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Texts Authored by Harry Albers, DDS
Bonding (Direct Resin)
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An unfilled or minimally filled fluid hydrophobic resin is the safest in terms of color stability and durability; e.g.,
(Vivadent). "Adhesive" bottles in some bonding kits are hydrophobic resin. However, many adhesives in dentin bond kits intended for both enamel and dentin bonding agents are hydrophilic and have air-inhibition layers that hinder direct placement techniques. Any flowable composite will work well as an enamel-resin bonding agent.
Dentin is generally conditioned with mild acids for longer periods, or stronger acids for short periods. The purpose of treatment prior to bonding is to remove the smear layer and create a porous outer layer of the dentin (hybrid zone) to which the resin bonding agent can attach. For convenience, since
37% phosphoric acid
is used to etch enamel, it can be used to etch dentin. Apply for a maximum of 10 seconds; longer etch times on dentin can greatly increase sensitivity. Be sure to rinse thoroughly.
Dentin-Resin Bonding--Two Component:
These two-part dentin bonding agents are the most reliable materials for resin-dentin bonding and are somewhat forgiving.
(3M) is the industry standard (light- and auto-cure). It is a resin ionomer in a solution of HEMA and water. It is the most clinically studied dentin bonding agent in the profession and has performed well.
(Kerr) is a phosphate bonding agent primer (light- and auto-cure) in a water and ethyl alcohol solution. It contains a filled adhesive agent. Clinical results are good. The Prodigy (Kerr) dentin bonding agent is very similar to Optibond. Other two-part dentin bonding agents:
Clearfil SE Bond
Dentin-Resin Bonding--One Component:
These one-part bonding systems have become popular because they are thought to be easier to use. One-component or "single-bottle" bonding systems are more technique-sensitive than two-component systems and do not yet have long-term clinical testing. We feel they result in more sensitivity from dissication and white line (open) margins than two-component materials.
Prime and Bond 2.1 and NT
(Caulk) have an accelerator available for dual curing;
(Vivadent) are available in unidose vessels, which reduces evaporation of the acetone solvent.
(3MESPE) was a self-etching light-cured material in blister unidose.
Adper Prompt L-Pop
was introduced with improved bonding. This is a "self-etch" primer which etches the enamel and dentin during its application.
(3M) come in a single bottle. There are many single-bottle self-etching materials available. Most need more coats than the manufacturer recommends. Be very careful when layering the composite against these materials to limit voids. At this time, two-component systems are recommended.
Dentin-Resin Bonding with Glass Ionomers:
Resin modified glass ionomers (RMGI) used as liners are recommended as the most reliable materials to achieve a long-term bond to dentin. With most restorations, a dentin-resin primer is not required since composites will adhere to RMGI materials if an unfilled resin (adhesive) is applied to the dry RMGI surface.
Fuji Bond LC
(GC) is a resin bonding material based on the Fuji liner chemistry.
Dual-Cured Resin-Dentin Bonding Agents:
Clearfill New Bond
(J. Morita/Kuraray) is a self-etching primer that retains the smear layer. Similar products include
\ (Parkell), and
Adhesive by Choice
These are fluid resins with enough accelerator to reduce the air inhibition layer. They are useful for sealing microcracks and small voids on the surface of a finished restoration.
by Bisco was the first; many others are now available, such as
There are many commerically available dentin desensitizers. Gluma is one of the most popular. Its active ingredient is 5% gluteraldehyde. Most desensitizers are resins that seal the tubules but the sensitivity can return when the resin wears off.
An excellent method to deal with dentin sensitivity is with a 5% aqueous solution of gluteraldehyde. Just apply to the sensitivity tooth area for 5 seconds at a time until the sensitivity to air is gone. The glutaraldhyde fixes the fluid in the dentin tubules into a gel which prevents fluid movement, the cause of tooth sensitivity. After treatment it is important to have the patient apply a fluoride gel to the area a few times a day. This calcifies the gel area to reduce reoccurance. The acid intake of the patients diet should be evaluated and minimized during fluoride treatment.
Gluteraldehyde can be purchased by many chemial supplies in 24% dulution. Add 4 parts of distilled water to one part of this 24% concentration to make 5%.
One known supplier:
Spectrum Laboratory Products, Inc.
Gardenia, CA 90248
Product number: GL140 is a 24cc bottle of 24% gluteraldehyde.
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