Smear layer on dentin in restorative dentistry

TLDR: Self-etching primer systems are undergoing rapid evolution; their results are not yet sufficiently predictable overall, but some systems have achieved positive results in both enamel and dentin bonding.

Abstract: Adhesion to enamel has become a routine technique in restorative dentistry. Adhesion to dentin, however, is still under investigation. Except structural elements of the dentin, smear layer has been one of the reasons that the interaction between the adhesive system and this tissue is difficult. The smear layer tissue created by cutting a tooth. It varies in thickness, roughness, density and degree of attachment andoccludes tubules and reduces the dental permeabilita. Dentin adhesivesystems can react with intertubular and peritubular dentin only when this smear layer is removed or when the adhesive system is capable of diffusion through layer of debris. As part of restorative procedures required by adhesive dentistry, the smear layer must be removed, modified or impregnated by the resin to allow for bonding between the tooth and the restorative material. For remove and dissolve of smear layer acid conditioners on total etch and self-etching primers were used. Self-etching primer systems are undergoing rapid evolution; their results are not yet sufficiently predictable overall, but some systems have achieved positive results in both enamel and dentin bonding. Further studies are necessary to confirm the long-term efficiency of these self-etching primers.

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LVKRGUHVWDXUDWLYQHSURFHGXUHNRMDQDMþHãüHXNOMXþXMHL
NRQGLFLRQLUDQMHSRYUãLQHGHQWLQD
5D]PD]QLVORMQDGHQWLQX
3RUHGVWUXNWXUDOQLKNDUDNWHULVWLNDGHQWLQDNRMHSUHG
VWDYOMDMX]QDþDMQXSUHSUHNXSULDQMDQMXELORNRJPDWHULMDOD
]DGHQWLQMHGDQRGSUREOHPDXRYRMREODVWLSUHGVWDYOMDL
SULVXVWYR³UD]PD]QRJVORMD´VPHDUOD\HUNRMLVHVWYDUD
QDSRYUãLQLGHQWLQDWRNRPQMHJRYHREUDGHVHþHQMDURWL
UDMXüLPLQVWUXPHQWLPD

.DGDVHGHQWLQREUDÿXMHURWLUDMXüLPLQVWUXPHQWLPD
QDQMHJRYRMSRYUãLQLVHVWYDUDMHGQDVSHFLMDOQDSRYUãLQ
VNDVWUXNWXUDNRMDSRNULYDLPDVNLUDQRUPDOQXVWUXNWXUX
GHQWLQDLþHVWRSRNULYDRWYRUHSUHVHþHQLKWXEXOD


2YDMVORMNRML]DRVWDMHSRVOHSUHSDUDFLMHNDYLWHWDVDGUåL
RUJDQVNHLQHRUJDQVNHþHVWLFHVHþHQRJGHQWLQDSRPHãDQH
VDSULVXWQLPIOXLGLPDNDRãWRVXGHQWLQOLNYRURUDOQLL
VXONXVQLIOXLGLSOMXYDþNDLHYHQWXDOQRRVWDFLNUYL

%URMQDLVWUDåLYDQMDVXSRND]DODGDVHUD]PD]QLVORM
QDMþHãüHVDVWRMLL]GYDVORMDSRYUãLQVNRJGHODNRMLQLMH
þYUVWRYH]DQ]DGHQWLQLGHEOMHJVORMDNRMLMHXWLVQXWX
GHQWLQWXEXOH

8NXSQDGHEOMLQDUD]PD]QRJVORMD
YDULUDRGPL]DYLVLRGYUVWHURWLUDMXüHJUHåXüHJ
LQVWUXPHQWDEU]LQHURWDFLMHSULPHQMHQRJSULWLVNDSUL
SUHSDUDFLMLYHOLþLQHLREOLNDNDYLWHWDNROLþLQHYRGH
QRJKODÿHQMDSRYUãLQHGHQWLQDJGHVHYUãLSUHSDUDFLMDL
GU

'HEOMLQDSRYUãLQVNRJGHODUD]PD]QRJVORMDSR*HWOH
PDQXLVDUDGQLFLPDVHNUHüHRGP

3DVKOH\XVYRMLP
LVWUDåLYDQMLPDQDOD]LGDMHUD]PD]QLVORMQDGHQWLQXQDMþHãüH
GHEOMLQHRGRNRPDGXELQD³þHSRYD´XGHQWLQWXEXOLPD
L]QRVLGRGDWQLKP

0HHUEHNLVDUGQLFLSRWYUÿXMXGDMH
GHEOMLQDUD]PD]QRJVORMDXJODYQRPUD]OLþLWDDOLGDVHQDM
þHãüHNUHüHRGPLGD]DYLVLRGYUVWHURWLUDMXüHJLQVWUX
PHQWDRGQRVQRXVORYDLVSLUDQMDWRNRPLQVWUXPHQWDFLMH

