A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications
Abstract
:1. Introduction
2. Enamel and Dentin—An Overview
3. Histology of Enamel and Dentin Structures
4. Effect of Dentin Structure on Resin–Dentin Bonding
Role of the Smear Layer in Dentin Bonding
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- The full elimination of the smear layer with H3PO4 before bonding in an ER approach (smear layer-removal approach) [74].
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- The application of bonding agents that can enter beyond the smear layer (various acidic primers are used), while integrating it following a SE approach (smear layer-modified approach) [80].
5. Resin–Dentin Bonding
5.1. Resin Adhesive Application
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- Restoration of traumatic and carious lesions of classes I, II, III, IV, V, and VI.
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- Repair existing restorations (amalgam, composite, crown).
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- Bonding fractured fragments of anterior teeth.
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- Sealing of cracks.
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- Sealing pits and fissures.
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- Desensitization of exposed root surfaces.
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- Bonding of ceramic restorations (all-ceramic crowns, inlays, onlays, veneers).
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- Improved retention of porcelain fused to metal crowns.
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- Bonding of molded or prefabricated metal and fiber posts.
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- Reinforcing fragile endodontically treated roots internally.
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- Bonding of orthodontic brackets.
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5.2. Mechanism of Adhesion
- Physical adhesion includes:
- Chemical adhesion includes:
- Covalent bonding that includes sharing electrons between two molecules. It is a strong bond that liberates considerable amounts of energy. A covalent bond is existent in all organic compounds.
- Ionic bonding that includes a transfer of electrons from an atom to another, like the ion exchange adhesion mechanism observed in glass ionomer cements.
- Mechanical adhesion includes:
- A diffusion of a material into another at a microscopic level. For instance, in composite resins the bonding includes the diffusion of resin into the enamel and the dentin substrates and the establishment of RTs [101].
5.3. Factors Influencing Adhesion
5.3.1. Wetting
5.3.2. Substrate Variations
5.3.3. Dentin Humidity
5.3.4. Configuration-Factor
5.3.5. Age of the Patient (Sclerotic Dentin)
6. Resin Adhesive Systems
6.1. Composition of the Adhesive Systems
6.1.1. Acidic Components
- Type I of etched enamel: privileged demineralization of the enamel prism core while keeping the prism periphery intact. The matching tags in this case are cone-shaped.
- Type II of etched enamel: the inter prismatic enamel is removed preferentially, leaving the prism cores intact. The matching enamel tags are cup-shaped.
6.1.2. Cross-Linking and Functional Monomers
- Cross-linking monomers
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- Acrylates (–CH2–CH=COO–): compounds characterized by double bonds that exhibit higher reactivity than methacrylates, causing problems in shelf-life and biocompatibility, and containing an ester group [48].
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- Methacrylates (–CH2–C(CH3)=CH2): compounds containing acrylates (double bonds), methyl group (–CH3), and ester group (Example: UDMA, Ethylene glycol dimethylacrylate, TEGDMA, or Bis-GMA) [167].
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- Methacrylamides: compounds composed of a methacrylate group and an amide group (R1–CO–NH–R2) instead of an ester group [48].
- B.
- Spacer
- C.
- Functional monomers
- Pentamethacryloyloxyethylcyclohexaphosphazene monofluoride (Dentsply company): Monomer with five methacrylate-alkyl chains and a fluoride as a functional group [48].
- N-phenylglycine glycidyl methacrylate and N-tolylglycine glycidyl methacrylate: Monomer with tertiary aromatic amine group [48].
- Dimethylaminoethyl methacrylate (DMAEMA): Monomer with tertiary amine group [169].
- Methacryloyloxydodecylpyridinium bromide (MDPB): Monomer patented by Kuraray company with antibacterial agent and a methacrylate group. This molecule is hydrophobic when compared to other hydrophilic functional monomers [170].
