Adhesion

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ADHESION

Advantages of adhesive techniques:


a. More retention & stability
b. Reduction of: microleakage, postoperative sensitivity (desensitization: seal dentinal tubules), marginal staining, recurrent
caries, pulp pathology
c. Better transmission & distribution of functional force: potential reinforcement of weakened tooth structure; promotion of
material strength  More conservative tooth decay preparation: minimal loss of hard dental tissues
d. Expanded range of possibilities for esthetic restorative dentistry
Adhesion - attachment of one substance to another whenever they come into close contact with each other; force that binds
two dissimilar materials together when they are brought into intimate contact. At a microscopic level, solids often have rough
surfaces, they contact each other only at certain points. To get better contact between 2 materials, intermediate layer, called
adhesive, has to be placed. Surfaces or substrates that are adhered to are termed adherent.
Theories of adhesion phenomena:
1) Mechanical theory - solidified adhesive interlocks micromechanically with roughness & irregularities of adherent surface.
2) Adsorption theory - all kinds of chemical bonds between adhesive & adherent, including primary & secondary valence
forces.
Adsorption adhesion:
Chemical adhesion - primary chemical bonding takes place whenever electrons of 2 different atoms are shared, which leads to
covalent forces or ionic forces.
Physical adhesion - attraction between polar groups; in dentistry, chemical bonding is only of minor importance.
Primary forces - ionic and covalent bonding: (Covalent bond – atoms sharing 1 or more of their electrons)
Secondary forces - hydrogen, dipole interaction and van der Waals forces
Requirements for long-lasting adhesion:
- 2 materials to be bonded to each other must be in sufficiently close & intimate contact.
- to achieve it for solid bodies, liquids or flowable materials - adhesives - should be used.
- their intimate contact with the substrate depends on:
1) the wettability of the substrate
2) the viscosity of the adhesive
3) the morphology and the roughness of the substrate
Adhesion - forces or energies between atoms or molecules at interface that hold 2 phases together; adhesion components: 2
Adherents & 1 Adhesive (bonding agent)
Requirements for long-lasting adhesion
1) Wettability of substrate – contact angle
- wetting of surface by liquid is usually characterized by contact angle of droplet placed on solid surface.
- the better liquid spread over the surface, the better wetting takes place  a contact angle close to 0 degree (lower than 90
degrees)
- if a contact angle is over 90 degrees  poor wetting
Contact angle – contact between liquid & solid surface; abilityof adhesive to contact a substrate
No wetting – contact angle higher than 90*
Partial wetting – contact angle equal to 90*
Perfect wetting – contact angle much lower than 90*
Surface energy is measured by internal angle of a droplet on a surface (dynes/cm).
Smaller angles means better spreading
Other factors affects wetting: a. Hydrophilic b. Hydrophobic
Wetting of adhesive
- adhesive must wet the surface
- adhesive must have low viscosity to penetrate irregularities
- adhesive must be able to displace air & moisture during process of adhesion
Acid + primer + adhesive
Wetting of the adhesive:
In current adhesive systems primers contain:
1) Hydrophilic monomer to improve wetting of hydrophobic resin
2) Solvent like acetone or ethanol to replace water & air

Roughness of surface: Measurements of contact angle for evaluation of wettability of certain liquid on certain surface is based
on assumption that the surface is perfectly flat & smooth. However, on a microscopic level, we always will find roughness in
varying dimensions. This is advantage causing increase of surface area & area of bonding. Irregularities at the surface
additionally can create capillary forces that support diffusion of adhesive into rough surface.
Adhesion promoters: Whenever 2 materials that should be bonded do not have any particular affinity to each other, special
adhesion-promoting agents have to be used. These agents can react with both materials to establish the bond. They
also can be used as primers because they modify surface of substrate to enable wetting of subsequently applied adhesive.
These promoters are essential to create bond to dentin.
Mechanisms of adhesion:
- Chemical: bonding at the atom or molecular level.
- Mechanical: interlocking or penetration of 1 phase into the surface of other.
Principles of adhesion:
- close & intimate contact
- surface wettability
- contact angle
- surface energy and surface tension
Surface energy (surface tension) - inward attractive forces of molecule of liquid or solid.
Ideal adhesive: Contact angle ↓; Wettability ↑; Surface energy ↓
Factors affecting adhesion to tooth: wetting of adhesive, composition & structure of enamel and dentin; internal & external
dentin wetness; smear layer; polymerization contraction (shrinkage), initial polymerization; thermal expansion coefficient and
thermal conduction; stress transmission across interface
Bonding/Adhesion to enamel
Structure of enamel: almost homogeneous, low water content [hydrophobic], enamel prism/rod; contain Hydroxyapatite
crystals
Microstructure of enamel: DEJ, enamel prisms (rods formed from tightly packed crystals, mineralization front (nucleation &
growth of crystals), cellular excretion zone; ameloblasts moving away from DEJ
Geometry and dimensions of apatite crystal: regular hexagonal prism; length=1600 A(0,05-0,1μm)
Bonding to enamel: Untreated enamel surface is smooth (i.e. not retentive) & covered by plaque, which prevents close contact
of any material with tooth surface. Therefore, enamel has to be conditioned. Adhesive technique started in 1955 when
Buonocore first applied phosphoric acid to enamel & proved that this procedure resulted in altered surface that increased
bonding of acrylic material to human teeth. Etching enamel with use of 30-40% phosphoric acid provides repeatable etching
pattern of enamel („honeycomb’). Acid etching of enamel results in rough & enlarged surface, which promotes wettability &
improved micromechanical retention needed to effective adhesion.
