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Manipulation:
 Selection of composite, type and shade
 Field isolation
 Pulp protection
 Matricing and wedging.
 Pre-treatment of the substrate surface.
 Packing.
 Carving.
 Polymerization.
 Finishing and polishing.

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 Pre-treatment of enamel
and dentin surfaces:
 Rationale for pre-treatment :
 The polymerization shrinkage of composite
resin often leads to marginal gap formation,
allowing for the passage of bacteria, fluids
and ions between the restoration and the
cavity wall. This microleakage seems to
predispose to secondary caries, marginal
discoloration and pulpal damage reducing the
longevity of the restoration.
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 Pre-treatment of
enamel and dentin
surfaces:
 Therefore, the capability of establishing
a strong and permanent bond to both
enamel and dentin is a highly desirable
property of a composite resin.

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 Advantages of adhesive
techniques:
Bonded restorations have a number of
advantages over traditional, non-adhesive
methods:
 Traditionally, retention and stabilization of
restorations often required the removal of
sound tooth structure. This is not necessary, in
many cases, when adhesive techniques are
used.

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 Advantages of
adhesive
techniques:
 Adhesion reduces microleakage at the
restoration interface. Prevention of
microleakage or the ingress of oral fluids
and bacteria along the cavity wall, reduces
clinical problems such as postoperative
sensitivity, marginal staining and recurrent
caries.

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 Advantages of
adhesive
techniques:
 Adhesive restorations better transmit and
distribute functional stresses across the
bonding interface to the tooth and have the
potential to reinforce weakened tooth
structure. In contrast, a traditional metal
intracoronal restoration may act as a wedge
between the buccal and lingual cusps and
increase the risk of cuspal fracture.

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 Advantages of
adhesive
techniques:
 Adhesive techniques allow deteriorating and
debonded restorations to be repaired with
minimal or no additional loss of tooth material.
 Adhesive techniques have expanded the
range of possibilities for esthetic restorative
dentistry (correction of unesthetic shapes,
positions, dimensions, or shades).

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 Steps in Forming Good Adhesion
(1) Clean adherend

(2) Good wetting

(3) Intimate adaptation

(4) Bonding –
+
chemical
physical mechanical
bondingbonding
bonding
(5) Good curing

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  (1) Clean Adherend (Substrate): The adherend must
not contain any surface debris or adsorbed films of oil
or dirt that would prevent an adhesive from coming
into good contact with the adherend. Surfaces can
be cleaned with water, solvent, or acid.

 (2) Good Wetting: The adhesive must spread onto

the adherend with a low contact angle so that it wets
the surface and develops good intimate contact.
Unfortunately some adhesives are not well-matched
to the surface energies of certain substrates.
Hydrophilic materials do not wet hydrophobic
surfaces very well, and vice versa. Enamel and
dentin are hydrophilic while most composites are
hydrophobic. The challenge for dental adhesives is
to provide acceptable wetting for both of these
materials.
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  (3) Intimate Adaptation: If good wetting occurs and
the material flows adequately, then it can penetrate
into all the surface interstices and develop good
adaptation. This process should occur without
entrapping air or leaving unfilled surface spaces.

 (4) Bonding: The adhesive should interact in as

many ways as possible with the substrate. It should
develop physical bonding, chemical bonding, and
micromechanical bonding. The last is the most
important and contributes the most (>90%) to the
strength of the joint.

 (5) Good Curing: The entire process depends on the

adhesive (and restorative filling materials) becoming
fully cured. Under-curing allows chemical erosion
and/or debonding of the adhesive system.
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 Design of Bonding Systems
(3-component, 2-component, 1-component)
1. Conditioning (cleaning)
2. Priming (wetting, adapting)
3. Bonding (mechanical adhesion, curing)

Instrumentation of the tooth substrate during cavity

preparation produces a smear layer with a low surface free
energy. Therefore, the natural tooth surface should be
thoroughly cleaned and pretreated prior to bonding
procedures to increase its surface free energy and hence to
render it more receptive to bonding.

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 Adhesion to
enamel:
 Structure of enamel: It consists of 96% by
weight inorganic hydroxyapatite and 4% matrix
containing proteins and water. Enamel has a
crystalline structure, the crystals form so-
called enamel rods. A pellicle consisting of a
protein-fat-carbohydrate complex (organic
material) is found on the enamel surface.
When the enamel is cut, the pellicle forms an
organic smear layer. Therefore, enamel
surface should be conditioned before each
adhesion.

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 SEM shows the direction of On the uncleaned E. surface
enamel crystals within a single there is a pellicle consisting
enamel rod. of organic material.