- N-methacryloyl-5-aminosalicylic acid: Monomer patented by Kuraray company and presented in adhesive systems with a salicylic group (desensitizing outcome) [48].
- MA: Monomer rarely used in adhesives due to its risk of allergic reactions [48].
- Methyl methacrylate (MMA): Old monomer rarely used in adhesive formulation like MA monomer [48].
- 4-META: Monomer with hydrophobic aromatic group, functional hydrophilic carboxyl groups, and demineralization assets. The adhesion capacity of 4-META has been well defined in the literature and depends on the interaction between the substrate and the carboxyl groups that substitutes P ions with Ca ions in HAp [17,33]. The resulting 4-META-Ca presents a low chemical stability [17,33,48]. This procedure is followed by the superficial dissolution of HAp due to the attack of hydronium ions resulting from the water protonation reaction with 4-META. After extracting Ca, P, and hydroxyl ions from the apatite surface, the solution turns out to be acidic, leading to the formation of dicalcium phosphate dihydrate precipitate [48]. Previous analysis showed that 4-META-Ca solubilized quicker than 10-MDP–Ca, which leads to decreased molecular stability [34]. This discovery supports the “Adhesion-Decalcification concept” (AD concept), which stipulates that the lower the solubility of Ca salt in the acidic molecule, the stronger and more stable the adhesion with the HAp substrate [17,34].
- 4-MET: 4-META + water = 4-MET: Two carboxylic groups attached to aromatic groups with methacrylate group as polymerizable group [48].
- 4-acryloyloxyethyl trimellitate anhydride: Patented by Shofu company (Kyoto, Japan), two carboxylic groups linked to aromatic groups similar to 4-MET except the presence of acrylate group instead of methacrylate group [48].
- 11-methacryloyloxy-1,1’-undecanedicarboxylic acid: Monomer patented by Tokuyama company (Tokyo, Japan); information regarding this monomer in the literature is quite sparse, 10 carbon atoms comparable to 10-MDP, with a hydrophobic spacer [48].
- Phenyl-P: Monomer with monohydrogen phosphate group [48].
- HEMA-P: Monomer with methacrylated H3PO4–HEMA esters group [48].
- HEMA: Monomer with low molecular weight (small size) and often utilized in several adhesive systems [171,172]. This hydrophilic monomer is frequently included in the formulation of adhesives because of its solvent like nature. It consists of a mixture of hydrophilic and hydrophobic polymers. Hydrophilic monomers are usually transported in a water-soluble solvent (acetone, ethanol, water) to encourage an adequate flow and a penetration in the hydrophilic dentin (to influence the strength of the resulting bonding), while hydrophobic monomers promote the chemical bond with resin layer [17,172,173]. This increases stability and helps in preserving hydrophobic and hydrophilic monomers in the mixture by reducing phase separation in the presence of water [174]. Adhesives lacking HEMA monomer might have issues related to phase separation [175]. Although HEMA has numerous positive attributes, it also has drawbacks. HEMA, both in the unpolymerized and polymerized state, certainly absorbs water from the underlying dentin through osmosis and from the outer oral environment [174]. Once polymerized, it can swell, discolor, and contribute to the hydrolysis of the adhesive interface (water blisters become entrapped in the adhesive layer) [48]. Finally, HEMA has been correlated with biocompatibility concerns, as it has been assigned rather substantial allergic potential, and even contributes to probable genotoxicity [176]. All in all, the most notable disadvantages of HEMA are as follow: low polymerization capacity, low mechanical strength, high water sorption, and critical biocompatibility in terms of allergic reaction. When the HEMA concentration declines beneath a critical level, phase separation will happen between the adhesive monomers and water, and a strong air-stream is needed to eliminate the water-containing droplets from the adhesives [177]. High amounts of HEMA might lessen the mechanical characteristics of the resulting polymer [178]. This will result in flexible polymers with inferior qualities. PolyHEMA is basically a flexible porous polymer (‘gel’). As such, high concentrations