Characteristics of etched enamel: honeycomb pattern; “Frosty appearance”, high surface energy; more than twice unetched
enamel. Enamel rods which are unetched provide less effective bonding between tooth surface & composite material. Etched
surface producing microundercuts which provides more effective bonding
Effect of acid etching depends on: kind of acid, acid concentration, etch time, rinse time, form of etchant (gel, semigel,
aqueous solution), enamel structure & composition: (primary or permanent teeth/ prism-structure or prismless enamel/
fluoridated or demineralized enamel)
Resin-enamel interface: resin can wet surface & penetrate to microporosity; resin is polymerized to form 10-20 μm “resin
tags”
Bonding to enamel - Formation of micromechanical retention by 1st step: Acid etching 2nd step: Apply resin adhesive: unfilled
resin or containing small fillers or low viscosity resin
Bonding/Adhesion to dentin:
Structure of dentin:
- Vital & dynamic tissue
- Dentinal tubules: large near the pulp but small near the enamel
- More organic and water content than enamel [more hydrophilic]
- Low surface energy
Comparison of enamel & dentin composition: Enamel: 86% hydroxyapatite, 12% water, 2% organic compound. Dentin:
45% hydroxyapatite, 25% water, 30% organic compound. Because of its high inorganic content, enamel is more difficult to
etch than dentin.
Structure of dentin: Dentin consists of two differently composed mineralized substrates - intertubular dentin with lesser
amount of mineralization compared to peritubular dentin with higher amount of minerals. Dentinal tubules filled with
odontoblastic processes & dentinal fluid make up main part of dentin. Dentin has intrinsic wetness. Number of tubules
decreases from about 45,000 per mm2 close to the pulp to 20,000 per mm2 at DEJ. The closer to pulp, the more fluid from the
tubules is expected. Complex of dentin structure makes difficulty to establish long-lasting bonds to this substrate. Intratubular:
odontoblastic process, fluid Peritubular: hypermineralized dentin Intertubular: more organic and collagen fibrils.
Enamel Dentin
Homogeneous in composition (almost) 95% Heterogeneous in composition 70% hydroxyapatite
hydroxyapatite.
Homogeneous in structure; prisms uniform despite Heterogeneous in structure; more tubules in the deeper dentin (double)
the depth. dentinal fluid in the deeper 1/3
Solid crystallites and non-dynamic Permeable and dynamic (secondary, tertiary - reactive & reparative,
dentinal sclerosis)
High surface energy; aids better wetting. Lower surface energy, less spreading of adhesives.
Smear layer: Whenever tooth surface is cut with hand or rotary instruments, it causes small particles of cut tooth surface to
tooth producing smear layer. Smear layer - any debris, calcific in nature, produced by reduction or instrumentation of enamel,
or dentin or cementum
Dentinal smear layer - - porous layer of about 1-7 μm composed of hydroxyapatite & altered collagen; its morphology &
thickness depends on type of instrument, the way it is used & on site of dentin; keeps any material from direct contact to solid
dentin; should be removed before bonding process; cutting of dentin during cavity preparation produces microcrystalline
grinding debris that coats dentin & clogs orifices of dentinal tubules; poorly adherent layer of ground dentin produced by
cutting of dentin surface; forms after each instrumentation; lowers dentin permeability by 86%.It has two phases Solid phase -
made up of cutting debris, primarily denaturated collagen & mineral Liquid phase - made up of tortuous fluid filled channels
around cutting debris. Bacteria entrapped in smear layer can survive & multiply beneath restoration
Difficulties in long-lasting bonding to dentin: complex of dentin structure; physiologic alternation (dentin ageing);
pathologic alternation (sclerotic dentin, hypersensitive dentin with its open tubules, caries-affected areas)
Different approaches to handle dentinal smear layer: can be used as substrate (impregnation), it means that the adhesive
makes use of porosities within smear layer; can be modified (partial dissolution) in being partly dissolved; can be totally
removed. Impregnation of smear layer - bonding to smear layer provides only low bond strength values. Partly dissolved smear
layer - it provides some higher bond strength values. Totally removed smear layer - provides higher bond strength values.
Totally removal of smear layer - total etch technique: Depth of decalcification of about 3 to 10 µm depends on type &
concentration of acid & etching time. Interaction of acids with dentin is limited by buffer capacity of hydroxyapatite. Etching
procedure not only dissolves smear layer but also removes superficial part of dentin, opens dentinal tubules to funnel-like
shape & demineralizes dentin surface. After etching dentin & rinsing the acid from cavity, demineralized dentin remains as
collagen network since it lost the support from hydroxyapatite. Space between fibres previously filled with hydroxyapatite now
contain water. Water has to be replaced by monomer. Any drying of dentine would result in a loss of water with collapse of
collagen fibres, hindering resin monomers from penetrating decalcified dentin. Therefore, it is recommended to keep
demineralized dentin wet or moist. It is a challenge for practicioner to keep dentin in correct degree of moisture after
demineralization  wet bonding technique.
Role of water in bonding process: Water acts as plasticizer for collagen & keeps it in soft state. If dentin is excessively dried
it will lead to collapse of collagen network. Critical amount of water is essential for bonding but over wet condition decreases
bond strength & formation of blister like structures at interface.
Dentin wetness - Etch & Rinse: After etching (conditioning) dentin - dentin must be wet to prevent collagen collapse. To
little water causes - collagen collapse giving ineffective resin penetration that leads to nanoleakage.
