservation. Etching of enamel is not adequate (depending on the pH of the Adhesive).  Two step self etch adhesive systems Advantages Disadvantages Modifies smear layer. Less post-operative sensitivity. Not adequate enamel etch. Ionic interaction with HAp – self assembled nano-layering. 10 – MDP. Final hydrophobic layer. Protection of collagen (Hap). Less technique sensitivity. No need to rinse. Excellent bonding (with SEE)  One step self etch adhesive systems Advantages Disadvantages Ease of use Not adequate enamel etch. Too acidic and hydrophilic after curing – water tree formation. Water permeability and fast degradation of the bond. Self cure resin incompatibility. Hydrolysis in the bottle. Water trees Nanoleakage  Bonding agent acidity Self Etch systems pH AdheSE (2 step) 2.5 Optibond Solo S/E (2 step) 2.1 Etch and Rinse – One bottle pH Optibond Universal 2.5 Bond 1 3.9 Clearfil SE Bond (2 step) 2.6 Cabrio 2.5 Touch & Bond (1 step) 2.6 Optibond S 2.8 i-Bond (1 step) 1.6 One-Step 4.7 All Bond Universal 3.1 PBNT 2.6 One – up – Bond (1 step) 2.3 PQ 1 2.1 Prompt L – Pop (1 step) 1.3 Single Bond 3.6 Xeno III (1 step) 1.1  Self etch bonding agent pH Self Etch systems pH Self Etch pH Etching AdheSE (2 step) 2.5 Depth Optibond Solo S/E (2 step) 2.1 Ultra mild Self Etch > 2.5 < 100-300nm Optibond Universal 2.5 Mild Self Etch ≈2 ≈ 1μm Clearfil SE Bond (2 step) 2.6 Intermediate – Strong Self 1-2 1-2μm Touch & Bond (1 step) 2.6 Etch i-Bond (1 step) 1.6 Strong Self Etch ≤1 >2μm All Bond Universal 3.1 One – up – Bond (1 step) 2.3 Total Etch pH Etching Depth Prompt L – Pop (1 step) 1.3 H3PO4 0.1 >5μm Xeno III (1 step) 1.1 Van Meerbeek et al. State of the art of self etch adhesives. Dent Mater 2011 ;27:533-44. Acidity of Self - etch systems (pH) pH < 2 Demineralization of Hydroxyapatite. Exposure of collagen fibrils. Incorporation of instable CaPO4 that are not rinsed away. Acidity of Self - etch systems (pH) pH ≥ 2 Protection of collagen due to maintenance of HAp. Ionic interaction with HAp. Chemical bond (similar to Glass Ionomer cements). Acidity of Self - etch systems (pH) pH ≥ 2: SELECTIVE ETCH A separate etching step of enamel is greatly improving the bond.  UNIVERSAL (2012- All Bond Universal) With or without etching Direct or indirect restorations Self cure or light cure For all substrates and materials Contain silane Contain 10-MDP  Functional monomer: 10 - MDP Interacts with Hap to create very stable Ca – salts through self-assembled nano-layering. Strong hydrophobic nature that protects the bond against degradation. Makes the residual Hap more resistant to acidic dissolution. The Hap-10-MDP hybrid layer protects the collagen as a shelter.  UNIVERSAL DBA pH FUNCTIONAL MONOMERS + OTHER INGREDIENTS Prime&Bond Elect 2.5 (Dentsply 2.5 Mono, di and trimethacrylate resins, PENTA, diketone stabilizers, organic phosphine oxide, Caulk) cetylamine hydrofluoride, acetone, water Scotchbond Universal (3M ESPE) 2.7 10-MDP, HEMA, silane, dimethacrylate resins, VitrebondTM copolymer, filler, ethanol, water, initiators All-Bond Universal (Bisco Inc., USA) 3.2 Bis-GMA, 10-MDP, HEMA, ethanol, initiators, water Clearfil Universal Bond (Kuraray 2.3 Bis-GMA, HEMA, ethanol, 10-MDP, hydrophilic aliphatic dimethacrylate, colloidal silica, DL- Noritake Dental Inc) camphorquinone, silane coupling agent, accelerators, initiators, water Futurabond U (Voco GmbH) 2.3 HEMA, Bis-GMA, HEDMA, acidic adhesive monomer, urethane dimethacrylate, catalyst, silica nanoparticles, ethanol Universal one step self etch adhesive systems Advantages Disadvantages Improved version of all in one Self Etch systems. 10-MDP Ultra mild or mild Not adequate enamel etch. Too acidic and hydrophilic after curing. Water permeability and fast degradation of the bond. Self cure incompatibility. Hydrolysis in the bottle. Lack long term research data. Extremely limited clinical research data.  SELF ETCH SYSTEMS NOT ALL ARE THE SAME !!!  Universal adhesive systems Laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material-dependent and subject to hydrolytic degradation. The lack of long-term data regarding the clinical performance of UAs further complicates clinical decision-making. Sanket Nagarkar, Nicole Theis-Mahon, Jorge Perdigão Universal dental adhesives: Current status, laboratory testing, and clinical performance  Universal adhesive systems Always use a SEE strategy. Additional hydrophobic layer. Active application of the adhesive (scrubbing). MMP inhibitors (BAC, Chlorhexidine). Use separate silane for silica based ceramics.  