Adhesives, Cements and Intraoral Repair
(Last updated: September 2, 2015)
ADHESIVE for direct bonding to enamel and dentin
Ultra-Etch 35% phosphoric acid (Ultradent) - Stocked
Optibond FL (Kerr) - Stocked
- Apply 35% phosphoric acid to enamel first, and then to dentin making sure that the etchant remains on dentin for LESS than 15 seconds. Rinse thoroughly for 15 seconds. Completely remove excess moisture from operating field, then from preparation with cotton pellet, sponget or microbrush. Dentin surface should appear slightly moist.
- Apply Primer (#1) with microbrush for 30 sec with continuous gentle agitation. Replenish primer as needed.
- Initially air dry primer gently, and then finish with moderate air pressure to evaporate all solvents. The dried surface should present a shiny, evenly primed appearance.
- Apply Adhesive (#2) with an applicator brush or microbrush to spread evenly, removing excess to avoiding pooling or marginal buildup. Do not use air syringe to disperse adhesive.
- Light cure for 30 sec. (18 J)
- Apply resin-based composite.
ADHESIVE for indirect bonding of "ceramic" restorations
All Bond TE Adhesive and ACE dispenser (Bisco)
Tooth Surface Treatment
- After isolating adjacent teeth (clear matrix strips) apply 35% phosphoric acid to enamel first, and then to dentin making sure that the etchant remains on dentin for LESS than 15 seconds. Rinse thoroughly for 15 seconds. Completely remove excess moisture from operating field, then from preparation with cotton pellet, sponget or microbrush. Dentin surface should appear slightly moist.
- Dispense ALL-Bond TE using the ACE dispenser into a dap pen dish, mix with an applicator for 5 sec.
- Again, protecting/isolating adjacent teeth (clean and dry clear matrix strips), apply 1-2 coats onto the entire tooth preparation with a light agitating motion for 5-10 seconds.
- Gently air dry until there is no visible movement of the material. Then dry thoroughly for a minimum of 10 sec. The surface should appear shiny; otherwise, apply additional coats of ALL-BOND TE and repeat.
- Light cure each surface for 10 sec at 500mW/cm2. (Optional when using Duo-Link from Bisco)
- Apply Duo-Link resin cement to the internal surface of the restoration directly from the syringe.
- Seat each restoration with gentle, passive pressure.
- Remove excess cement immediately with a brush or instrument.
- Light cure each surface of the restoration for 40 seconds
- Check occlusion.
- Clean up excess and polish margins if necessary with resin composites polishers. Porcelain surfaces should be adjusted and polished with ceramic polishers.
- Optional: Clean surface/margins and apply surface sealant and light cure
Directions for use: http://www.bisco.com/instructions/IN-187R1_English.pdf
Adhesive resin cementation guides for ‘ceramic’ restorations
(Dr. Marcos A. Vargas - Department of Family Dentistry)
Ceramic Restorations Classification
Note: If not previously silanated by lab, confirm restoration fit on model, clean restoration and apply silane in advance of patient visit. Silane bond "maturation" has been shown to improve bonding to ceramic. Silane will not subsequently be removed by ultrasonic cleaning in alcohol or phosphoric acid cleaning after patient try-in.
Lava Ultimate Restorative for chairside CAD/CAM
- Complete try-in, adjustment, finishing and polishing steps
- Air abrade with aluminum oxide less than or equal to 50 micron at two bars (30 psi) until entire bonding surface has a matte appearance
- Clean with alcohol and dry thoroughly
- Apply silane (Bis Silane A & B - Bisco)
- Apply adhesive (All Bond TE adhesive - Bisco)
- Apply cement and seat (Duo-Link - Bisco)
Luting and Resin Cements
Calibra (Dentsply/Caulk) – clinic approved, available in OPER
DUO-LINK (Bisco) – clinic approved, available in OPER
Panavia 21 (Kuraray) – clinic approved, available in OPER
Panavia V5 (Kuraray) – may replace Panavia 21 in near future, available in OPER
FujiCem 2 (GC America) – clinic approved, available in OPER
Flecks Cement (Mizzy) - stocked
Luting Recommendations Table
|Adhesive resin cement||RMGI||GI||Zinc phosphate|
|Resin-based Composite (RBC)||XXX|
Intraoral Repair Kit (Bisco)
Clinic Approved - Available in Oper
Chair side AIR ABRASION (NOT involving enamel or dentin)
CoJet Silicate Ceramic Surface Treatment System (3M ESPE)
- Description: High-purity aluminum oxide 30 μm, modified with silica (SiO2). Embeds a ceramic layer on the surface of metal, porcelain or previously cured composite, producing/enabling silane coupling with composite by a chemical bond.
- Applications: Intraoral repair of fractured composite or porcelain, even with exposed metal. Extra oral pre-treatment of inlays/onlays, veneers, crowns and bridges, and pins and posts for adhesive luting. Rocatec lab system is also marketed for extra oral surface preparation.
Chair side AIR ABRASION(when enamel and/or dentin is involved)
Alumina 50 micron (Ivoclar Vivadent)
- Description: Alumina (Al2O3) air abrasive.
- Applications: Use when CoJet silicate abrasive is indicated but enamel and dentin is also to be bonded. CoJet interferes with bond to tooth structure.
Porcelain etchant: Buffered hydrofluoric acid gel (Bisco)
clinic approved – available in OPER
- intraoral repair
- preparing restorative material surface for luting
- HF porcelain etchant improves the adhesive bond between porcelain and RBC/cement by increasing the surface area of the porcelain to be bonded.
HF porcelain etchant is available in 2 concentrations:
9.5% - reduce etching time during intraoral repair
4% - during preparing restorative porcelain for luting
- BARRIER GEL is placed where etching is not desired
Bis SILANE (Bisco)
- Description: BIS-SILANE is a two-part silane coupling agent that is used to enhance adhesion between porcelain and composite resins. Based on clinical experience, it has been noted that the silane, as packaged in the one-bottle systems, tends to polymerize as it approaches the end of its shelf life. The two-bottle silane system offers a more stable system to ensure effective bonding to porcelain. Silane is a dual function monomer consisting of a silanol group that reacts with the porcelain surface, and a methacrylate group that co-polymerizes with the resin matrix of the composite. Silane coupling agents are known to enhance the wettability of glass substrates by composite resins, increase physical, mechanical and chemical bonding of composite to porcelain, and yield a greater resistance to water attack at the bonding interface.
- Prior to applying BIS-SILANE, the porcelain surface must be etched with buffered hydrofluoric acid. This process allows porcelain to become not only highly porous, but also highly receptive to the silane by creating reactive hydroxyl groups on the surface of the porcelain.
Directions for use:
- Mix the BIS-SILANE by dispensing one drop from each of the two bottles (Parts A & B) into a mixing well and stir. Brush on 1-2 coats (thin coats are sufficient) of BIS-SILANE to the internal surface of the etched porcelain restoration and wait for 30 seconds. Dry with (warm if available) air syringe. NOTE: Surface of the porcelain will look the same after BIS-SILANE application to the naked eye.
- Continue with cementation procedures.