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Dentin bonding agents

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DENTIN BONDING AGENTS in dentistry

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Dentin bonding agents

  1. 1. Presented by: Anuradha Roy Collected by- Aziz Ikbal Final year BDS Dept. Of Conservative and Endodontics
  2. 2.  INTRODUCTION  ROLE OF ADHESIVE DENTISTRY  CONCEPT OF ADHESION ENAMEL ADHESION DENTINE ADHESION CHALLENGES IN DENTINE ADHESION  ENAMEL BONDING STEPS FOR ENAMEL BONDING MECHANISM INVOLVED  DENTINE BONDING CONDITIONING OF DENTINE PRIMING OF DENTINE
  3. 3.  DENTINE BONDING AGENTS CLASSIFICATION GENERATIONS OF BONDING AGENTS FIRST GENERATION SECOND GENERATION THIRD GENERATIONS FOURTH GENERATION FIFTH GENERATION SIXTH GENERATION SEVENTH GENERATION  SUMMARY  BIBLIOGRAPHY
  4. 4.  There is much interest and activity in dentistry today with dentin bonding agents.  In the modern society, aesthetics has become a major concern for every individual .Thus most of us desire for a perfect set of teeth.  Therefore, teeth that have been deformed or ravaged by dental diseases need to be restored to their natural form and colour.  Moreover, the classic concepts of tooth preparation advocated in the early 1900s have changed dramatically.  Now more focus is laid upon conservative approach to the tooth preparation.  Therefore the introduction of adhesive restorative materials has reduced the need for an extensive tooth preparation.  In order to successfully accomplish this, dentin bonding systems have been introduced which bond the composite resin to the tooth structure.
  5. 5.  In 1955,Michael Buonocore described a clinical technique that used a diluted phosphoric acid to etch the enamel surface to provide retention of unfilled, self-cured acrylic resins.  The resin would mechanically lock to the microscopically roughened enamel surface, forming small "tags" as it flowed into the 10-µm to 40-µm deep enamel microporosities and then polymerized.  The first clinical use of this technique was the placement of pit and fissure sealants.  The formation of resin micro tags within the enamel surface is the basis of RESIN-ENAMEL ADHESION.  The steps involved are:
  6. 6.  Acid etching transforms smooth enamel into an irregular surface & increases its free surface energy  Application of a fluid resin based material to the irregular etched surface , facilitates penetration of the resin into the surface aided by capillary action  Monomers in the material are polymerised and the material becomes interlocked with the enamel surface.
  7. 7.  Enamel etching leads to the following types of micro morphological patterns:  TYPE 1 ETCH PATTERN-dissolution of prism cores without involvement of prism peripheries.  TYPE 2 ETCH PATTERN-PERIPHERAL ENAMEL IS DISSOLVED , but the cores are left intact.  TYPE 3 ETCH PATTERN-it is less distinct than the other two patterns.
  8. 8.  Buonocore used 30-40% phosphoric acid.  Currently,37% phosphoric acid in gel form is used.  Silverstone found that the application of 30-40% phosphoric acid resulted in a very retentive enamel surface.  >40% - Calcium salts are less dissolved - ETCH pattern with poorer definition.  <27% - Formation of dicalcium phosphate dihydrate - cannot be easily removed by rinsing.
  9. 9.  Currently, an etching time of 15 seconds is used.  An etching time of 60 seconds originally was recommended for permanent enamel using 30-40% phosphoric acid.  However , studies show that a 15 second etch resulted in a similar surface roughness as that provided by a 60 second etch.