Smear layer  dentin etching (removal of smear layer & exposure of collagen net)  overdrying  collapse of collagen net
 re-wetting
Overwet phenomena: Too much water - not completely displaced. Phase separation - blister & globule formation
Adhesion-promoting agents - Hydrophilic primer is used, which is able to change surface properties to promote diffusion of
adhesive into collagen network & into opened tubules. Penetration into collagen network results in mixed zone called the
„hybrid layer” or „resin-dentin interdiffusion zone”. Priming process has to produce efficient wetting of exposed collagen
fibrils, which displaces any residual surface moisture, transform hydrophilic into hydrophobic surface condition & sufficiently
carries monomers into interfibrilar channels of demineralized dentin.
Hybrid layer: zone where adhesive resin of dentin bonding agent micromechanically interlocks within intertubular dentin &
surronding collagen fibres. Hybrid layer formation: (1) etching removes smear layer & exposes collagen fibres; it also removes
hydroxyapatite with intertubular dentin (2) primers penetrate collagen network (3) adhesive resin along with primers form
resin microtags within intertubular dentin

Mechanisms of dentin bonding = micromechanical


Bonding to dentin: Differs from bonding to enamel. Dentin has more organic substance than enamel. There is smear layer &
smear plug covering the dentinal tubules. Steps: etching, priming, bonding
Etching & achieve Hybrid layer
1st step: Etch dentin - Demineralization of dentin
2nd step: Dentin primer - Improve Dentin/Resin wettability; Primer: Bifunctional Monomers (Hydropilic - hydrophobic)
3rd step: Adhesive or Bonding - Bis-GMA or Modified resin monomers
Etching dentin: Remove smear layer, Remove inorganic substances from dentin, Create space for penetration of resin
Priming dentin: Using difunctional chemical coupling agent. One part can bond with dentine [hydrophilic end]. The other
attaches to resin [hydrophobic end]
Dentin primer: N-phenylglycine-glycidylmethacrylate [NPG-GMA] is the earliest molecule to use for this purpose. N-
phenylglycine group bonds to calcium ion of tooth. In the past the bond strength when bonding to enamel was stronger than
bonding to dentin, but now is comparable. Newer generation of dentin primer try to bond with collagen in dentin. Collagen
has several reactive groups: hydroxyl and amine groups. Primer can bond with dentine by mean of bonding to collagen which
creates the hybrid layer
Bonding to dentine: Collagen plays an important role in bonding of resin to dentin. After etching process, the dentin surface
should be moist but not wet. Overdried dentin leads to collagen collapse.
Hybrid layer: Layer of resin bonding to collagenous dentin. Other terms: resin interpenetration zone, resin interdiffusion zone,
resin infiltrated zone
Dentin hybrid layer: Critical to bond strength; Thickness is not critical requirement for bond strength as fully impregnated.
Longer etching time does not increase bond strength.
Self-etching adhesive system: Primer (1) + Bonding agent (2)
Composition of bonding system: Etchant, Primer, Bonding
Etchant: Phosphoric acid gel (37%, 35%, 10%); produce most reliable etched pattern, add filler or cellulose thickening  gel;
3% ferric chloride/10% Citric acid; acidic monomer
Primer: hydrophilic monomer in solvent; Solvent: Acetone, Ethanol/water, Water, Solvent-free; solvent help to control film
thickness & wettability of primer
Bonding agent: unfilled resin; High fluidity, flowable to the etched surface; single component: activated by light; 2 fluid
components: initiator and activator
Classification of dentine bonding agents: According to generation; Based on mode of application; Based on number of steps;
Based on etching pattern
Classification of dental adhesive systems by generations: Dental adhesives may be categorized chronologically by
generation, a system of identification used commonly by manufacturers.
First generation: Buonocore [1956] used glycerophosphoric acid dimethacrylate [GPDM] for etching dentin. Bond strength
was only 2-3 MPa, no clinical acceptance. Bond the enamel and dentin via the calcium ions.
Second generation: Using phosphorous esters of methacrylate derivative. Primary bond was to smear layer not to underlying
dentin
Third generation: The concept of etching dentin & removal of dentinal smear layer was developed by Japanese scientist.
1982: The dentin hybrid layer was found by Nakabayashi. 1990: Dentin etching was accepted worldwide.
The first three generations of bonding agents are no longer used, mainly due to failed attempts to bond with a loosely bound
smear layer. Fourth-generation of bonding systems remove the smear layer completely.
Fourth generation – 3 step total etch - Etchant + Primer + Adhesive: Development of multistep dentin adhesive system.
Formation of dentin hybrid layer is important. Term of “Bonding agent” was replaced by “Adhesive system”. Examples:
Permaquick - Ultradent, OptiBOND - Kerr/Sybron, SolidBond - Kulzer, AllBond 2 - Bisco, Scotchbond Multi Purpose – 3M
Dentin hybridization – hybride layer: Dentin decalcification. Collagen fibrils are exposed for resin infiltration. Formation of
resin tags. Monomers cross-linked
Fifth generation – 2 step Etchant + Primer & Adhesive (1 bottle system)- similar to fourth generation, improved material;
Bond strength > 20 MPa ; Reduce steps;; Examples: Permaquick - Ultradent, OptiBOND Solo Kerr/Sybron, Prime&Bond 2.0,
2.1. - Dentsply Caulk, Single Bond –3M, Tenure Quick – Dent-Mate, Syntac Single Component - Vivadent, Syntac Sprint –
Vivadent Adper Single Bond Plus; differs from 4th in relation to solvent & number of layers application; in relation to solvent -
water: Syntac Single Component (46%); Revolution Bond (40%); acetone: Bond One (67%); One Step (40-60%),
Prime&Bond (80%), Tenure Quick (50-55%); Solist (75%); Syntac Sprint (acetone+water 45,8%); ethanol: Single Bond
OptiBond - in relation to number of layers application: 1) two layers cured separately: Prime&Bond 2.0, 2.1, 3.0; Solist;
Syntac Single Component; One Step 2) two layers cured simultaneously: Bond One, Single Bond 3) one layer cured together
with composite resin: Syntac Sprint. Mechanical properties of bonding obtained with use of formation of hybrid layer & resin
tags are greater than polimeralization shrinkage.
