Principles of bonding and

adhesives in dentistry

Dental materials

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In this lecture:
◼ Advantages of adhesives and their applications in dentistry
◼ Types of bonding
◼ Etching and bonding to enamel
◼ Bonding to dentine
❑ Micromechanical or Chemical bonding

❑ Etching, conditioning, priming and bonding

◼ The hybrid layer and smear layer concepts

◼ Classification of bonding systems
◼ Bonding of amalgam, ceramics, & alloys
◼ Measurement of bond strength

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Introduction
◼ The development and regular use of adhesive
materials has begun to revolutionize many
aspects of restorative and preventive dentistry

◼ it is no longer necessary to produce large

undercuts in order to retain the filling. These
techniques are, therefore, responsible for the
conservation of large quantities of sound tooth
substance

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Procedures relying on adhesive
procedures

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Advantages of adhesives

◼ Retention of restoration
◼ No need to use undercut or mechanical lock
◼ Conservation of tooth structure
◼ Reduction in microleakage
◼ Lower post operative sensitivity, ↓stain
◼ Reduction in recurrent caries
◼ Reinforcement of tooth structure
◼ Repair of restorations
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Types of bonding

1. Bonding through micromechanical Attachment

(acid etching on enamel and dentine)

2. Chemical adhesion to either enamel or dentine

(GIC)

3. Bonding through Hybrid layer formation

(between dentine and adhesive resins).

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ENAMEL ETCHING AND
BONDING

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Acid etching of enamel

◼ Enamel surface is usually smooth

◼ Etching done using phosphoric acid (35-37%)
gel of liquid (which one is better?)
◼ Etching pattern:
❑ Core of enamel prisms
❑ Periphery of enamel prism
❑ Combination

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Etched enamel

SEM of etched enamel with 37% phosphoric acid after rinsing

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Factors Influencing Type of Etched
Surface
❑ Etching time: 10-60 seconds (if too long re-
precipitation occurs)
❑ Washing stage
❑ Drying stage (hydrophobic adhesive and
hydrophilic primers effect)

◼ Etching produces a rough surface (pits) into

which adhesive resin and composite flows and
forms resin tags = micromechanical retention
(25 microns long)

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Procedure

◼ Acid etch is applied

using a brush

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Enamel prisms

Taken from the web

Etched enamel prisms
Taken from the web
Applications of acid etch technique

◼ Fissure sealants:
❑ Bis-GMA or UDMA
❑ Two component system (chemically cured)
(dimethacrylate monomer alone or with triethylene
glycol dimethacrylate)
❑ One component system (light cured
❑ Not filled or lightly filled
❑ Titanium oxide for easy detection
❑ Retention is monitored to assess success

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Examples • Susceptible to wear
• If partially lost may still provide protection
due to resin impregnated enamel surface
present

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Applications cont,

◼ Resin luting cements

❑ Resin bonded bridges
(conservative) e.g
Maryland bridge

◼ Orthodontic appliances:
2 component or single
component composite
maybe used

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Continued,

◼ Veneers (porcelain veneers used to mask

discolored and stained anterior teeth or
reshape malformed teeth). Their fitting
surface is etced

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DENTINE ETCHING AND
BONDING

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Shear bond strength of various bonding systems to etched
enamel, conditioned or unconditioned dentine

Bonding system (Shear bond strength (Mpa)

Acid etched enamel+ resin 16-20

Unconditioned dentine+ adhesive 3-5

Conditioned dentine with total 15-25

etch bonding

Conditioned dentine with 15-25

self-etching primer system

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Shear bond strength

Bonded
surface

Bonded
surface
sample Bonded
sample

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Measurements of bond strength
◼ Tests used:
❑ Shear bond strength Macro and micro
❑ Tensile bond strength
❑ Mode of failure assessment (adhesive, cohesive,
mixed)
◼ Data were variable
◼ What is an acceptable bond strength value to
prevent debonding? The stress caused by
shrinkage during setting is a function of cavity
shape and size as well as the nature of the
material
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 Enamel vs. dentin 22

Enamel Dentin
Homogeneous in composition Heterogeneous in composition
(almost) 95wt% hydroxyapatite. 70wt% hydroxyapatite

Homogeneous in structure; prisms Heterogeneous in structure; more

uniform despite the depth. tubules in the deeper dentin/m²
(double). dentinal fluid in the deeper
1/3

Solid crystallites and non-dynamic Permeable and dynamic (secondary,

tertiary (reparative), dentinal
sclerosis)

High surface energy; aids better Lower surface energy, less spreading
wetting. of adhesives.
Challenges to dentine bonding

◼ Hydrophilic nature of
dentine
◼ Presence of smear layer
(3-15microns thick)
◼ Acids used to remove the
smear layer:
❑ Phosphoric acid

❑ Maleic acid

❑ 17% EDTA
Smear layer removal or
modification?