  10. 10. Phosphoric acid is said to be a more aggressive acid,so alternative etchants have been suggested:  EDTA (24%; ph=7)  Citric acid  Tannic acid  Maleic acid  Polyacrylic acid ALTERNATE ETCHANT SYSTEMS:  Lasers  Air abrasion-Al2O3 particles
  11. 11. LASERS  Adhesion to dental hard tissues after Er:YAG laser etching is inferior to that obtained after conventional acid etching.  Enamel and dentin surfaces prepared by Er:YAG laser etching show extensive subsurface fissuring that is unfavorable to adhesion. (J Prosthet Dent 2000.)  Adhesion to laser-ablated or laser-etched dentin and enamel was inferior to that of conventional rotary preparation and acid etching. ( Dental Materials (2005) )
  12. 12.  Bonding to dentin is challenging & difficult.  Adhesion to dentin occurs by mechanical method,chemical or both.  But the main method is by penetration of adhesive monomers into collagen fibrils which are exposed post acid etching.  Structural differences exist between enamel & dentin.  Therefore the following reasons account for challenges faced in dentin adhesion:  STRUCTURE OF DENTIN  SMEAR LAYER  STRESSES AT RESIN-DENTIN INTERFACE
  13. 13.  Enamel contains 90% of hydroxyapatite crystals whereas dentin has only 50% and the rest is constituted by water(25%) and type I collagen(25% by volume).  Dentinal tubules exert pressure of 25-30mmHg, thus creating decreased stability of bond between composite resin and dentin.  The number of dentinal tubules decreases from about 45000 near the pulp to 20000 near DEJ
  14. 14.  It is the residual organic or inorganic components formed when a tooth is prepared using a bur or other instrument. (Sturdevant’s Art & Science of operative dentistry,4th edition)  It is 1-10 µm thick .
  15. 15. COMPOSITION OF SMEAR LAYER:  According to SEM studies done by Shulien TM(1988),it consists of:  Small particles of mineralized collagen matrix  Inorganic tooth preparation  Saliva  Blood  Bacteria  According to branstroem,the organic component consisted of coagulated proteins from collagen denatured by frictional heat of cutting.
  16. 16.  Therefore optimal bonding can occur by: 1.Removal of smear layer by using etch and rinse adhesives. 2.Incorporation of smear layer into bonding layer by self- etch adhesives Complete removal of smear layer increases the dentin permeability by 90%.
  17. 17.  It is defined as ”a thin layer of resin applied between conditioned dentin and resin matrix of a composite.”  The term dentine bonding agents is no longer relevant as current bond agents bond to enamel and dentine.  Due to acid –etching ,micro leakage or loss of retention is not a hazard at the resin-enamel interface but its encountered at the resin-dentine interface.  Due to the differences in the composition of enamel and dentine,developing agents that will adhere to dentine was challenging due to the following reasons:  The high water content interferes with bonding.  Presence of a smear layer on the dentine surface.
  18. 18.  Therefore the bonding agent should be hydrophilic to displace the water ,permitting it to penetrate the porosities in dentine and react with the inorganic/organic components.  But, restorative resins are hydrophobic, therefore the bonding agent should contain both hydrophilic and hydrophobic components.  The hydrophilic part bonds with either calcium or collagen whereas the hydrophobic part bonds with the restorative resin.
  19. 19.  It is the etching of dentin surface with acids or calcium chelators.  So, when acid is applied to it, dissolution of hydroxyapatite crystals in intertubular dentin and outer surface of peritubular dentin occurs  Ultimately, the smear layer gets removed and collagen fibrils are exposed.  Materials used are: 1. 37% phoshporic acid 2. nitric acid 3. citric acid 4. EDTA (ethylene diamine tetra-acetic acid)
  20. 20. Ideal duration is 15-20 seconds. Increased duration: greater collapse of collagen due to denaturation. Decreased monomer infiltration. Decreased duration: insufficient depth of etching.
  21. 21.  It is the process of applying primers to the etched/conditioned dentin surface to improve the diffusion of the adhesive resin into moist and demineralized dentin  Primer solution is a mixture of monomers with hydrophilic and hydrophobic components dissolved in organic solvent  Priming agents are HEMA(hydroxyethyl methacrylate) and 4- META(4-methacryloxyethyl trimellitae anhydride)