Sixth generation – 2 step self-etch adhesive system
SELF-ETCH SYSTEMS - etchant usually is acidic monomer of primer (pH 1-2), no rinsing water; ease to use, combine
etchant to primer, combine primer to bonding; combine etchant, primer, and bonding
Features of sixth generation: Type I: two bottles: 1 – acidic primer; 2 – adhesive agent; water is the solvent; light cured;
unprepared enamel can require to be etch with use of phosphoric acid; Etchant, self etching primer, primer in 1 bottle +
adhesive Type II: 1 connected bottle containing acidic primer & adhesive agent; water is the solvent; light cured; unprepared
enamel can require to be etch with use of phosphoric acid: Etchant + All in one adhesive + Adhesive
Enamel surface etched with use of self-etching primer is less retentive than with etch by phosphoric acid!
Sixth generation
Type I – self-etching primer + adhesive - Examples: Adhese Vivadent, Clearfil Liner Bond 2V i Clearfil SE (& protect);
Bond (Kurray), Contax (Zenith-DMG), Fl-Bond (Shofu), GC Unifil Bond (GC America), Nano-Bond (Petron Clinical
Technologies), One-Step Plus with Tyrian SPE (Bisco), Optibond Solo Plus Self-Etch Adhesive System
FL BOND II Adhesive System (Shofu) - The 2-step, self etching, fluoride releasing adhesive system features provides an
excellent bond to both enamel and dentin with a secure marginal seal. The FL-BOND II PRIMER contains a new adhesion
promoting monomer and is acetone free with no incorporation of HEMA to minimize odor and post operative sensitivity. The
FL-BOND II BONDING AGENT contains the S-PRG filler (Surface Pre-Reacted Glass-ionomer), which helps to reinforce the
bonding interface between the restorative material and the tooth structure.
CLEARFIL SE PROTECT - Light-Cure Dental Adhesive System – 1. Prepare tooth 2. Apply Primer & leave for 20 sec. 3.
Dry with gentle air flow 4. Apply Bond. 5. Air flow gently 6. Light cure for 10 sec.
One Coat Bond Self Etching (Coltene Whaledent) - Primer 1 solubilizes smear layer, it is not totally removed as total etch
bonds do. Bond 2 penetrates through the smear layer into the tubules and creates there the so called resin tags, which are
responsible for the out-standing retention. Additionally, the methacrylate functionalised acid. Indications: Direct filling
technique Adhesive bonding of composite & compomer materials to natural enamel and dentin Dentin sealing Indirect
restorative technique Adhesive bonding of ceramic and composite patterns with indicated cement to natural enamel and dentin
Adhesive bonding of other dental materials Composite material to ceramics Composite material to composite material
Composite material to metals and amalgam
One Coat Bond Self Etching (Coltene Whaledent) Steps: Prepare the cavity. Apply primer 1, rub it for 20 sec. Thoroughly
dry Primer with gentle air stream.
Type II – self-etch adhesive Examples: Adper Prompt L-Pop Self- Etch Adhesive (3M ESPE), Brush&Bond (Parkell), One-
Up Bond F (Tokuyama Dental Corp./J. Morita USA), Tenuire Uni-Bond with Gloss-in-Seal (Den-Mat), Touch&Bond
(Parkell), Xeno III (Dentsply/Caulk)
Adper Prompt L-Pop Self- Etch Adhesive (3M ESPE) Steps: 20 sec – apply adhesive to tooth surface. 5 sec – dry adhesive.
10 sec – light cure
Xeno®III Single Step Self Etching Dental Adhesive (Dentsply/Caulk): Indications: for direct, light-cured composite
restorative materials. However, Xeno III is less effective on unground, unprepared, or uncut enamel. ors, and mixing dish.; It
impregnates the hybrid layer with Nanofiller Technology . It provides excellent sealing of the gingival wall. It is indicated for
use with light-cured direct restorative materials
Seventh generation - self-etch adhesive does not require mixing & does not need rinsing - one bottle contains adhesive light
cured, solvent is water; ‼ unprepared enamel can require to be etch with use of phosphoric acid Examples: iBond (Heraus
Kulzer) G-Bond (GC Corp) Xeno V (Dentsply) OptiBond All-In-One (Kerr) BeautiBond (Shofu)
iBOND (Heraeus Kulzer) Self Etch - the "All-in-One" Adhesive: Steps: Shake vigorously. Dispense. Close immediately.
Dip brush. Apply 1 x to enamel, then dentin. Agitate for 20 sec. Air dry. Glossy surface (if not, apply additional coats). Light
cure for 20 sec.
