Modern Restorative Materials

Part III. Adhesive Systems

Maria K. Makeeva
PhD,
Senior Teacher of
Operative Dentistry Department,
Russian University of People Friendship
Adhesive Systems. Terminology
Adhesio from Latin sticking

Adhesive system (bonding system) is a fluid to provide

adhesion of composite to tooth hard tissues. Consists
from different substances and could be in one bottle or
more.

Primer (dentin adhesive) - a substance for providing

adhesion to dentin.

Bond (enamel adhesive, or just adhesive) a substance

for providing adhesion to enamel.
Adhesive Systems. Beginning

Idea of adhesive technology dates

back to the 60s of the XX century.
Dentist Dr. Michel Buonocore
from US thought that etching of
enamel before applying resin
fissure sealant can increase Dr. Michel Buonocore
strength of connection.
 Adhesive Systems. Beginning

Dr. Michel Buonocore working with his laboratory technician Richard Glena (1967).
Source: Eastman Institute of Oral Health, Rochester, N.Y.
Adhesive Systems. Beginning
Mechanisms of Adhesion
Mechanisms of adhesion
are different for:
enamel
dentine
Adhesion to Enamel
Enamel Structure:
- Enamel rods (prisms) are
built from hydroxyapatite
crystals
- Interprismatic spaces
Adhesion to Enamel

SEM: Enamel rods SEM: Enamel rods

on cross section on longitudinal
section
Adhesion to Enamel. Buonocore Experiment

1. Etch enamel slice.

2. Apply fissure sealant.
3. Dissolve by strong acid
enamel slice.
4. Look at undersurface
of sealant.
Enamel slice
Adhesion to Enamel. Buonocore Experiment

1. Etch enamel slice.

2. Apply fissure sealant. Acid
3. Dissolve by strong acid
enamel slice.
4. Look at undersurface
of sealant.
Enamel slice
Adhesion to Enamel. Buonocore Experiment

1. Etch enamel slice.

2. Apply fissure sealant. Acid
Sealant
3. Dissolve by strong acid
enamel slice.
4. Look at undersurface
of sealant.
Enamel slice
 Adhesion to Enamel. Buonocore Experiment

1. Etch enamel slice.

2. Apply fissure sealant. Acid
Sealant
3. Dissolve by strong acid
enamel slice.
4. Look at undersurface
of sealant.
Enamel slice
..Undersurface of sealant
was microrough and
looked like many processes
different sizes..
 Adhesion to Enamel. Buonocore Experiment

1. Etch enamel slice.

2. Apply fissure sealant. Acid
Sealant
3. Dissolve by strong acid
enamel slice.
4. Look at undersurface
of sealant.
Enamel slice
..Undersurface of sealant
was microrough and
looked like many processes
different sizes..
 Adhesion to Enamel. Buonocore Experiment
Connection between enamel surface and resin
is NOT chemical BUT micromechanical by resin tags...

Dr. Michel Buonocore

 Adhesion to Enamel. Buonocore Experiment
Connection between enamel surface and resin
is NOT chemical BUT micromechanical by resin tags...

Concept of resin tags

became
the beginning of
Era of Adhesive Technology!

Dr. Michel Buonocore

Adhesion to Enamel. Scheme
 Adhesion to Enamel
Etching with 3537%
orthophosphoric acid results
in partial dissolving of
hydroxiapatite crystals in
prisms and interprismatic
spaces.

Surface became chalky

white and microrough.

Bond is low viscosity

HYDROPHOBIC monomer
penetrates into etched
enamel and provide strong
MICROMECHANICAL
connection.
Adhesion to Enamel. Bevel Function
Bevel function is to
increase square of
contact between tooth
tissues and filling
material both on
MACRO and MICRO
levels.

NOT 2/3 enamel 1/3 enamel

beveled bevel bevel
Mechanisms of Adhesion
Mechanisms of adhesion
are different for:
enamel
dentine
Adhesion to Dentine. Dentine Structure
Dentinal tubules
contain odontoblast
process and dentinal
fluid inside.
Polarized microscopy

SEM SEM
Adhesion to Dentine. Dentine Structure
SMEAR LAYER contains
hydroxyapatite particles,
destroyed processes of
odontoblasts and
denatured collagen
fibers.