The aprismatic E. layer proceeds

parallel to the surface of the tooth
and perpendicular to the underlying
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 Adhesion to
enamel:
 Such conditioning is achieved through acid
etching of this highly mineralized substrate
which substantially enlarges its surface area for
bonding.
 Enamel etching transforms the smooth enamel
surface into an irregular surface with a high
surface free-energy. An unfilled liquid acrylic
resin with low viscosity (bonding agent) wets the
high energy surface and is drawn into the
microporosities by capillary attraction.

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 The ends of the
enamel prisms form a
typical etch pattern.

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 Adhesion to
enamel:
 The bond between enamel and the restorative
material is established by polymerization of
monomers inside the microporosities and by co-
polymerization of bonding agent with the matrix
phase of resin composite, producing strong
chemical bond.
 The form of the etchant : gel, semi-gel, or
aqueous solution. An acid gel is generally
preferred over a liquid because its application is
more controllable.

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 Adhesion to
enamel
 Use of a phosphoric acid concentration
between 30-40%, an etching time of not less
than 15 seconds, and washing time of 10-20
seconds are recommended. Rinsing times of at
least 15 seconds are required to remove
dissolved calcium phosphates from the etched
surface (which otherwise might impair
infiltration of monomer into the etched enamel
microporosities).

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 Adhesion to
enamel
 Etching of enamel dissolves the rods with
faster effect on prism cores than on organic
rich inter-prismatic substance. Thus it
produces:
 Inter-prismatic.
etching
 Intra-prismatic.

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 Adhesion to dentin
 Structure of dentin: Dentin is a mineralized hard tissue,
consisting of; peritubular dentin with high mineral
content, intertubular dentin (collagen rich), and dentinal
tubules containing odontoblastic process and tubular
fluid. Thus dentin characterized by an intrinsic wetness.
 Dentin consists of 50(volume)% inorganic material,30%
organic and 20% water. The organic matrix of dentin
consists of 91-92% collagen and 8-9% noncollagen
ground substance. The inorganic components consist
mainly of hydroxyapatite crystals. During cutting, smear
layer forms, consisting of burnished components and
hydroxyapatite fragments.

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 Smear layer that is pressed
approx. 5-10 um
into the dentin tubules.
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 Adhesion to dentin
 This smear layer closes the dentinal tubules
and prevents the seepage of the dentinal
fluid, thus providing a drier surface for
adhesion, minimizing post operative
hypersensitivity and preventing the ingress of
irritants from restorative materials to the
tubules. However, it keeps any material from
direct contact to the dentin.

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Different approaches to
handle the smear layer:
 1- It can be used as a substrate: which means
that the adhesive makes use of the porosities
within the smear layer low bond strength 
unacceptable.
 2- Partly dissolved and incorporated into the
adhesive layer.
 3- Or it can be totally removed. Both approaches
2&3 can be achieved by etching procedure.

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 The etching procedures not only dissolves
the smear layer but also demineralizes the
dentin surface. After etching the dentin and
rinsing the acid from the cavity wall, the
demineralizes dentin remains as a
collagen network since it lost the support
from the hydroxyapatite. This collagen-rich
layer has a low free energy level. The
space between the fibers previously filled
with hydroxyapatite now contains water.
This water has to be replaced by the
monomer.
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10/14/08 Collagen network 28
  Be aware:
 Any drying of the dentin would result in a loss of
water with a collapse of the collagen fibers,
hindering the monomers from penetrating the
decalcified dentin.
 N.B
Etching of dentin 1- Elimination of smear layer.
2- Exposure of dentin collagen.

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 Priming:
 Primers serves as adhesive–promoting agents. They
are composed of bifunctional hydrophilic and
hydrophobic groups of monomers, e.g. HEMA
( hydroxyethylmethacrylate ), in ethanol or acetone
solvent.
 They are used to promote the resin-bondability of
substrate E. and D. surfaces.
 The solvent displaces compositional water and
trapped air at the depth of pores. ( Acetone is
miscible with water and evaporated with it from the
substrate surface and moist collagen network during
the air drying ).
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 Priming:
 The hydrophilic group (e.g. hydroxyl) increase the
 Wettability of demineralized substrate surface to bonding
resins and facilitate their full depth infiltration.
 The hydrophobic group ( monomer e.g. methacrylate )
interdiffuse to demineralized substrate E. & D. They are
subsequently polymerized in situ forming intra & inter-
prismatic resin micro-tags in E. They form resin micro-
tags in inter & peri-tubular demineralized D. and
encapsulate the uncollapsed collagen fibers to form
resin-collagen hybrid.

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Priming:
 The bonding resin is subsequently copolymerized
to the primer resin, to support it and complete the
establishment of the intermediary adhesive resin
joint.
 N.B.
Primer must be polymerized after been applied
and before application of bonding resin, to effect
optimum conversion.

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