  22. 22. Acid washing / rinsing Removes smear layer Dissolves HA Drying shrinks remaining Collagen polymer molecules Rehydration / priming Swells collagen Mechanism of dentine bonding
  23. 23. Monomer penetration Mechanism of dentine bonding Monomer polymerisation And collagen entanglement
  24. 24. 1. HISTORICAL STRATEGIES  FIRST GENERATION(1965)  SECOND GENERATION(1978)  THIRD GENERATION(1984) 2. CURRENT STRATEGIES  ETCH & RINSE ADESIVES i. THREE STEP-ETCH &RINSE ADHESIVE(FOURTH GENERATION) ii. TWO STEP –ETCH & RINSE ADHESIVE(FIFTH GENERATION)  SELF ETCH ADHESIVES  TWO COMPONENT –SELF ETCH ADHESIVE(SIXTH GENERATION) o TWO STEP-TWO COMPONENT –SELF ETCH ADHESIVE o ONE STEP –TWO COMPONENT - SELF ETCH ADHESIVE  SINGLE COMPONENT-ONE STEP-SELF ETCH ADHESIVE(SEVENTH GENERATION)
  25. 25. Current strategies ETCH & RINSE ADESIVES SELF- ETCH ADHESIVES THREE STEP-ETCH & RINSE ADHESIVE TWO STEP –ETCH & RINSE ADHESIVE (FOURTH GENERATION) (FIFTH GENERATION) TWO COMPONENT –SELF ETCH ADHESIVE SINGLE COMPONENT - ADHESIVE ( SIXTH GENERATION ) ( SEVENTH GENERATION) TWO STEP-TWO COMPONENT –SELF ETCH ADHESIVE ONE STEP –TWO COMPONENT - SELF ETCH ADHESIVE
  26. 26. BASED ON MODERN ADHESION STRATEGY: Van Meerbek et al(2001) suggested a classification based on adhesion strategy. TYPE OF ADHESIVE STEPS INVOLVED ETCH AND RINSE ADHESIVES THREE STEP ADHESIVE:FOURTH GENERATION TWO STEP ADHESIVE:FIFTH GENERATION SELF ETCH ADHESIVES TWO STEP ADHESIVE:SIXTH GENERATION ONE STEP ADHESIVE:SEVENTH GENERATION
  27. 27.  BASED ON THE TREATMENT OF SMEAR LAYER:  Smear layer modifying  Smear layer removal  Smear layer dissolving
  28. 28. DECADE BONDING AGENT FEATURES 1960s 1970s FIRST GENERATION SECOND GENERATION • DENTIN ETCHING WAS CONTRAINDICATED • ADHESION WAS TO SMEAR LAYER • WEAK BOND STRENGTH 1980s THIRD GENERATION • ETCHING ENAMEL & DENTIN • PRIMING-A SECOND STEP WAS DONE • BETTER BOND STRENGTH EARLY 1990s FOURTH GENERATION • TOTAL ETCH CONCEPT WAS INTRODUCED • WET BONDING & HYBRID LAYER CONCEPTS INTRODUCED • MULTIPLE TECHNIQUE SENSITIVE CLINICAL STEPS MID 1990s FIFTH GENERATION • PRIMER & ADHESIVE COMBINED IN ONE BOTTLE • HIGHER BOND STRENGTHS LATE 1990s SIXTH GENERATION • INTRODUCTION OF SELF-ETCHING PRIMERS • POST OPERATIVE SENSITIVITY WAS REDUCED • LOWER BOND STRENGTHS EARLY 2000s SEVENTH GENERATION • ALL IN ONE/ONE STEP BOND CONCEPT INTRODUCED • BOND STRENGTH LOWER THAN 4TH & 5TH GENERATIONS
  29. 29.  Most products use a three-component system consisting of a conditioner, primer, and adhesive. 1. CONDITIONER (CLEANSER, ETCHANT) –  weak organic acid (e.g., maleic acid),  a low concentration of a stronger inorganic acid (e.g., phosphoric or nitric acid)  a chelating agent (e.g., EDTA).
  30. 30.  MAIN ACTIONS:  Alters or removes the smear layer.  demineralizes peritubular and intertubular dentin  exposes collagen fibrils --demineralizes up to a depth of 7.5 microns.  peritubular dentin is etched more deeply than the intertubular dentin increases dentin permeability.
  31. 31.  PRIMER  bifunctional monomer in a volatile solvent such as acetone or alcohol  examples of HEMA (hydroxyethyl methacrylate), NMSA (N-methacryloyl-5- aminosalicylic acid), NPG (N-phenylglycine), PMDM (pyromellitic diethylmethacrylate), and 4-META (4- methacryloxyethyl trimellitate anhydride).
  32. 32.  MAIN ACTIONS:  Links the hydrophilic dentin to the hydrophobic adhesive resin  Promotes infiltration of demineralized peritubular and intertubular dentin  increases wettability of the conditioned dentin surface
  33. 33.  ADHESIVE (BONDING RESIN):  It is an unfilled or partially-filled resin; may contain some component of the primer (e.g., HEMA) in an attempt to promote increased bond strength.  MAIN ACTIONS:  Combines with the primer s monomers to form a resin- reinforced hybrid layer ( resin-dentin interdiffusion zone ) 1 to 5 microns thick.  Forms resin tags to seal the dentin tubules
  34. 34.  It consisted of surface active co-monomer NPG-GMA(N- phenylglycine glycidyl methacrylate)  MECHANISM OF ACTION:  This co-monomer could chelate with calcium on the tooth surface to generate chemical bonds of resin to calcium.  Example:  Cervident(S S White burs,Lakewood)
  35. 35.  Clinical result:  It had poor bond strength of 2-3MPa.  Therefore when used to restore noncarious cervical lesions without mechanical retention.