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Dentin near the
DEJ (outer) and
near the pulp
(inner) are
compared to show
relative differences
in intertubular and
peritubular dentin
and in lumen
spacing and volume
Dentine etching
◼ 1979 etching was done for dentine as well as
enamel using 37% phosphoric acid. Research
proved enhanced bonding (total etch technique)
◼ Over etching will remove more mineral than needed
and open up tubules, and expose more collagen,
◼ Over etching dentine leads to weaker bond and
sensitivity
◼ Over drying should be avoided to prevent collapse
of collagen

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 Bonding to dentine
◼ How dentine is different from enamel:
❑ 50% HA, 30% polypeptides (collagen)
❑ Dentinal tubules containing dentinal fluid
◼ Adhesion promoters are needed to bridge the
gap between tooth surface and resin based
materials that provide difunctional molecules
(some what like a coupling agent)
M _____________R______________X

Methacrylate gp Linking molecule Reactive gp

Chemically activated or light cured

Priming and bonding

◼ Priming : Designed to change the chemical

nature of the dentine surface and to
overcome the normal repulsion between the
hydrophilic dentine and the hydrophobic
resin. (similar concept to M-R-X model)
HEMA (r-x group is C2H4OH)

◼ Bonding agent: fluid resin (light cured).

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Bonding

Bonding agent
Curing

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GENERATIONS OF ADHESIVE
SYSTEMS

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Classification
of
contemporary
adhesives
according to
adhesion
strategy and
clinical
application
steps

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 Leave it or remove it (SL)? 34

Removal of the smear layer Use bonding agent that

penetrates the SL
Etch and rinse approach Self-etch approach

successful successful

Expose high surface energy that Leaves the surface with lower energy
improves wetting and spreading of but the bonding agent can penetrate
adhesive and incorporate into the bonding layer

Removes the smear plug and Reduces pulp sensitivity by leaving the
exposes tubules exposing water tubules plugged
and affecting wettability !!

35%-37% phosphoric acid is used. Both weak and strong acids are used
The stronger the acid, more
complete removal.
Generations of bonding agents
◼ Fourth generation: procedure,

❑ Total etch technique for enamel and dentine, dentine

conditioned for 15 seconds. Rinsing with water
follows, then gentle drying without desiccation

❑ Dry to ensure enamel is etched

❑ Slightly moisten dentine
❑ Absorb excess water with cotton

❑ Apply hydrophilic primer (contains resin that

polymerizes within collagen and a solvent that
evaporates to ensure drying of tooth surface).
❑ Apply adhesive (bonding resin) then cure
❑ Composite applied and cured

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Generations of bonding agents

◼ Fifth generation
bonding agents:
❑ Etching is achieved
using phosphoric acid.
❑ Priming and bonding is
combined in one step.

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Continue,

◼ Sixth generation: ❑ Self etching primers

applied then dried
❑ Self-etching primers ❑ Followed by bonding
◼ Acidic groups are agent application
added to etch tooth
surface
◼ No need for rinsing

Adper SE scotchbond adhesive

(self etch primer and adhesive)

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Continue,
◼ Seventh generation, no mix
self etching adhesive:
❑ One bottle
❑ No etching, no rinsing
Kerr
❑ Light cured
◼ Possible disadvantages:
❑ Weak acid
❑ Inappropriate or shallow
etching
❑ Narrow hybrid layer

DENTSPLY
Current concepts on bonding (the hybrid layer),

◼ Studies showed how

resin tags from
bonding agents in
dentine infiltrated a
surface layer of
collagen in
demineralized
dentine to form the
HYBRID LAYER (2–
10 μm thick)

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 Etch-and-rinse-adhesives
Type 3 step Etch and Two step Etch and
rinse rinse
Advantages Separate bottles, effective, Simpler to apply,
most consistent long term consistent and stable
results.

Disadvantages Risk of over etching, time Not substantially faster,

consuming, the need for risk of bonding layer too
rinsing, sensitivity to rinsing thin, risk of over etching,
(wet-dry) sensitive to dentin
wetness

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 Self-etch adhesives
Type 2-step self etch 1-step self etch

Advantages No etching, rinsing, or drying, Most time efficient, less

saves time, less sensitive to sensitive to dentin
dentin wetness, consistent and wetness
controlled, desensitizes dentin

Disadvantages More elaborate application, More technique

incompatible with autocured sensitive, Sensitive to
resin, sensitive to water, water, short shelf life,
impaired durability. impaired durability.