.OLQLþNHLPSOLNDFLMHUD]PD]QRJ
VORMDQDGHQWLQX
5DVSUDYHRRYRPVOXþDMXVXþHVWRNRQWUDGLNWRUQH
-HGQDJUXSDLVWUDåLYDþDVPDWUDGDMHRQLGHDOQDSRGORJD]D
UDVWLUD]PQRåDYDQMHPLNURRUJDQL]DPDLGDJDQHL]RVWDYQR
WUHEDXNORQLWLGDELVHSREROMãDODDGKH]LMDPDWHULMDOD

'UXJLSUHGODåXRVWDYOMDQMHRYRJVORMDNRMLSRQMLKRYRP
PLãOMHQMXX]RGJRYDUDMXüLSUHGWUHWPDQLOLNRQGLFLRQLUD

6HUELDQ'HQWDO-
QMHPRåHGHORYDWLNDRVLJXUQDEDULMHUDSULURGQLODMQHU
SURGRUXRUDOQLKIOXLGDVDHJ]RJHQLPQRNVDPDSUHPD
SXOSLLWLPHRPRJXüLWLRVLPGREUHYH]HLSUHYHQFLMX
SXOSQHLULWDFLMH

1HVODJDQMDSRSLWDQMXXNODQMDLOL
QHXNODQMDQMDUD]PD]QRJVORMDþLQHRYXSUREOHPDWLNXMRã
LQWHUHVDQWQLMRPDOLLVDL]UDåHQLMRPSRWUHERP]DQMHQLP
UD]MDãQMHQMHP
:LH]NRZVNL

LVDUDGQLFLXVYRMLPLVWUDåLYDQMLPD
SRWYUÿXMXGDMHUD]PD]QLVORMQDSRYUãLQLGHQWLQDRVQRYQL
SXWSURGRUDPLNURRUJDQL]DPD

,VWLDXWRULJRGLQXGDQD
NDVQLMHSURXþDYDMXNYDOLWHWYH]HQHNROLNRGHQWLQDGKH
]LYQLKVUHGVWDYDNRMDVDPRPRGLILNXMXUD]PD]QLVORMQD
NDYLWHWLPD9NODVH0HWRGRPOLQHDUQRJSURGRUDERMHVD
UDVWYRURPVUHEURQLWUDWDRQL]DNOMXþXMXGDMHUD]PD
]QLVORMRVQRYQLSXWEDNWHULMVNRJPLNURSURGRUDNUR]VWYR
UHQXPLNURSXNRWLQX

8VYRMLPLVWUDåLYDQMLPD'DYLV

LVDUDGQLFLSURXþD
YDMXHIHNDWDGKH]LMHþHWLULUD]OLþLWDDGKH]LYQDVLVWHPDWUH
WLUDMXüLUD]PD]QLVORMQDWULQDþLQDGHOLPLþQRRVWDYOMDQMH
NRQGLFLRQLUDQMHVDIRVIRUQRPNLVHOLQRPNRQGLFLRQL
UDQMHVDSROLDNULOQRPNLVHOLQRP$XWRUL]DNOMXþXMX
GDQHPD]QDþDMQLKUD]OLNDXMDþLQLYH]HL]PHÿXWYUGLK
]XEQLKVWUXNWXUDLNRPSR]LWQLKPDWHULMDODSRVOHGHOLPL
þQRJLOLSRWSXQRJXNODQMDQMDUD]PD]QRJVORMD

6(0VWX
GLMDDQDOL]HSRYUãLQHGHQWLQDSRVOHDSOLNDFLMHDGKH]LYQRJ
VUHGVWYDSUHNRUD]PD]QRJVORMDQDNDYLWHWLPD9NODVHMH
WDNRÿHSRWYUGLODGDMHPHÿXVORMUD]PD]QLVORM±GHQWLQ
QDMVODELMDNDULNDXDGKH]LYQRMYH]LDGDYH]DUD]PD
]QRJVORMD]DGHQWLQPRåHELWLGRGDWQRNRPSURPLWRYDQD
WHUPDOQLPVWUHVRYLPD

1DOD]L.DQFHWDNRÿHXND]XMX
GDUD]PD]QLVORMXLQYLYRXVORYLPDþHVWRELYDQDSDGQXW
EDNWHULMDPDDYH]DGHQWLQDGKH]LYDQDED]LIRVIDWQLKHVWD
UD]QDþDMQRRSDGDVDYUHPHQRP

0HÿXWLPSRRYRPSLWDQMXLPDLGUXJDþLMLKVWDYRYD
7DNR7DRL3DVKOH\XLQYLWURXVORYLPDLVSLWXMXHIHNDW
LQWUDSXOSQRJSULWLVNDQDMDþLQXYH]HNRGGYDGHQWLQDGKH
]LYQDVLVWHPDXSULVXVWYXLRGVXVWYXUD]PD]QRJVORMD2QL
]DNOMXþXMXGDUD]PD]QLVORMQHXWLþH]QDþDMQRQDNYDOLWHW
YH]H