  36. 36. SECOND GENERATION DENTIN BONDING AGENT:  Introduced in 1978.  They were based on phosphorous esters of methacrylate derivatives. MECHANISM OF ACTION:  Adhesion was by means of ionic interaction between the negatively charged phosphate groups & positively charged calcium in the smear layer.  Advantage:  Bond strength was 3 times higher than the earlier ones.  Disadvantage:  Bond strength was still lower around 5-6 Mpa.  Clinical failure due to the bonding instability in the wet oral environment & their primary bonding to the smear layer and not the dentin.
  37. 37.  ADVANTAGE:  Bond strength was 3 times higher than the earlier ones.  DISADVANTAGE:  Bond strength was still lower around 5-6 Mpa.  Clinical failure due to the bonding instability in the wet oral environment & their primary bonding to the smear layer and not the dentin.
  38. 38.  EXAMPLES:  Clearfil Bond System(Kuraray,Japan)  Scotchbond(3M ESPE)  Bondlite(Kerr Corporation.CA)  Prisma Universal Bond(Dentsply)
  39. 39.  It was a phosphate based material containing HEMA and a 10- carbon molecule 10-MDP(10-methacryloyloxy decyl dihydrogen phosphate)  These were introduced with Clearfil New Bond in 1984. MECHANISM OF ACTION:  The concept of phosphoric acid etching of dentin before the application of a phosphate ester type of bonding agent was put forward by FUSAYAMA et al in 1979
  40. 40.  Most of the other III generation bonding agents were designed not to remove the smear layer but only to modify it and therefore allow the penetration of acidic monomers like pheny-P or PENTA(dipentaerythritol penta-acrylate monophosphate)  EXAMPLES:  Clearfil New Bond(Kuraray)  Scotchbond 2(3M ESPE)
  41. 41. Adhesive system Etchant Primer Adhesive Bond strength Scotch Bond 2 2.5% maleic acid + 55% HEMA HEMA Bis GMA 8.8 Mpa Tenure Oxalate bonding system aluminium oxalate in 2.5% nitric acid NPG-GMA. BisGMA, TEGDMA 15 Mpa This generation attempted to deal with both the smear layer and dentinal fluid, with following 2 approaches: i. Smear layer modification to improve its properties. ii. Remove s.layer without disturbing the smear plugs that occlude dentinal tubules.
  42. 42. 1. ETCH AND RINSE ADHESIVE: The smear layer is considered to be an obstacle that must be removed to permit resin bonding to dentin. The next generation of dentin adhesives was introduced for use on acid –etched dentin. The clinical technique involves simultaneous application of an acid to enamel & dentin.This was called as total-etch technique.
  43. 43. MECHANISM OF ACTION: application of acid to dentin results in complete or partial removal of smear layer and demineralization of dentin Intertubular & peritubular dentin are demineralised,thus exposing collagen fibres & increasing microporosity of intertubular dentin 7.5µm of dentin is demineralised Primer increases the free surface energy of dentin Formation of resin tags and hybrid layer.
  44. 44. IT CONSISTS OF ETCHANT PRIMER ADHESIVE
  45. 45.  Here three components came into being:  Phosphoric acid etchant(in gel form)  Primer –it consisted of hydrophilic monomers in ethanol , acetone or water.  Primer is a bifunctional molecule having a hydrophilic and a hydrophobic part.the former attaches to tooth whereas the latter attaches to composite resin.  Examples: HEMA NTG-GMA PENTA
  46. 46.  Bonding agent:  It consists of unfilled or filled resin which may be BisGMA(Bisphenol glycidyl methacrylate),UDMA(urethane dimethacrylate) with TEGDMA & HEMA(2-hydroxyethyl methacrylate).  Thus after the application of primer and bonding agent to etched surface aids in their penetration into intertubular dentin to form a resin-dentin inter diffusion zone called HYBRID LAYER which was introduced by Nakabayashi in 1982.