G-BOND (GC America): Single-component , single-bottle adhesive system. It is the combination of phosphoric acid ester
monomer and 4-methacryloxyethyl trimellitic acid adhesive technology and creates superior etch and adhesion to enamel in
addition to providing chemical and mechanical seal to dentin. Steps: Apply to entire dried cavity. 2. Leave undisturbed for 10
sec. 3. Dry thoroughly under maximum air pressure for 5 sec. Light cure with a visible light curing unit.
Xeno V - One-Component Self-Etching Dental Adhesive (DENTSPLY) Steps: Dispense 2-3 drops of liquid into clean
mixing well. Apply generous amount onto cavity surfaces. Actively scrub for 15 sec. Repeat. Uniformly spread adhesive by
gentle stream of air pressure until there is no more flow. Light cure for at least 10 sec. Place restoration immediately. Features:
Composition based on Prime&Bond® NT ™. One-component self-etching dental adhesive. Xeno® V is a one component self-
etching dental adhesive designed to bond resin-based, light-curing direct restorative materials to enamel and dentine. It is
applied in one coat and one step without mixing. It etches and bonds enamel and dentine simultaneously and exhibits high
bond strengths on enamel and dentine. New monomers used in Xeno® V give improved safety due to high tolerance towards
storage conditions: now refrigeration is not needed anymore
OptiBond All-In-One (Kerr) Features: Direct and Indirect Applications: Excellent adhesion to enamel, dentin, and all
porcelain and ceramic materials. Ternary Solvent System: The only bonding system that currently uses three solvents (water,
acetone, and ethanol) for effective enamel etching, a uniform adhesive layer, and material stability shelf life. Unique Nano-
Etching: Delivers the most effective etching of any single-component adhesive, creating a deeper etched surface for higher
mechanical retention and chemical bonding. Fluoride Releasing & Filled Adhesive Technology: Incorporates a fluoride-
releasing filler along with nanofiller, ensuring protection against microleakage.
BeautiBond: Bond strengths comparable to leading multi-component brand. Single coat for shorter working time. Efficient 30
second application. 5µm film thickness. HEMA-free. Convenient unit dose, no mixing. Dual Adhesive Monomers -
phosphonic acid monomer enhances enamel bonding and its carboxylic acid monomer facilitates bonding to dentin. Bond
Strength - similar to sixth-generation adhesives. Thin - 5 μm Bonding Layer for better adaptation of aesthetic restorative
materials
Comparison of interface dentin and adhesive resin: Clearfil SE Bond - homogenous hybrid layer with long and diffuse tags
Excite Bond - resin tags are shorter and irregular in comparison to Clearfil SE bond, but they are evenly distributed Prime &
Bond’s - small hybrid layer and resin tags are not homogenous  Prompt L-Pop’s - hybrid layer is not hogennous and the lenght
of resin tags is variable Xeno III’s - hybrid layer and resin adhesive tags
Dentine bonding strength of different generation adhesive systems - 1 – 2MPA 2 -5MPA 3-12MPA 4-25MPA 5-25MPA
6-20MPA 7- 25 MPA
Number of components and clinical steps in application of different generation adhesive systems:
generation steps description components
1 2 Etching adhesive system 2
2 2 Etching adhesive system 2
3 3 Etching primer 2-3
4 3 Total etching, primer 3-5
5 2 Total etching, adhesive system 2
6 1 Self-etch adhesive system 2
7 1 Self-etch adhesive system 1
2012 - new dental universal adhesives are commercialized: The universal adhesives bond to all dental substrates, which
include enamel, dentine, metal, porcelain, ceramic and zirconia, with a single application. The term “universal” adhesive is not
new. In fact, many early bonding agents were named or described as “universal” adhesives, such as XP Bond-Universal Total-
etch Adhesive (Dentsply), One-Step-Universal Dental Adhesive (Bisco). However, there is still not a definition of dental
“universal adhesive”. It is highly confusing what the term “universal” means. In 2012, the term “universal adhesive” has
several definitions which may include: a) Can be used in total-etch, self-etch, and selective etch techniques; b) Can be used
with light-cure, self-cure, and dual-cure materials (without the separate activators); c) Can be used for both direct and indirect
substrates; d) Can bond to all dental substrates, such as dentin, enamel, metal, ceramic, porcelain, and zirconia.
Dental universal adhesives
2012 - 1 - a new ScotchBond Universal (3M ESPE, 2011) was released. However, ScotchBond Universal requires a separate
self-cure activator or a special amine-free dual-cure cement when use with dual-cure or self-cure materials. It is still not a truly
“universal” adhesive. 2. a new All-Bond Universal, (Bisco 2012) was released , which can be use in total-etch, self-etch and
selective etch techniques, can be used with any dual-cure, self-cure and light-cure materials without the need of a separate
activator, can be used for both direct and indirect substrates, and can bond with any dental substrates. All-Bond Universal is
the first truly “universal adhesive”.
2013 - Every Bond (Centrix), 5th-generation (2-step) Universal Dental Adhesive designed to bond composite to dentine,
enamel, cast metals, treated porcelain and set amalgam. Prime&Bond Elect (DENTSPLY Caulk) Universal Dental
Adhesive Single Bond Universal (3M ESPE), Total Etch and Self Etch Dental Adhesive
8th generation -dual-cured self-etch adhesive for direct and indirect restorations with self-, light- and dual-cured resin
materials
Scotchbond™ Universal Adhesive: One adhesive for Self-Etch and Total-Etch. One application procedure. Effective on All
Surfaces Scotchbond Universal adhesive bonds to all surfaces, including enamel, dentin, glass ceramic, zirconia, noble and
non-precious alloys, and composites – without additional primer. In combination with Scotchbond™ Universal DCA Dual
Cure Activator, Scotchbond Universal adhesive is compatible with all resin cements, core build-up materials and even self cure
composites.
