Bonding Products

 3M products
Optibond products
Bisco

4th Generation - gold standard. 1 etch 2 rinse 3 prime 4 bond more technique sensitive Top 3

• 3M Adper Scotchbond Multi-purpose plus
• Optibond FL
• All-Bond 2

5th Generation - 1 etch 2 rinse 3 prime and bond. not all adhesives in this category are compatible with DC and SC composites because the lower pH of the oxygen inhibited layer de-activate the tertiary amine in chemical cured composites.

• Optibond Solo Plus adds a dual cure activator, benzene sulphinic-acid/sodium salt solution, to raise pH.  With that it can bond to DC and SC but the extra chemical lowers bond strength.
• 3M Adper Single bond plus, Excite, Prime&Bond NT

6th Generation - selective etch products
Type 1 - 1 etch and prime 2 bond.

• Clearfil SE Bond, AdheSE

Type 2

• All-Bond SE, Adper Prompt L-Pop, Xeno III

7th Generation - selective etch with a all-in-one consistency

• Clearfil S3 Bond
• G-Bond, Futurabond DC, Bond Force, Xeno IV

Universal (2011) Compatible with both total and self etch systems, works with both dual and self cure products, primer for silica and zirconia.

1. Differs from 7th in that can bond dentin after phosphoric etch due to higher pH
2. Contains Silane (ceramic) and/or acidic monomer like MDP (zirconia) Tests show coat silane still improves and HF is mostly responsible anyway so not sure much advantage. 1

Scotchbond Universal has silane and phosphate monomer
All-Bond Universal found spot said has phosphate monomer BUT said needs Z-Prime still?? 1
Voco Futrabond U  is DC universal

 

Source

Generation	Dates	Dentin Bond Strength (MPa)	Smear Layer	Products
4th	Late 1980's	20-35	Removed	ALL-BOND 2, OptiBond FL., Adper Scotchbond Multipurpose
5th	Early 1990s	20-30	Removed	Optibond SOLO Plus, Prime & Bond NT, Adper Single Bond Plus, Excite
6th Type I	Mid-late 1990's	15-35	Modified	AdheSE,CLEARFIL SE Bond
6th Type II	Mid-late 1990's	10-30	Modified	ALL-BOND SE, Adper Prompt L-Pop, Xeno III
7th	Early 2000's	20-30	Modified	CLEARFIL S3 BOND, G-BOND,Futurabond DC, BOND FORCE, Xeno IV
Universal	Late 2011	30-50	Modified	Scotchbond Universal, Peak Universal, ALL-BOND Universal, Optibond XTR, Prime & Bond Elect

Universal Bonding Agent	Shear Bond Strength – Enamel (MPa)	Shear Bond Strength – Dentin (MPa)
Optibond XTR	39	47
Scotchbond Universal	26 (SE) / 30 (TE)	41 (SE) / 43 (TE)
ALL-BOND Universal	nt	29 (SE) / 39 (TE)
Total Etch and Self Etch Bonding Agents	Shear Bond Strength – Enamel (MPa)	Superficial Dentin-(MPa)
Kerr Optibond All In One	26.3	40.4
3M ESPE Adper Scotchbond SE	34	33
All Bond TE	22	34

Table 3: Universal, Total Etch and Self Etch bonding agents tested using the Ultradent Shear Test. (“nt” = not tested, “SE” = self-etch, “TE” = total-etch)

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

MMP inhibition

MMP=matrix metalloproteinase=zinc-dependent endopeptidase that degrade extracellular matrix proteins.  They are present in dentin and when exposed to a weak acid or even water become active so they do help slow decay grow.

protease inhibitors

1. Chlorhexidine

galardin (synthetic MMP-inhibitor)
green tea polyphenols (especially epigalolocatechin-3-gallate)
doxycylcines
Quaternary ammonium compounds

1. benzalkonium chloride bac like in Bisco's uni-etch 
2. METMAC
3. MAPTAC
4. MDPB in clearfil SE Protect

Reference - list of MMPp inhibitors
MMP and Clearfil SE - helps with SE too (article saved)
Effect CHX in SE Adhesion - tested up to 1% with no decrease in initial bond strength (article saved)
Total etch article references many more check references 31-44
Studies show that the application of chlorhexidine or benzalkonium chloride solutions before or in conjunction with the placement of both total- and self-etch adhesives has the potential to inhibit MMP activity, resulting in a more durable adhesive interface.^31,33,35,36
In any case, based on this(32) and other studies,^37,38 the author’s current technique when using a rewetting protocol for total-etch systems is the placement of a 2% chlorhexidine solution after the etching step.