  47. 47.  ADVANTAGES:  Higher bond strength of 17-24MPa.  They show reliable and consistent results.  DISADVANTAGES:  Technique sensitive  Time consuming procedure  Over wetting or over drying of dentin may occur
  48. 48. • BRAND NAMES- • All Bond 2 & All Bond 3 • Optibond FL(Kerr Corporation) • Adper Scotchbond Multi-purpose(3M ESPE) • BOND STRENGTH- • 17-30 Mpa.
  49. 49.  CLINICAL STEPS INVOLVED:  STEP1:application of etchant gel(37% phosphoric acid) for 15 seconds .  STEP2:rinse the etchant thoroughly and blot dry the substrate (moist bonding technique)  STEP3:application of primer (bottle 1) on the substrate.  STEP4:application of adhesive(bottle 2)on the tooth substrate.  STEP5: light cure .
  50. 50. 1st step: -Total etching(removal of smear layer) Leaving free minerals on surface -Rinse surface -Without drying of surface (residual water left) 2nd step : adding primer 3rd step: Adding adhesive resin & then composite Composite Smear layer Residual water Primer Adhesive resin
  51. 51.  DEFINITION  “The structure formed in the dental hard tissue by demineralization of the surface and the sub-surface followed by infiltration of monomers & subsequent polymerization.” ( Nakabayashi,1982)  It is a hybrid combination of the above two. It is a process which creates a molecular level interfacebetween dentin and composite resin.
  52. 52. ZONES TOP LAYER MIDDLE LAYER BASE TOP LAYER :loosely arranged collagen fibrils directed towards adhesive resin. MIDDLE LAYER: collagen fibrils separated by electron lucent spaces(10- 20nm) represent areas in which HA crystals have been replaced by resin due to hybridization. BASE : partially demineralized dentin.
  53. 53.  This was developed to simplify the procedures involved in bonding.  Therefore , the primer and the bonding agent is present in a single bottle.  COMPONENTS:  ETCHANT GEL + PRIMER & ADHESIVE
  54. 54. It consists of BOTTLE I BOTTLE II (Etchant+Primer) (Adhesive)
  55. 55.  STEPS INVOLED ARE:  STEP1:application of etchant gel.  STEP2:rinse the etchant thoroughly and blot dry the substrate (moist bonding technique)  STEP3:application of primer and adhesive (single bottle)  STEP4:light cure .  BRAND NAMES:  Prime & Bond NT(Dentsply)  Adper single bond2  ExciTE(Ivoclar,Vivadent)  One coat Bond  XP Bond
  56. 56.  They are defined as “bonding systems which dissolve the smear layer and create porosities in the underlying dental substrates without needing an extra conditioning agent(eg:phosphoric acid) to be applied in a single step. (Quintessence International,vol(8), nov-dec2013)  No separate etching step is needed.  ADVANTAGES:  Decrease in the number of steps  Less technique sensitive.
  57. 57.  The self-etching approach has been proposed in an effort to simplify the dentin/enamel bonding systems.  These materials combine tooth surface etching and priming steps into one single procedure.  The elimination of separate etching and rinsing steps simplified the bonding technique and has been responsible for the increased popularity of these systems in daily practice.
  58. 58.  Based on the acidity of self-etch primers & adhesives, they are classified as:  Weak- pH-2  Medium pH-1.5  Strong pH≤1  Most commonly pH ranges from1.3-2.7
  59. 59. SELF-ETCH ADHESIVES 2 COMPONENT SELF-ETCH ADHESIVES 1 COMPONENT SELF-ETCH ADHESIVES (VI GENERATION) (VII GENERATION) 2 STEP & 2 COMPONENT I STEP BUT 2 COMPONENT
  60. 60. 1. 2 STEP : 2 COMPONENT SELF-ETCHING ADHESIVES: (NONRINSING CONDITIONERS OR SELF PRIMING ETCHANTS) MECHANISM OF ACTION:  These acidic primers contain phosphonated resin molecule that performs two function:  Etching and priming of enamel  Incorporating smear plugs into resin tags.