ALL-BOND UNIVERSAL - Light-Cured Dental Adhesive Indications: 1. ALL Direct Restorations (e.g. resin-based
composite, resin-modified glass ionomers, core build-ups, etc.) 2. ALL Indirect Restorations (metal, glass ceramics,
zirconia/alumina, etc.) 3. Desensitization/Sealing of Tooth 4. Intraoral Repair (e.g. chipped porcelain, additions to direct
restorations, etc.) 5. Protective Varnish for Glass Ionomer Based Fillings Properties: I has mild acidity monomers pH>3 It
forms a thick hybrid layers with deep resin tags. It is compatible with all lightcured, self-cured, and dual-cured resins, making
it ideal for all direct and indirect restorations. It also can be used for desensitization, for intraoral repairs, or as a protective
varnish for glass-ionomer-based fillings. Direct placement: Self-etching technique: Prepare cavity. Wash thoroughly with
water spray, remove excess water (do not dessicate). Applu All-Bond Universal according to instructions. Evaporate excess
solvent by air drying thoroughly, then light cure. The surface should have uniform glossy appereance. Continue with
placement of restorative material Indirect placement: Maxillary right posterior teeth prepared for full contoured zirconia
restorations. Two coats of All-Bond universal applied & light cured. Application of All bond Universal (Or z-prime plus) to
inside surface of crowns. Restoration completed after cementation with Duo-Link.
EveryBond - For light-cured, self-cured and dual-cured composite materials. Minimal and uniform film thickness. Works with
phosphoric acid technique. Bond strength to enamel - 25.2 MPa Bond strength to dentine - 21.5 MPa
Prime&Bond Elect: Prime&Bond Elect™ Adhesive - Direct, light cured composite and compomer restorative. Indirect
restorations; light cured, resin cemented veneers. Composite, ceramic and amalgam repairs. Cavity varnish for use with fresh
amalgam Prime&Bond Elect™ Adhesive with Self Cure Activator (dual cure or self cure) - Direct, dual cure or self cure
composite restorations and core build-ups Indirect restorations; dual cured and self cured resin cemented inlays, onlays, crown
and bridge retainers. Dual cured and self cured resin cemented endodontic post cementation Prime&Bond Elect™ Adhesive
with Self Cure Activator and Amalgam Bonding Base & Catalyst (dual cure or self cure): Adhesive bonding of direct
amalgam restoration
Single Bond Universal: Total-Etch, Self-Etch, Selective-Etch for both direct and indirect restoration. It bonds to all surfaces
including enamel, dentine, glass ceramic, zirconia, noble and non-precious alloys, and composites – without additional primer.
8th generation adhesive system reinforced with nano-particles
Futura Bond DC – dual cured, works with all light, self or dual cured resins, works in self-cured mode without any light,
great for endo, takes only 35 sec from start to finish, needs only 1 coat, bonding strength to enamel -31,4 MPa; to dentin –
30,6 MPa Steps: Futurabond DC placement Glossy surface after placement of Futurabond DC. Final Post Op After Placement
of Resin Composite
Surpass Self Etch Adhesive System: The conditioner etches enamel as well as phosphoric acid while eliminating post
operative sensitivity The primer completely wets and penetrates the tooth structure to maximize bond strengths and completely
seal the surface The bonding resin links the primed surface to all self cure, dual cure or light cure restorative materials Shear
bond in direct restoration To enamel= 62.7 MPa To dentine =50.1 MPa Indications: Direct Restorations: to seal enamel /
dentin prior to restoring with light-cure or self-cure composite material. Indirect Restorations: bonding light-cured, self-cured
or dual-cured composite cements or glass ionomer or resin-modified glass ionomer cements. Bonding CEREC® restorations.
Desensitization: to treat hypersensitive and / or exposed root surfaces. Desensitizing crown preparations. Sealing preparations
before placing amalgams. Bonding crowns and bridges. Bonding in posts and cores. Bonding veneers
Enamel- dentin bonding systems: Etch & Rinse systems: 4th generation – Acid+ Primer+ Adhesive 5th generation - Acid +
(Primer+Adhesive); 4&5 – blue etch in separate syringe. Self Etch systems: 6th generation – (Acid+Primer) + Adhesive 7th
generation – (Acid+Primer+Adhesive) 6th&7th generation – etchant is in the bottle
Classification according to number of components
Evolution of Components Used for Dentine Bonding System
Shifting to a reduced number of components: E + nP + B  E + nPB or nEP +B (self etching primer)  EPS (Self-Etching
BS) [E – Etchant; P – Primer; B – Bonding agent]
Examples of current dentin bonding system designs:
3-COMPONENT SYSTEMS (E + nP + B): Scotchbond Multipurpose Plus (3M) Permaquick (Ultradent) Bond-It (Jeneric /
Pentron) All-Bond 2 (BISCO) Tenure A/B/S (Denmat) ProBond (Dentsply)
Examples of current dentine bonding system designs:
2-COMPONENT SYSTEMS (E + nPB): Syntac Single Component (Ivoclar) Ecusit Primer/Mono (DMG Hamburg) One
Coat Bond (Coltene / Whaledent) Bond-1 (Jeneric / Pentron) Tenure Quik with Fluoride (Denmat) Solid Bond (Hereaus-
Kulzer) Imperva Bond (Shofu) EG Bond (Sun Chemical) PQ1 (Ultradent) Easy Bond (Parkell) Paama 2 and Stae (SDI)
Prime&Bond NT (Dentsply) Single-Bond (3M) Optibond Solo and Solo Plus (Kerr) One-Step (BISCO) Excite
(Ivoclar/Vivadent) OSB Bonding System (ESPE) IntegraBond (Premier)
2-COMPONENT SYSTEMS (nEP + B): Clearfil SE Bond & LinerBond 2v (Kuraray) Tyrian SPE (Bisco) Optibond Solo SE
Plus (Kerr) Fluoro Bond (Shofu) UniFil Bond (GC) Mac Bond II (Tokuyama) NanoBond (Pentron)
1-COMPONENT SYSTEMS (nEPB): AQBond (Sun Medical) or Touch-and-Bond (Parkell) Adper Prompt or LP3 (3M-
ESPE) Solist (One-bottle-bond) (DMG Hamburg) iBond (Hereaus-Kulzer) Xeno V (Dentsply)
Classic bonding technique: The classic bonding technique involves a three-step procedure: etching, priming & bonding =
using etchant (that is, a conditioner or cleaner), primer (an adhesion promoter, adhesion enhancer, bi-functional monomer), and
adhesive (bonding agent, bonding resin, sealing resin), respectively.