of HEMA in an adhesive may have deteriorating effects on the mechanical properties of the resulting polymer. HEMA also reduces the vapor pressure of water, and probably also of alcohol [48,178]. High amounts may therefore hinder good solvent evaporation from adhesive solutions. Like all methacrylates, HEMA is vulnerable to hydrolysis, especially at basic pH, but also at acidic pH [178]. Uncured HEMA also has the ability to lower the vapor pressure of water and can make evaporation more difficult through the air-drying stage [48]. The ideal HEMA concentration to obtain higher BSs in primer/adhesive is between 30–40% [179], and 5–25 wt% in single-bottle adhesives [17], though this can depend on the specific adhesive formulation. Despite its effectiveness, the use of HEMA remains controversial. Some studies have shown no significant differences between the clinical performances of HEMA-based and HEMA-free adhesive systems [180,181]. While other findings revealed clinically significant difference between HEMA and HEMA-free adhesive systems [182,183]. In current adhesives, manufacturers strive to significantly lower the HEMA contents or even substitute HEMA with other monomers such as methacrylamide monomer [33]. To conclude, it may be stated that in very favorable conditions, the presence or absence of HEMA monomer might not influence the clinical behavior of adhesive systems. However, it is critical to have a thorough understanding of the advantages and limitations of HEMA to make informed decisions and select the best adhesive system based on the clinical situation.
- 10-MDP: This monomer was patented by Kuraray (Kuraray Noritake, Tokyo, Japan) and introduced in 1981 (following ‘CSE’ Technical Information from Kuraray Noritake). 10-MDP is used in many UAs including All-Bond Universal (Bisco, Inc., Schaumburg, IL, USA), Adhese Universal (Ivoclar Vivadent, Schaan, Liechtenstein), G-Premio Bond (GC, Tokyo, Japan), Futurabond U (Voco, Cuxhaven, Germany), Clearfil Universal Bond (Kuraray Noritake, Tokyo, Japan), and Scotchbond Universal (3M ESPE, St. Paul, MN, USA) [184]. In addition, 10-MDP is a major constituent of SE adhesive systems, with a dihydrogen phosphate group qualified to bond the tooth substrate, long carbonyl chains that render this monomer hydrophobic, and a methacrylate group on the other side capable of bonding to methacrylate-based materials [185]. 10-MDP outperformed the other functional monomers studied in terms of chemical bonding potential. This monomer was documented to self-assemble into “nano-layering”, a process focused on the deposition of 10-MDP–Ca salts with low solubility in order to obtain an optimum hybridization [186,187]. Each nano-layering involves two sublayers of parallel 10-MDP monomers placed in reverse direction. This monomer’s methacrylate group is pointed inwards, allowing mutual co-polymerization among two contrasting monomers. Its functional P group is oriented outwards, collecting Ca released from dentin structure [184,185,188] (Figure 13).
- 16.
- GPDM: In 1949, Oskar Hagger invented the first adhesive technique by combining GPDM in a liquid cavity sealer with a chemically cured resin-based restorative substance (Sevriton®) [201]. GPDM is a monomer with two methacrylate groups linked by a short carbon spacer to one P acidic functional group. Due to the presence of two polymerizable methacrylate groups, GPDM can promote better polymer formation than 4-META, 10-MDP, and HEMA [17]. The hydrophilicity of GPDM aids in adhesive infiltration into the demineralized dentin due to having similar characteristics to HEMA monomer [13]. GPDM also enhances the interaction between the bonding agents and HAp, comparable in function to 4-META which forms an unstable GPDM–Ca salt. GPDM behaves in a decalcification route, but unlike 10-MDP, it does not expose collagen, but rather promotes the creation of a thick HL with exposed collagen. However, the variances in chemical bonding do not eliminate the actual bonding effectiveness of adhesive systems comprising GPDM [13,17]. The interaction between GPDM and the co-monomers should be further assessed to gain a better understanding of the positive outcomes with regards to bonding durability of adhesive systems containing this monomer [17,33].