  61. 61.  Steps involved are:  Application of bottle I(etchant +primer)  After 10 s, application of bottle2 on tooth surface  Light cure  BRAND NAMES:  Clearfil SE Bond(Kuraray,Japan)  AdheSE(Ivoclar-Vivadent)  Optibond Solo Plus Self-etch(Kerr Corp)
  62. 62. 2. ONE STEP:TWO COMPONENT-SELF-ETCH ADHESIVE:  consists of- BottleI +Bottle II  Bottle I:conditioner +primer  Bottle II: adhesive resin  Both have to be mixed prior to application on tooth surface.  BRAND NAMES:  Xeno III(Dentsply)  One up bond(Tokuyama)  Prompt L bond(3M ESPE)
  63. 63.  Self etching primers are acidic in nature, leading to its penetration along the aqueous channels found in the smear layer and widening them.  These offer a simpler clinical step when compared to the tota;l etch adhesive systems.  self etching primers contain acidic esters like HEMA,TEGDMA,MDP.  These primers are similar to those found in third generation dentin bonding systems, the only difference being that in the latter ones only milder acids were used leading to inability to etch beyond the smear layer.
  64. 64.  In the sixth generation dentin bonding systems, acidic monomers like 4-MET and 10-MDP are used ,thus dissolving the smear layer.  When the concentration of acidic monomers increasd from 5-10% wt %(III generation dentin bonding agent) to 30-40% (VI generation dentin bonding agent) and dissolved in 30-40% HEMA, pH-1-2 was developed which aided in etching through smear layer.
  65. 65.  ADVANTAGES  No etching needed, therefore possibility of over-etching or over- drying is removed  Less technique sensitive.  Self-etch adhesives are less likely to result in discrepancy between depth of demineralization and depth of resin infiltration as both the processes are done simultaneously.  Less time consuming  DISADVANTAGES  Decreased shelf life  Incompatible with chemical cure composites.  Self-etch adhesives that are currently available do not etch as efficiently as phosphoric acid, especially if the enamel has not been instrumented.
  66. 66.  TYPE 2 ( TWO BOTTLE 1 STEP SYSTEM):  Liquid A contains primer.  Liquid b contains a phosphoric acid modified resin.  Both are mixed before application.  Eg:Xeno 3(Dentsply),Adper-prompt L-pop(3M).
  67. 67.  Here the etchant, primer and the adhesive resin are combined into one bottle .  In vitro studies have shown that tooth-restoration interface created when using self etching adhesives do not eliminate the micro leakage and bacterial penetration, which can lead to secondary caries.  (Kakar S,Goswami M,nagar R.Dentin bonding agents-2 Recent trials. World J Dent2012;3(1);115-118.
  68. 68.  ADVANTAGES OF VII GENERATION DENTIN BONDING AGENTS:  Lesser application time  Decrease in errors with each step.
  69. 69.  Examples are:  iBond(Heraeus kulzer)  G bond(GC)  XenoIV(Dentsply)  Clearfil S3(Curare)  XenoV+ XenoV+
  70. 70.  In 2012, the term “universal adhesive” has been given several definitions which are: a)Can be used in total-etch, self-etch, and selective etch techniques; b)Can be used with light-cure, self-cure, and dual-cure materials (without the separate activators); c)Can be used for both direct and indirect substrates; d)Can bond to all dental substrates, such as dentin, enamel, metal, ceramic, porcelain, and zirconia.
  71. 71. In November 2011, a new “ScotchBond Universal” was discovered. Which needs a separate self-cure activator or a special amine-free dual-cure cement when in use with dual-cure or self-cure materials, hence not a truly “universal” adhesive.
  72. 72.  In March 2012, a “All-Bond Universal” was discovered, which can be used in: i.total-etch, self-etch and selective etch techniques, ii.can be used with any dual-cure, self-cure and light-cure materials without the need of a separate activator, iii.can also be used for both direct and indirect substrates, and can bond with any dental substrates.  All-Bond Universal is the first truly “universal adhesive”.
  73. 73. In today’s era, numerous improvements in materials and procedures have been made to meet the growing aesthetic demands of the patients.  In all the aesthetic restorations a bonding step is involved to ensure durability and reliability.
  74. 74.  Thus the ideal bonding system should be biocompatible, bond perfectly to enamel and dentin, have sufficient strength to resist to failure as a result of masticatory forces, have mechanical properties close to those of tooth, and be resistant to degradation in oral environment and easy to use.
  75. 75.  STURDEVANT'S ART & SCIENCE OF DENTISTRY-4TH, 5TH & 6TH EDITION  PHILLIPS-SCIENCE OF DENTAL MATERIALS...11TH EDITION  TOOTH COLORED RESTORATIVES-PRINCIPLES AND TECHNIQUES..9TH EDITION  PICKARD'S MANUAL OF OPERATIVE DENTISTRY...8TH EDITION

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