Available adhesive systems In addition to the classic three-step etch-and-rinse adhesive systems, simpler systems with one- or
two-step protocols also are available. However, despite their apparent simplicity, these newer systems may not be successful
at bonding to such distinct surfaces as enamel, dentin, adhesive, composite, and ceramic, all of which differ markedly in their
chemical composition. Simplified adhesive protocols do not always guarantee clinical bonding success; in fact, successful
adhesive restorations require meticulous technical considerations and an understanding of the principles involved in each
clinical procedure.
Classification of dental adhesive systems:
Classification by mechanism of adhesion and number of clinical steps: Dental adhesives may be classified into three types,
based on their interaction with the tooth surface: etch-and-rinse (total-etch), self-etch, and glass ionomer.
These systems may be subcategorized based on the number of clinical steps: two- and three-step etch-and-rinse systems
and one- and two-step self-etch systems.
Classification of dental adhesive systems: The etch-and-rinse system is distinct in that it has a separate etch-and-rinse step
prior to the priming and bonding steps. The three-step etch-and-rinse system (using fourth-generation adhesives) follows the
conventional “etch-rinse-prime-bond” approach. The two-step etch-and-rinse system (using fifth-generation adhesives, also
known as one-bottle adhesives) combines the primer and the bonding agent into one application. The self-etch adhesive
system eliminates the rinsing phase after etching by using non-rinse acidic monomers to etch and prime dentine
simultaneously. The two-step self-etch system (involving sixth-generation adhesives) uses acidic monomers as self-etch
primers in the initial step and an adhesive resin in the second step. The one-step self-etch system (using seventh generation
adhesives, also known as all-in-one adhesives) combines the (self-etch) acidic primer with the adhesive resin in one application
step. This allows for simultaneous infiltration of adhesive resin to the depth of demineralization, which may reduce
postoperative sensitivity. This system has no rinsing step.
Properties of enamel & dentin bonding:
Bond strength - Bond to enamel & dentin 15-35 MPa. Deep dentin tend to be lower bond strength than
superficial dentin.
Biological properties: Solvent, monomers are typically skin irritant. Properly polymerized material is very little risk of
side effect
Critical steps in adhesion:
Enamel etching: Etching times vary depending on type & quality of enamel Frosty appearance Deciduous, Prismless enamel
need longer etching time
Dentin conditioning: Too dry dentin  collagen collapsed, primer can’t penetrat; Too moist  dilute primer, interfere resin
penetration
Clinical application: For composite filling Use with resin cement Cementation for cast, resin, and ceramic restoration For
amalgam filling Pit & fissure sealant Desensitization: Seal dentine
Glass Ionomer Adhesion: Glass-ionomers cements bonds chemically to the tooth structure. Bonding is due to reaction
occuring between carboxyl group of polyacid and calcium hydroxyapatite Bonding with enamel is higher than that of dentin
due to greater inorganic content. Polyacrylic acid conditioner acts as a self-etching primer, because it demineralizes and
probably penetrates the surface promoting a surface receptive fo the cement. It may also improve the wetting ability and
surface integrity of the cement. Resin modified glass-ionomers: Weak conditioner pretreatment - polyacrylic acid removes
smear layer and exposes collagen Mechanical bonding – hybride layer Chemical bonding - carboxyl groups with calcium in
tooth Two steps weak conditioner Mix and apply glass ionomer adhesive Fluoride release
Classification according to steps: 3 steps 2 steps 1 step
three-step systems: “etch-and-rinse.” - when phosphoric acid is used to condition enamel and dentin and then rinsed, in
three separate steps, etching and a primer and adhesive from separate bottles are performed - Examples of adhesive systems
like this are Scotchbond Multipurpose (3M ESPE), OptiBond FL (Kerr), and All-Bond (BISCO).
two steps: Etch-and-rinse - systems that combine the primer and adhesive into one bottle still have the acid conditioning and
rinsing, and the application of the adhesive resin. Examples of bonding agents in this category include Prime & Bond NT and
XP Bond (DENTSPLY), Single Bond (3M ESPE), OptiBond Solo
one step: “self-etching” -As the adhesive system contains acid monomers that simultaneously demineralize and infiltrate the
dentin and enamel. The advantage of these materials is the elimination of the rinsing and drying step inherent when using
phosphoric acid in etch-and-rinse systems. However, some of these systems use separate primer and adhesive, such as Clearfil
SE Bond (J. Morita) and AdheSE (Ivoclar Vivadent), and some are one-component systems such as Prompt L-Pop (3M ESPE)
and Xeno III (DENTSPLY), in which two liquids are mixed and applied to the tooth. Most recently, single-component no-mix
systems have been introduced, such as Xeno IV (DENTSPLY), iBond (Heraeus Kulzer), G-Bond (GC America), and
OptiBond All-in-One (Kerr).
