Dental Materials Bonding

Front 1

Bonding describes…

Back 1

A process of attachment (adhesion)
*Per Mrs. Fox, 2 materials become 1.*

Front 2

What will enamel bond to?

Back 2

Sealants
Composite Resins (any class)
Porcelain (inlay, onlay & veeners)

Front 3

What will dentin bond to?

Back 3

Composite Resins (Class 1,2, 3 & 4)
Porcelain (inlay, onlay & veneers)

Front 4

Why do we not bond a class 5 restoration to dentin?

Back 4

A class 5 is at the CEJ. We would be cutting into enamel or cementum (at root surface).
We wouldn't be going so deep as to reach the dentin.

Front 5

Describe an "inlay"

Back 5

Doesn't include a cusp tip.

Front 6

Describe an "onlay"

Back 6

It does include a cusp tip.

Front 7

On the GV Black Classificatin of carious lesions, describe a Class I & Class II lesion

Back 7

Class I: Occlusal area & buccal or lingual pits.
Class II: Posterior Interproximal

Front 8

On the GV Black Classificatin of carious lesions, describe a Class III & Class IV lesion

Back 8

Class III: Anterior Interproximal
Class IV: Anterior Interproximal including the incisal corner

Front 9

On the GV Black Classification of Carious Lesions, describe a Class V & VI carious lesion

Back 9

Class V: Gingival at facial or lingual
Class VI: Cups Tip

Front 10

Which materials do we most often see in bonding?

Back 10

Amalgam to enamel
Comoposite (resin) to enamel
*Remember, there is a chemical reaction happening. The attraction is between the different molecules of each surface.*

Front 11

What is the 2 step prep for bonding?

Back 11

1) Remove plaque & debris
2) Etch or condition the surface w/most common acid.

Front 12

What is the most common acid used in the prep for bonding?

Back 12

10-38% phosphoric acid

Front 13

What is the purpose of the 10-38% phosphoric acid?

Back 13

To demineralize (etch) the surface-->create roughness & allow for microscopic porosity.
*These two items allow for better bonding.*

Front 14

What does the term "polymerizes" refer to?

Back 14

Curing/Hardening (baked, cooked)

Front 15

When bonding to an etched surface, now that the surface is "porus" what does this mean for the resin or primer?

Back 15

The etched or porus surface allows the resin/primer to flow over and into the pores. It allows for better retention.

Front 16

What does the resin or primer do after flowing over the surface?

Back 16

It polymerizes (hardens) and creates resin "tags" in the pores creating a mechanical bond.

Front 17

When the material flows into the pores, what type of bond is created?
What is the material called that flows into the pores?

Back 17

Physical or Mechanical Bond

The tags

Front 18

What is it about the bonding process that is allowing for the physical or mechanical bond?

Back 18

The resin tags, by extending into the pores and "locking" in place

Front 19

Good wetting is an example of what type of surface energy?

Back 19

High Surface Energy-->the product will flow!

Front 20

If the product is "beading up" what type of surface energy do you have?

Back 20

Low surface energy

Front 21

How is bond strength determined?

Back 21

By Tensile force …pulling in opposite directions

Front 22

Bond strength is measured in MPa's (Know this for Boards!) What does MPa stand for?

Back 22

Mega Pascals
1MPa = 150psi

Front 23

When bonding to Enamel what level of MPa is considered good?

Back 23

30 Mpa…(4500psi)

Front 24

Do you need more or lessing bonding when "attaching" to dentin? Why?

Back 24

Less
Because dentin has tubules present which the product will naturally flow into and create a better bond.

Front 25

What if there is fluid in the dentinal tubules?

Back 25

The fluid can reduce the bonding…as such we would use products that bond in the presence of fluid.

Front 26

What factors can impact the effects of bonding? (4 items)

Back 26

Moisture
Chewing Pressure
Temperature Changes
Expansion & Contraction

Front 27

If the bond eventually fails what can be the result?
(2 items)

Back 27

Sensitivity
Root Caries
(both due to the loosening of the bond)

Front 28

What is the purpose of a dental dam?

Back 28

It serves as a safet net!

Front 29

Why is enamel etching often blue in color?

Back 29

So you can see where its going.
It's also gelatinous so you can "control" where it goes.

Front 30

What material is actually being removed in the etching process?

Back 30

The hydroxyapatitate of the enamel rods

Front 31

What is the optimal Enamel etching time for permanent teeth?

Back 31

20-30 seconds (includes both enamel & dentin)

*Can be as little as 10 seconds if etching enamel only. *

Front 32

What is the Enamel etching time for primary teeth?

Back 32

60 seconds

Front 33

How does the surface appear after etching?

Back 33

"frosty"

Front 34

What do you have to do after placing the acid for the proper amount of time?