What bonding system???? Low technique sensitivity H3PO4 enamel etching Mild self etching if SE Final hydrophobic layer Not acidic after curing Dual Cure 10-MDP Universal 2-Step SE 1-Step SE 3-Step ER 2-Step ER with SEE with SEE  Universal adhesives and silane Silane does not work well when combined with resin monomers. Silane is deactivated in low pH environments. Dimitriadi M et al. Stability and reactivity of γ-MPTMS silane in some commercial primer and adhesive formulations. Dent Mater 2018;34(8): 1089–1101 Chen L, et al. Effect of incorporating BisGMA resin on the bonding properties of silane and zirconia primers. J Prosthet Dent 2013;110(5):402–407 Kalavacharla VK et al. Influence of etching protocol and silane treatment with a universal adhesive on lithium disilicate bond strength. Oper Dent 2015;40(4):372–378 Yoshihara K et al. Effectiveness and stability of silane coupling agent incorporated in ’universal’ adhesives. Dent Mater 2016;32(10):1218–1225.  Universal adhesives and Zirconia/Metal primers Abrasive treatment needs to precede Zirconia priming. There is indications that UA work but also that bond stability may be worse. Reliable bond to Zirconia is anyway challenging with any strategy. Bömicke W et al. Durability of resin-zirconia bonds produced using methods available in dental practice. J Adhes Dent 2016;18(1):17–27. Seabra B et al. Influence of multimode universal adhesives and zirconia primer application techniques on zirconia repair. J Prosthet Dent 2014;112(2):182–187 Al Jeaidi ZA et al. Bond strength of universal adhesives to air-abraded zirconia ceramics. J Oral Sci 2017;59(4):565–570. Alves M et al. Effect of adhesive cementation strategies on the bonding of y-tzp to human dentin. Oper Dent 2016;41(3):276–283. Tribochemical silica coating Bonding agents  Bonding agent generations 1st Cosmic Bond, Sevriton 1956 2nd Clearfil Bond, Scotchbond 1978 3rd Tenure, Scotchbond 2, Probond 1986 4th All Bond, Amalgambond, Scotchbond MP 1990 5th One Step, Prime & Bond, Optibond, 1995 Scothbond 6th Clearfil SE 1996 7th Prompt L-Pop, One-Up Bond 2000 8th i – Bond, G Bond, Xeno IV 2006 1st, 2nd, 3rd generation: NOT bonding to dentin. 4th generation: The first hydrophilic dentin bonding agents. Compatible to dentin.  Bonding agent generations 1st Cosmic Bond, Cervident 1956 2nd Clearfil Bond, Scotchbond 1978 3rd Tenure, Scotchbond 2, Probond 1986 4th All Bond, Amalgambond, Scotchbond MP 1990 5th One Step, Prime & Bond, Optibond, 1995 Scothbond 6th Clearfil SE 1996 7th Prompt L-Pop, One-Up Bond 2000 8th i – Bond, G Bond, Xeno IV 2006  Bonding agents classification 3 Step Acid Etching Primer Bonding Resin 2 Step Acid Etching Bonding Agent (Primer + Bonding Resin) 2 Step Self Priming Etchant /Self Etching Primer (Self Etch) Bonding Resin 1 Step All in one bottle (Universal) (Self Etch) Bonding agents classification ETCH AND RINSE 3 Step Acid Etching Primer Bonding Resin 2 Step Acid Etching Adhesive (Primer + Bonding resin)  Bonding agents classification SELF ETCH 2 Step Self etch primer (Self Etch) Bonding resin 1 Step Mixing 2 or 3 components. (Self Etch) Application in one step 1 Step All in one / UNIVERSAL (Self Etch)  Bonding steps classification ETCH AND RINSE (ER) SELF ETCH (SE) 3 step Etching 2 step Self etching Primer Primer Bonding resin Bonding resin 1 step Mix and apply in one step 2 step Etching Primer + Bonding resin 1 step All in one/ UNIVERSAL  Classification depending on Bonding Strategy ETCH AND RINSE (ER) SELF ETCH (SE) SELF ETCH with 3 step Etching Selective Enamel 2 step Self etching Etch (SEE) Primer Primer Bonding resin 2 step Self etching Bonding resin Primer 2 step Etching 1 step Mix and apply in Bonding resin Primer + Bonding one step 1 step Mix and apply in resin 1 step All in one/ one step UNIVERSAL 1 step All in one/ UNIVERSAL  Incompatibility of simplified adhesives with dual cure resins  SC : BPO (Benzoyle Peroxide) + A3IoD Y A mix 2R AC ILITCatalyst Base ATIB Acid(H+) H OMP C6H6-N-CH3 + C6H6-N-CH 3 CH3 CH3 C Swift et al, Am J Dent N Sanares et al,Dent Mater I Tertiary-N Quaternary-N Tay et al, J Dent  Bonding Agent Acidity Self Etch systems pH AdheSE (2 step) 2.5 Etch and Rinse – One bottle pH Optibond Solo S/E (2 2.1 Dual Cure step) activators Bond 1 3.9 (Sodium Optibond Universal 2.5 Cabrio 2.5 Benzosulfinate) Clearfil SE Bond (2 step) 2.6 Optibond S 2.8 Touch & Bond (1 step) 2.6 One-Step 4.7 Incompatibility i-Bond (1 step) 1.6 instructions for PBNT 2.6 All Bond Universal 3.1 DC/SC PQ 1 2.1 One – up – Bond (1 step) 2.3 Single Bond 3.6 Prompt L – Pop (1 step) 1.3 Xeno III (1 step) 1.1 Dual cure compatible vs. Dual cure Indirect restorations – Αdhesive luting