Six principles of adhesion 1) Know your bonding system 2) Follow the product instructions carefully 3) Create clinical
environmental control 4) Don`t mix components from one system to another 5) Don`t mix adhesives from one manufacturer
with dual-cured resins from another 6) Follow sound principles of cavity design
1) Know your bonding system The fundamental mechanism for all modern adhesive systems is the same. Using acid or acid-
resin monomers, mineral is removed from both enamel and dentin. In the spaces created by the demineralization process, resin
monomers are introduced and polymerized. In both enamel and dentin, the region of the tooth where dentin is partially
demineralized and resin monomers have been infiltrated around the exposed collagen is called the hybrid layer. The successful
creation of this interface, especially in dentin, is critical for a long-lasting restoration without postoperative sensitivity.
However, the large number of products and their specific differences can make the adhesive landscape confusing for
practitioners. For marketing simplicity, companies have used the term “generations” to describe new adhesive systems as they
are developed and commercialized. The implication is that the higher the generation number, the more advanced - and
supposedly better performing - the adhesive system will be. This, however, is not always the case. A better and more useful
classification system uses the specific clinical technique to categorize the bonding system so practitioners can understand the
system they use based on the materials and steps required to get the adhesive system to work as it was intended.
2) Follow the product instructions carefully: Even though the fundamental mechanism for bonding is generally the same
regardless of the classification of the adhesive, careful attention to the specific details of the product instructions is critical
for clinical success. The critical steps needed for each system are different depending on the category of the adhesive, the
number of application steps, the solvent systems, and the specific chemistry of the material to be used. Etching time is critical
with total-etch systems. When enamel and dentin are conditioned, enamel requires enough demineralization for micro-
mechanical retention, and dentin should not be conditioned too long (mostly the etch time is 15 seconds). In addition, most
etch-and-rinse adhesives contain solvents that must be volatilized off the tooth surface before the adhesive can be cured
properly. Self-etching systems do not require rinsing, but they may have critical steps to follow. Generally, enamel bond
strength values are lower compared to etch-and-rinse systems. These systems bond better to freshly cut enamel, and bonding
to uncut enamel is contraindicated for many of these materials. Some of these materials are more effective if they are applied
to the surface with agitation or scrubbing. Also it is critical that self-etching systems be dried after the application step to
remove the solvent and any remaining water in the adhesive film.
3) Create clinical environmental control: Creating the optimal environment for adhesive dentistry is absolutely
essential for success regardless of the clinical procedure. Managing the tooth surface is even more important in bonding
than in making impressions for crown and bridge restorations. Modern agents can create bonds that lead to long-lasting
restorations only to surfaces free of debris, saliva, and blood. While rubber dams are frequently used for assuring the proper
isolation of a tooth to be restored, they cannot be used in some situations. The clinician should think in terms of
“environmental control” before bonding, and use strategies to maintain the tooth surface so that contamination does
not occur. This is especially important in the gingival box area of Class II restorations where inadequate bonding can lead to
early restoration failure.
4) Don`t mix components from one system to another Mixing the primer of one system with the adhesive of another, or
using a phosphoric acid conditioning step with rinsing followed by a self-etching system, are contraindicated. This could lead
to failure of the adhesive to work properly, as well as early restoration failure or even loss of the tooth.
5) Don`t mix adhesives from one manufacturer with dual-cured resins from another: There is general compatibility
with all light-cured dental bonding agents and light-cured restorative materials regardless of the brand. However, when
using a self-cured or dual-cured material, it is essential that the adhesive system designed for that material is used to avoid
serious product failures. Self- and dual-cured resin cements, liners, and core materials contain acid-base chemistries that are
sensitive to the chemistry of the adhesive systems. Acid adhesives can actually prevent the chemical-curing chemistry from
allowing the cement or core material to polymerize. Some adhesive systems mix a so-called dual activator with the bonding
agent to assure compatibility with the adhesive system. Some cements have specially designed self-etching adhesives that can
only be reliably used with that cement system. The only sure way to prevent interference from the adhesive system when
using a resin cement is to carefully follow the manufacturer’s instructions.

6) Follow sound principles of cavity design: For direct composite restorations, regardless of cavity class, sharp vertical
walls and line angles are not needed, and rounded internal line angles are actually preferred because it is easier to adapt
resin restoratives without voids to rounded surfaces. Cavity design should be dictated by access to achieve complete
removal of carious hard tissue and access to place the adhesive system and assure proper adaptation of the restorative
material to the cavity wall. While minimally invasive cavity preparations can be used, care must be taken to gain enough
visibility to determine if caries is completely removed. It is also important that all unsupported enamel be removed to prevent
marginal fractures from the polymerization shrinkage inherent in the composite-curing process. Proper preparation of enamel
margins, especially with self-etching adhesive systems, will maximize bond strength and improve marginal integrity.

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