- 17.
- PENTA-P: This monomer is characterized by P ester monomers containing carbon=carbon double bonds and a P group [-OP(=O)(OH)2]. When compared to 10-MDP functional monomer, the chain of PENTA is shorter. PENTA has five vinyl groups compared to one in 10-MDP monomer, and these four additional vinyl groups make PENTA more resilient to hydrolytic degradation [51,202,203]. Thus, when hydrolysis occurs and eliminates one vinyl group from the main structure of the monomer, four vinyl groups will still be present for the conservation of the P group. Accordingly, copolymerization to other monomers and adhesion to tooth structure happen at the same time [189,202]. This finding could be elucidated by a previous study which demonstrated that PENTA incorporated into the formulation of the adhesive Prime & Bond Elect (Dentsply Caulk, Milford, DE, USA) had more stability than 10-MDP, as the BS is maintained even at the end of its shelf-life. This is explained by the sustained connection between the four vinyl groups and the P group [202,204] (Figure 14).
6.1.3. Solvents
6.1.4. Other Components
6.2. Etch-and-Rinse Adhesive Strategy
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- Application of a solution or gel, usually H3PO4 (with a pH of 0.1 to 0.4), for a period of 15–30 s on the enamel and a maximum of 15 s on the dentin (a duration longer than 15 s will cause “over-etching”) [33,267]. Etching agents are mostly colored gels (thickened by means of silica microparticles) that regulate the application and ensure that all the gel is rinsed off the tooth substrate [15].
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- Copious rinsing (15 s and more) using an air/water spray to remove the residues that result from the chemical reaction between the acid and the minerals. However, the surface must remain moist in order to prevent collagen collapse. This is done using a dry applicator, absorbent paper points, or air that removes any excess humidity [9,10,266].
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- Once the dentin is moist, the application of a hydrophilic primer solution on enamel and dentin in several layers will be necessary to infiltrate the exposed collagen network, followed by a slight air pump for 5 s to eliminate the solvent (depending on the solvent). Thus, the dentin will exhibit a glossy appearance [9,10].
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- Application of adhesive resin on enamel and dentin, followed by the elimination of excess adhesive by a dry micro-brush. Afterwards, polymerization is done according to the manufacturer’s recommendation. Thus, the HL is formed by the resin infiltrated surface layer on dentin and enamel. The purpose of the ideal hybridization for these adhesives is to gain high BSs [9], typically in the range of 20 MPa for both enamel and dentin substrates [262].
6.3. Self-Etch Adhesive Strategy
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- Type I adhesives, which are self-etching primer and adhesive systems such as CSE (Kuraray Noritake Dental, Tokyo, Japan), Prelude SE (Danville Materials, San Ramon, CA, USA), and Ultradent Peak SE (Ultradent Products Inc, South Jordan, UT, USA). These adhesives have liquid components including a self-etching primer and an adhesive resin, which are applied separately to the tooth and are generally compatible with self-cured composites.
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- Type II adhesive systems such as All-Bond SE (Bisco, Inc., Schaumburg, IL, USA), Brush&Bond (Parkell, Edgewood, NY, USA), Futurabond NR (VOCO America, Inc., Cuspis, CA, USA), Touch&Bond (Parkell, Edgewood, NY, USA), Adper Prompt L Pop (3M ESPE, St. Paul, MN, USA), and Xeno III (DENTSPLY Caulk, Milford, DE, USA). They use a self-etching primer and adhesive that are mixed together prior to placement and are not compatible with self-cured composites [9,15,33].
6.4. Universal Adhesives
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- UAs integrate the primer and the adhesive resin, each with a distinct purpose, in a single application step [15].