31. Campos EA, Correr GM, Leonardi DP, et al. Chlorhexidine diminishes the loss of bond strength over time under simulated pulpal pressure and thermo-mechanical stressing. J Dent. 2009;37(2):108-114.

32. Brackett MG, Tay FR, Brackett WW, et al. In vivo chlorhexidine stabilization of hybrid layers of an acetone-based dentin adhesive. Oper Dent. 2009;34(4):379-383.

33. Hiraishi N, Yiu CK, King NM, Tay FR. Effect of 2% chlorhexidine on dentin microtensile bond strengths and nanoleakage of luting cements. J Dent. 2009;37(6):440-448.

34. Tezvergil-Mutluay A, Mutluay MM, Gu LS, et al. The anti-MMP activity of benzalkonium chloride. J Dent. 2011;39(1):57-64.

35. Sadek FT, Braga RR, Muench A, et al. Ethanol wet-bonding challenges current anti-degradation strategy. J Dent Res. 2010;89(12):1499-1504.

36. Pashley DH, Tay FR, Yiu C, et al. Collagen degradation by host-derived enzymes during aging. J Dent Res. 2004;83(3):216-221.

37. Breschi L, Cammelli F, Visintini E, et al. Influence of chlorhexidine concentration on the durability of etch-and-rinse dentin bonds: a 12-month in vitro study. J Adhes Dent. 2009;11(3):191-198.

38. Chang YE, Shin DH. Effect of chlorhexidine application methods on microtensile bond strength to dentin in Class I cavities. Oper Dent. 2010;35(6):618-623.

39. Zhou J, Tan J, Chen Li, et al. The incorporation of chlorhexidine in a two-step self-etching adhesive preserves dentin bond in vitro. J Dent. 2009;37(10):807-812.

40. de Castro FL, de Andrade MF, Duarte Junior SL, et al. Effect of 2% chlorhexidine on microtensile bond strength of composite to dentin. J Adhes Dent. 2003;5(2):129-138.

41. Ersin NK, Candan U, Aykut A, et al. No adverse effect to bonding following caries disinfection with chlorhexidine. J Dent Child. 2009;76(1):20-27.

42. Komori PC, Pashley DH, Tjäderhane L, et al. Effect of 2% chlorhexidine digluconate on the bond strength to normal versus caries-affected dentin. Oper Dent. 2009;34(2):157-165.

43. Zhou J, Tan J, Yang X, et al. Effect of chlorhexidine application in a self-etching adhesive on the immediate resin-dentin bond strength. J Adhes Dent. 2010;12(1):27-31.

44. Soares CJ, Pereira CA, Pereira JC, et al. Effect of chlorhexidine application on microtensile bond strength to dentin. Oper Dent. 2008;33(2):183-188.

CHX after etch how tested here 1
CHX after etch recommended here also Moon

 

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

Steps

1. Seat patient confirm completing filling on tooth listed today.
2. Place bid
3. Dry mucosa at site of injection and place topical with cotton gauze or roll over top
4. If anterior filling check shade with mock composite
5. Doctor deliver first step anesthetic
6. Doctor deliver second step anesthetic
7. ASK patient feels numb
8. Remove decay and bevel all enamel edges
9. Use Viscostat, cords, or traxodent as needed.