Back 34

Rinse it away! Avoid getting it on any soft tissue.

Front 35

What 6 items can make up the smear layer?

Back 35

1) cut tooth structure
2) plaque
3) bacteria
4) pellicle
5) saliva
6) blood
**Can't simply be washed away with Air or Water as its very sticky.**

Front 36

What does the smear later do in relation to dentin?

Back 36

Interferes with the bonding to dentin.

Front 37

What has to happen to remove the smear layer?

Back 37

You have to etch it.
*The etching happens at the same time..the enamel etch and the dentin etch. Its not two separate processes.*

Front 38

What will etching the dentin remove?

Back 38

The smear layer!
*Think of the smear layer as "the sludge".

Front 39

What is the optimal Dentin etching time of Permanent teeth?

Back 39

10 seconds..so if doing a deeper restoration you're etching both enamel & dentin for a total of 20-30 seconds.

Front 40

What is found inside the dentinal tubule?

Back 40

odontoblasts!

Front 41

Why does the dentinal tubule need to be kept partially moist?

Back 41

It allows for a better bond.

*Think of it as a sponge..a dry sponge won't absorb anything but a damp sponge will.*

Front 42

What is usually used when bonding to enamel?

Back 42

A curing light

Front 43

When bonding to enamel what needs to be penetrataed to ensure adhesion?

Back 43

The material needs to penetrate enamel rods…the tags will secure the resin

Front 44

What does a shallow or Class I composite restoration bond to?

Back 44

Etched rods

Front 45

What bond is greater? End etched rods or side etched rods?

Back 45

End etched rods

Front 46

What is a class I restoration bonding to?

Back 46

End etched rods…coming in from the occlusal surface. A class II or III is bonding to the side etched rod as it is an interproximal restoration.

*Sometimes the Dr will carry the prep into the occlusal surface to ensure a little better bond.*

Front 47

What are some reasons there might be a failure to bond?

Back 47

Failure to isolate the area
Surface contaminants-->saliva, blood, debris

Front 48

What has to happen if the bonding area is contaminated…like if a Pt runs their tongue over the area?

Back 48

Must re-Etch for 10-15 seconds

Front 49

When bonding to dentin what is used 1st? 2nd?

Back 49

1st: primer (hydrophillic-->allows to penetrate H20)
2nd: use adhesive resin over primer

Front 50

What is this 2 step bonding process called that is currently being used?

Back 50

Wet Dentin Bonding

Front 51

What is the primer material for dentinal bonding?

Back 51

Acetone
*It will evaporate so apply twice.*

Front 52

What are 3 modes of curing?

Back 52

Self Cure--> chemical reaction between the 2 materials Light Cure-->accelerates the bond using a blue light wave range.
Dual-cure-->Combination of the two.

Front 53

Where does microleakage take place?

Back 53

At the junction of the restoration and the tooth

Front 54

What can cause microleakage?

Back 54

Expansion/contration of the area.

Front 55

What does microleakage contribute to?

Back 55

Recurrent decay, sensitivity, and possibly the loss of the restoration

Front 56

What is the theory behind hypersensitive teeth?

Back 56

Hydrodynamic theory!

Front 57

What happens if the resin is cured in increments?

Back 57

You can ensure each layer is completely cured and thus reduce the opportunity for shrinkage-->microleakage.

Front 58

What are some clinical applications of when bonding is utilized?

Back 58

Porcelain
Metal
Amalgam
Orthodontic Brackets
Endodontic Posts

Front 59

Where are composite (tooth colored) restoration used?

Back 59

Anteriorly and now often in the posterior region as well.

Front 60

What is added to the composite to match the tooth?

Back 60

Pigments

Front 61

What is mixed together to get the composite?

Back 61

Organic resin matrix & Inorganic filler particles.
(They are joined by saline which causes the organic & inorganic elements to bond.)

Front 62

What is the most common resin matrix called?

Back 62

Bis-GMA

Front 63

The filler components of resin/composite restoration does what?

Back 63

Makes the resin stronger & resistant to wear, allows for either radiolucency or radiopacity.

Front 64

Composites will wear. The irregular surface is a result of:

Back 64

erosion and loss of filler particles.

Front 65

What are the 3 types of polymerization?

Back 65

1) Chemical cure (self cure)
2) Light Cure
3) Dual Cure (combination)

Front 66

What 2 items make up the self cured composite?

Back 66

Base + Catalyst
*Usually supplied as a paste, in jar, or syringe cartridge-->sometimes a preloaded cartridge.*

Front 67

What type of curing is most comon?

Back 67

Light Curing
*There is no mixing involved and it gives the DH more control*

Front 68

What do you need to be cautious of when light curing?

Back 68

That your "loops" light isn't on or any operatory light.

*Be sure to cure in 2mm increments*

Front 69

What makes up a dual cure composite?