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- UAs generally contain less resin and more solvent compared to systems with separate primer and adhesive components. This formulation can impact the adhesive layer’s thickness and its properties. The increased solvent content aids in better wetting and penetration of the adhesive into the tooth structure, but it may also lead to thinner adhesive layers after evaporation and curing, which could be prone to suboptimal polymerization [9,290].
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- UA’s film thickness is usually less than 10 µm, influenced by air blowing pressure and time. This thin layer can result in suboptimal polymerization due to polymerization-inhibition by oxygen, suboptimal adhesive interface stabilization, and reduced ability to absorb stress from the restorative composite [33]. Both excessively thin and overly thick adhesive resin films can negatively impact BS, emphasizing the need for an optimal film thickness to ensure effective adhesion and durability [291].
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- UAs absorb much more water and have lower hydrolytic resistance [294].
- Advantages:
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- Suitable for ER and SE adhesives, as well as SEE, making them highly versatile [9].
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- Application of this class of adhesives in SE mode with a scrubbing technique enhances the BS to enamel substrate [325].
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- Suitable for a wider range of restorative procedures [172].
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- Used as zirconia primers [172].
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- Patient and operator factors may have a greater impact on restoration longevity than the adhesive used. When using UAs in clinical settings, isolation with a rubber dam is recommended, and moisture control is crucial. However, the reduced number of steps and the associated time savings may also be considered important advantages [124,324,329].
- Disadvantages:
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- When H3PO4 is used to etch dentin, they do not effectively seal the margins [333].
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- UAs, like traditional SE I adhesives, can act as permeable membranes following polymerization. This allows fluids to pass through the adhesive layer and degrade the resin–dentin contact via hydrolysis [9].
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- Solvent evaporation time must be extended to prevent water entrapment and NL [334].
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- The addition of silane to the adhesive solution does not increase BS to glass-matrix ceramics. Thus, a separate silane solution must be employed for better adhesion to glass-matrix ceramics [312].
7. Clinical Applications of Dental Adhesion
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
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Solvent | Dipole Moment (D) | Dielectric Constant | Boiling Point (°C) | Vapor Pressure (mmHg 25 °C) | Ability to Form Hydrogen Bonds |
---|---|---|---|---|---|
Water | 1.85 | 80 | 100 | 23.8 | High |
Ethanol | 1.69 | 24.3 | 78.5 | 54.1 | Medium |
Acetone | 2.88 | 20.7 | 56.2 | 200 | Low |
Tert-Butanol | 1.7 | 12.5 | 82.4 | 46 | Medium |
Solvent | Advantages | Disadvantages |
---|---|---|
Acetone/Ketones [204,217,218] | - Low intrinsic viscosity - Easy removal | - Undesired solvent loss - Risk of interaction with other components |
Ethanol/Primary Alcohols [204,221,222,223] | - Sufficient penetration - Evaporation/removal | - Side reactions (e.g., Michael-addition) - Low stability with acids |
Water [204,230] | - Best dentinal compatibility - Essential for etching | - Lowers evaporation rate |
Tert-Butanol/Secondary/Tertiary Alcohols [204,234] | - Limited/no side reactions - Acrylate compatibility - High stability with acids | - Increased matrix viscosity |
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Bourgi, R.; Kharouf, N.; Cuevas-Suárez, C.E.; Lukomska-Szymanska, M.; Haikel, Y.; Hardan, L. A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications. Appl. Sci. 2024, 14, 8111. https://doi.org/10.3390/app14188111
Bourgi R, Kharouf N, Cuevas-Suárez CE, Lukomska-Szymanska M, Haikel Y, Hardan L. A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications. Applied Sciences. 2024; 14(18):8111. https://doi.org/10.3390/app14188111
Chicago/Turabian StyleBourgi, Rim, Naji Kharouf, Carlos Enrique Cuevas-Suárez, Monika Lukomska-Szymanska, Youssef Haikel, and Louis Hardan. 2024. "A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications" Applied Sciences 14, no. 18: 8111. https://doi.org/10.3390/app14188111