Thickness is about
5 microns.

Plugs dentinal tubules.

 Adhesion to Dentine
Special features of dentine: Primer should:
- vital dentine always wet
Be HYDROPHILIC
because of dentinal fluid

- after drilling dentine

surface is covered by
SMEAR LAYER which plugs To INTERACT
dentine tubules with smear
layer
 Adhesion to Dentine due to Interaction with
Smear Layer
Three approaches to dentine adhesion:
1. Preserving (NOT removing, NO Etching) and impregnating of
smear layer (not used any more)
1. Impregnating of smear layer by hydrophilic monomer (primer)
2. Strengthening of smear layer after polymerization
3. Connection is provided by connection of smear layer with dentin
connection is weak.
2. Dissolving and removing of smear layer; dentin surface
demineralization (adhesive systems requires total etching)
1. Etching removes of smear layer, disclosures of dentinal tubules,
demineralizes of dentin surface, exposed collagen fibers.
2. Primer penetrates into dentinal tubules and encapsulates collagen
fibers - forms HYBRIDE LAYER very strong connection.
3. Transformation of smear layer (self-etched adhesive systems)
1. Organic acid PARTLY dissolve smear layer, PARTLY disclosed dentinal
tubules, PARTLY demineralize superficial layer of dentine.
2. Demineralized dentin and remnants of smear layer are impregnated by
hydrophilic monomers these form a HYBRIDE LAYER strong
connection.
Adhesion to Dentine. Total Etch Concept
Etching of dentine during
15 seconds by 3537%
orthophosphoric acid:
removes of smear
layer disclosures of
dentinal tubules
demineralizes of dentin
surface exposes
collagen fibers

collagen lace
Adhesion to Dentine. Total Etch Concept
Etching of dentine during
15 seconds by 3537%
orthophosphoric acid:
removes of smear
layer disclosures of
dentinal tubules
demineralizes of dentin
surface exposes
collagen fibers
Adhesion to Dentine. Total Etch Concept
HYBRID LAYER is exposed collagen fibers
encapsulated by polymerized adhesive
system.

ACID

EXPOSED COLLAGEN HL = COLLAGEN +

DENTIN FIBERS ADHESIVE SYSTEM
Adhesion to Dentine. Total Etch Concept
HYBRID LAYER is exposed collagen fibers
encapsulated by polymerized adhesive
system.

ACID

EXPOSED COLLAGEN HL = COLLAGEN +

DENTIN FIBERS ADHESIVE SYSTEM
Adhesive System in Dentin and Enamel.
COMPARE

D
E

D
D
Adhesive System in Dentin and Enamel
COMPARE
Classification of Adhesive Systems
Generations
 Why 4th Generation Adhesive is Considered to Be
More Reliable and Has Best Long-term Results?

Step-by-Step Transition
HYDROPHOBIC HYDROPHILIC
MEDIA MEDIA

(SEM by Dr. John Gwinnett)

 Most Common Protocol of Direct Composite
Restoration with 5th Generation Adhesive System
1. Total etch enamel about 20 seconds, dentin 15 seconds.
2. Rinsing from air-water syringe 20 seconds or more up to whole acid will be
removed.
3. Gentle drying by air from air-water syringe
4. Application of adhesive system:
application of first layer of adhesive system. Big drop on a brush
should be placed in cavity and exposed during 20 seconds, during this
exposition some scientists recommend gently brush adhesive in
enamel borders of cavity. Then gently dry with air from air-water
syringe.
polymerize by halogen lamp 20 seconds, by LED lamp 10 seconds.
application of second layer of adhesive system. Dry gently with air
from air-water syringe.
polymerize by halogen lamp 20 seconds, by LED lamp 10 seconds.
Composite material placement and polymerization of each layer.
Halogen lamp 40 seconds, LED lamp 5 seconds.
QUESTIONS ?