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Etch and rinse adhesives
 Phosphoric acid is used to etch enamel and dentin.
 Removes the smear layer
 Decalcifies the most superficial 1–5 μm of dentin to
remove hydroxyapatite and leaves collagen fibrils wet
after rinsing off the etchant.
 The bond is micromechanical through resin tags in
the formed hybrid layer with dentine (moist vs dry?
in-vitro vs. clinical evidence*) and resin infiltrated
micro-pores on enamel.

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Self etch adhesives (simplified)
 Includes one step and 2-step modes with
different acidic groups in terms of pH.
Stronger acidic groups in one step
adhesives may not be compatible with dual
cure or chemically cured composites since
their acidity may deactivate the tertiary
amine action.

 The resulting bonding interface is semi-

permeable and susceptible to degradation.

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New trends in adhesives

UNIVERSAL ADHESIVES

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Universal adhesives

◼ Universal adhesives are one-step SE adhesives that are

also recommended by the respective manufacturers as
two-step E&R adhesives when phosphoric acid is used
to etch enamel and dentin. Clinicians may also use these
adhesives with the selective enamel etching technique,
in which only enamel is etched with phosphoric acid.
◼ The depth of penetration depends on acidity of the acidic
groups.
◼ They are recommended for a multitude of clinical
applications, including direct restorations, indirect
restorations, core buildups, zirconia primer, and dentin
desensitizer
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Universal adhesives (used as 1-step SE, 2-step
E&R, selective etching)

 The major difference between universal adhesives and

traditional one-step SE adhesives is the presence of
functional phosphate and/or carboxylate monomers in
universal adhesives Some of these functional
monomers are able to trigger chemical bonding to
calcium in hydroxyapatite.

 Some of these functional monomers are able to trigger

chemical bonding to calcium in hydroxyapatite.
(JDR 2001) & Yoshihara et al. (DM 2013))
Ref. (Yoshida etal.

 The functional monomer (MDP) molecule includes a

methacrylate polymerizable end, a long hydrophobic
10-carbon chain, and a short hydrophilic phosphate
component that is able to ionize and interact with
hydroxyapatite

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APPLICATIONS OF ETCHING
AND BONDING CONCEPTS

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Bonding to alloys, amalgam and ceramics
(handout only)
◼ The concept of surface treatment and
bonding is applicable to bonding with alloys
when using resin luting cements.
◼ It involves in many cases roughening of the
alloy surface by abrasion or electrolytic
etching.
◼ Can be done for base metals and precious
metal alloys and aided by oxide layer
formation, but precious metals require Tin
plating to form the desired oxide layer
continue
◼ Technique for preparing metal
surface for composite resin lutes
is to etch the metal surface
producing a micro porous
surface (the Maryland
technique).
Ceramic bonding

◼ Porcelain bonding (resin cements) and repair

involves:
❑ Sandblasting
❑ Special etchant (hydrofluoric acid)
❑ Silane applied for 30 seconds then dried to
evaporate solvent (leaving a layer of vinyl that
bonds resin to adhesive)
❑ Bonding agent applied
❑ Composite applied

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Bonding in orthodontics

◼ Specific requirements of the adhesive:

❑ The adhesive must possess ideal rheological
properties (controlled by filler content and
amount) which allow the positioning
❑ Should be easy to remove with no remnants
once treatment is done
❑ Retention to enamel is by acid etching and to
the metal bracket mechanical
❑ Light and chemical cured available
Microleakage

◼ Occurs when the restoration does not

completely seal the surrounding margins of
the cavity preparation

◼ Possible outcomes of microleakage?

◼ What contributes to microleakage?
❑ Shrinkage
❑ CTE
❑ Contamination
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Resin based luting agents

◼ Chemically cured or light cured resin cements

can be used depending on the restoration
material
◼ When bonded to tooth structure, chemical
cured resin cements requires etching and
bonding using 5th generation, and not self
etch adhesive systems, why?
◼ Bonding to other core material such as
amalgam is a challenge
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Conclusion
◼ On one hand:
❑ The development of these adhesive resins has
allowed a new era of restorative dentistry where
mechanical retention is not necessarily a pre-
requisite for long-term success
❑ Allowed for conservation of tooth structure
◼ On the other hand:
❑ There must be surfaces to be bonded
❑ Isolation is essential
❑ Shrinkage is an issue

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Remember! Skill

Good dentist
Knowledge Ethics
Thank you
References:
Applied dental materials
Lecture notes

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