 Anterior filling Total etch technique

1. Place mylar strip and wave wedge
2. Etch enamel 15 seconds and dentin 10 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Optibond Fl Prime 15 seconds scrubbing then air dry 5 sec
7. Step 2 1 tooth?=same brush Optibond Fl Adhesive 15 seconds scrubbing then air thin 3 sec
8. Cure
9. Layer composite curing as needed
10. Peel mylar strip back place flowable comp IP and pull mylar through and cure

Buccal filling Total etch technique

1. Place #0 cord soaked in hemodent
2. Etch enamel 15 seconds and dentin 10 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Optibond Fl Prime 15 seconds scrubbing then air dry 5 sec
7. Step 2 1 tooth?=same brush Optibond Fl Adhesive 15 seconds scrubbing then air thin 3 sec
8. Cure
9. Layer composite curing as needed
10. Remove cord

Posterior filling Selective etch technique

1. Place V-ring if IP
2. Etch enamel 15 seconds then wash and dry (with bac etch)
3. 2% CHX unknown duration 30-60 sec suggested (only beneficial on areas etched) air dry
4. Gluma 10-20 seconds with scrubbing in dentin and air dry
5. If deep, line dentin with RMGI (but etch and CHX steps get moved to right after this step)
6. Step 1 Clearfil SE Protect prime and etch 20 seconds with scrubbing then air dry
7. Step 2 Clearfil SE Protect bond, air thin then cure 5-10 seconds
8. Burnish metal matrix if needed
9. Layer composite curing as needed
10. Removal V-ring, wedge, and peel back matrx to cure IP

 Finish and polish

1. Bulk reduction excess composite
2. Check occlusion and excursion with Troll foil
3. Check contacts with floss
4. Fine tune with finishing burs
5. Polish

Total etch article is good
6 month test showing total etch maintains bond strength best
Kanca article on moist bonding with total etch technique
Kanca article on HEMA.

Kanca says HEMA is acting as the wetting agent, most glutaraldehyde products also contain that.

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

Armatarium

1. Anesthetic: lower 27 gauge long (yellow tip) with 2 carps of 4% articaine (Septocaine) for block, upper or lower infiltration 30 gauge short (blue tip) with 1 carp 4% articaine (Septocaine).  Always use the color of tip instead of having to say the word long needle in front of the patient.  Also we never say “shot”, we say injection.
2. Topical anesthtic
3. Restorative tray
4. Dr. Bauer bur block
5. 2% CHX
6. Gluma
7. Etch bac
8. 3 microbruses for multiple teeth only 2 or 1 for single tooth
9. Vitrebond Plus
10. Clearfil SE Bond or Optiobond Fl
11. Composite =
12. Clearfil SE A2 APX if posterior and some anterior
13. Filtek Supreme Ultra if anterior
14. Buccal requires #0 cord soaked in hemodent?
15. IP need V-Ring system
16. Anterior need mylar strip and white wave wedge
17. Troll Foil
18. IP polishing strip for some anteriors

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

BPA

I cover this topic to some extent here


The number of chemicals in a composite filling is pretty large and many are known to be toxic to some degree.  BPA is used directly in the manufacturing of some resins, it is also a byproduct of chemical degradation of resin-based dental materials, and residual amounts can be found in nearly all composites from incomplete chemical reactions. (reference) Composites also have been proven to result in higher levels of BPA in the urine (for how long is unknown) no matter how they are applied (a protective rubber dam has 0 influence on amount of BPA leaked into your system).  BPA in the urine does mean the body is eliminating it, but how much of it? reference

There are several studies showing effects like  prenatal exposure to BPA being tied to hyperactivity and anxiety, especially in girls.  Newer studies are showing effects on behavior.

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists

Glass Ionomer Filling

Steps

1. 20% Polyacrylic Acid (Cavity Conditioner) for 10 seconds, removes smear layer
2. 2% CHX unknown duration 30-60 sec suggested air dry
3. Gluma 10-20 seconds with scrubbing in dentin and air dry to moist
4. Glass ionomer
5. Coating placed GC Fuji Coat or G coat Plus or 

Bryan Bauer, DDS, FAGD                                                                
630-665-5550                                                                  

Wheaton General and Cosmetic Dentists