Back 69

2 paste system-->cure light will initiate the set reation.

*Its ideal for core buildup of endo treated teeth.*

Front 70

What is a hybrid composite?

Back 70

A combination of Macrofilled (big parts) & Microfilled (little parts) elements.

Front 71

What is a flowable composite?

Back 71

A light cured, low viscosity composite resin.
*Delivered from a syringe*

Front 72

What is a packable composite?

Back 72

A light cured, highly viscous material…"scooped" into site, doesn't spread.

Front 73

What is a smart composite?

Back 73

One that releases fluoride into the prep over time.

Front 74

What is a core build up?

Back 74

Adding material so a crown can be placed..Is used if there isn't enough tooth structure for a crown, so its "built up."

Front 75

Provisional is another word for _________.

Back 75

Temporary

Front 76

What are some characterists of Macrofilled composites? (6 items)

Back 76

Large filler particles
Hard to polish
Will become rough
Will stain
Stronger than microfilled composites
Require replacement sooner-->will breakdown
Rarely used-->due to improved products.

Front 77

What did microfilled composites replace?

Back 77

Macrofilled composites

Front 78

What are some characterists of Microfilled composites? (4 items)

Back 78

Smooth/shiny surface
Poor strength
Not suitable for class I, II or IV restorations
Used primarly for esthetic anaterior fills

Front 79

What can be said about Hybrid Composites? (4 items)

Back 79

Best Product to date
Contains both micro & macro size fillers
Provides both strength & polish
Can be used in both posterior & anterior.
*Do know that composites will shrink due to porosity.*

Front 80

Flowable composites can be __________________________.

Back 80

placed directly in to the prep…they adapt well to small areas.
*Sometimes they are used as sealants.*

Front 81

When are packable composites utilized?

Back 81

Class I & Class II restorations (Occlusal & Posterior interproximal restorations)

*They are marketed as substitues for amalgams..more for posterior occlusal surfaces.*

Front 82

In addition to fluoride, what can smart composites release?

Back 82

calcium & hydroxyl ions…remineralizes effects of acid

Front 83

When would core buildup composites be utilized?

Back 83

For badly broken down teeth before placing a crown.

*Some contain pigment to contrast the color of tooth structure so its easier to place the crown…can see it better.*

Front 84

When would provisional restorative composites be utilized?

Back 84

They are temporary fills for lab processed restorations like: Inlays, onlays, crowns & bridges.

Front 85

What are some physical properties of composites? (8 items)

Back 85

1) Biocompatibility
2) Strength
3) Wear
4) Polymerization Shrinkage
5) Reduced or No Thermal Conductivity
6) Elastic Modulus (Thermal expansion similar to tooth structure)
7) Water Sorption (can stain)
8) Radiopacity..look less opaque than metal.

Front 86

What are some atributes of composite resins? (6 items)

Back 86

1) Used on all class of restoration
2) Not as durable as amalgam
3) More Costly $$
4) Tooth Colored
5) Prep is more conservative than amalgam..don't remove as much tooth structure
6) May be temperature sensitive-->due to porosity of material.

Front 87

What can be said about choosing a shade when using composites?

Back 87

You may have to customize the shade by mixing 2 shades together.
Can't always match
Most products come with a shade guide.

Front 88

Layering of a composite is used…..

Back 88

to design a specific color…start at cervical 1/3.

Front 89

What are 3 clinical consideratins of composites?

Back 89

1) Shelf life of product
2) Dispensing--reusable syringe, don't usually use entire amount so watch cross contamination
3) Cross Contamination--use barrier, wipe with disinfectant

Front 90

Glass Ionomer Cements tend to be ____________________

Back 90

more liquid in nature.
They aren't as strong as composites!

Front 91

What is a Type I Glass Ionomer cement used for?

Back 91

Cementation for crowns & bridges

Front 92

What is a Type II Glass Ionomer cement used for?

Back 92

Restorations

Front 93

What is a Type III Glass Ionomer cement used for?

Back 93

Liners & bases for cavity preps..helps with bonding & sensitivity

Front 94

Feldspar, Quartz and kaolin are all names refering to…..

Back 94

Porcelain restorations

Front 95

PFM stands for?

Back 95

Porcelin Fused to Metal

Front 96

PBM stands for?

Back 96

Porcelin Baked to Metal

Front 97

Porcelin will ________ under stress.

Back 97

Fracture…but it is strong enough to use in posterior teeth.

Front 98

What are some DH considerations for porcelain?

Back 98

No direct contact with Ultra Sonics!
Minimal hand scaling
Always use a soft brush
CPR prophy paste can be used for stain

Front 99

Porcelain Veneers will/will not disturb the natural tooth?

Back 99

Will Not!
They are very thin and the incisal edge usually wraps around to the lingual area.