'DOLXNODQMDQMHUD]PD]QRJVORMDXWLþHQDSRMDYX
PLNURSXNRWLQHNRGNDYLWHWD9NODVHELORMHSUHGPHWLVWUD
åLYDQMD6ULVDZDVGLMDLVDUDGQLND

$XWRULVX]DNOMXþLOLGD
SULVXVWYRUD]PD]QRJVORMDQLMHLPDORQLNDNYRJHIHNWDQD
SRMDYXPLNURSXNRWLQHDOLSUHSRUXþXMXQMHJRYRXNODQMDQMH
NDGDVHXUHVWDXUDWLYQRMSURFHGXULNRULVWHJODVMRQRPHU
FHPHQWL

3DVKOH\XVYRMLPLVWUDåLYDQMLPDSRWYUÿXMHGD
UD]PD]QLVORMSUHGVWDYOMDSULURGQLODMQHUNRMLVPDQMXMH
SURSXVWOMLYRVWGHQWLQDYLãHQHJRELORNRMLGUXJL]DãWLWQL
ODMQHU3RQMHJRYRPPLãOMHQMXXNODQMDQMHUD]PD]QRJVORMD
SREROMãDYDNYDOLWHWYH]HDOLLSRYHüDYDPRJXüQRVWGD
GRÿHGRLULWDFLMHSXOSH

'HQWLQDGKH]LYQDVUHGVWYDNDRãWRVXJODVMRQRPHU
FHPHQWLRVWYDUXMXEROMXYH]XDNRVHUD]PD]QLVORMXNORQL
SROLDNULOQRPNLVHOLQRP1DLPHWDGDVORERGQLMRQLNDOFLMX
PDL]GHQWLQDYH]XMXNDUERNVLOQHJUXSHL]ODQFDSROLDNULOQH
NLVHOLQHLRVWYDUXMXRGUHÿHQLYLGKHPLMVNHYH]H

1HNDLVWUDåLYDQMDVXWDNRÿHSRND]DODGDMHNYDOLWHW
YH]HL]PHÿXUHVWDXUDWLYQLKPDWHULMDODLWYUGLK]XEQLKWNLYD
]QDþDMQRPDQMLDNRVHUD]PD]QLVORMXNORQL2YRSRVHEQR
YDåL]DYH]LYQDVUHGVWYDQDED]LIRVIDWDNRMDKHODWQLP
YH]DPDDGKHULUDMX]DNDOFLMXPL]GHQWLQD


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NYDOLWHWYH]HNRGRYLKDGKH]LYDPRJORELELWLXþLQMHQLFL
GDMHUD]PD]QLVORMXJODYQRPERJDWLMLNDOFLMXPRPRG
GHQWLQDNRMLJXELNDOFLMXP]ERJSULVXWQHNLVHOLQHX
XVWLPDSDMHQDWDMQDþLQRPRJXüHQRYLãHSURVWRUD
]DYH]XL]PHÿXNDOFLMXPDLIRVIRUD
GDUD]PD]QLVORMSRNULYDSRYUãLQXGHQWLQDNRMDSRVWDMH
QHUDYQDDOLSRYROMQLMD]DPLNURPHKDQLþNXYH]X
GDUD]PD]QLVORMEORNLUDGHQWLQWXEXOHLVPDQMXMH
SURWRNWHþQRVWLNUR]QMLKþLPHREH]EHÿXMHHILNDVQLMX
YH]XKLGURIREQHYH]LYQHVPROHLKLGURILOQRJGHQWLQD
1DLPHSRWYUÿHQRMHGDVHDGKH]LMDXRYLPVOXþDMH
YLPDXVSRVWDYOMDLVNOMXþLYRVDUD]PD]QLPVORMHPDQHVD
GHQWLQRP

$GKH]LYQDVUHGVWYDLGHQWLQ
5HãDYDMXüLQDYHGHQHSUREOHPHVDYUHPHQDGHQWDOQD
WHKQRORJLMDMHXVWUXþQXSUDNVXXYHODGHQWLQDGKH]LYQH
VLVWHPHNRMLREH]EHÿXMXSRMDþDQXYH]XL]PHÿXWYUGLK
]XEQLKVWUXNWXUDLNRPSR]LWQLKPDWHULMDOD9H]DDGKH]L
YQLKVLVWHPDVDGHQWLQRP]DVQLYDVHSUHVYHJDQDPLNUR
PHKDQLþNRMYH]LLOLLQHNRMYUVWLKHPLMVNHYH]HVDNDOFLMX
PRPRGQRVQRNRODJHQRPGHQWLQD
%H]RE]LUDQDNRQWUDGLNWRUQHVWDYRYHUD]PD]QLVORMX
UHVWDXUDWLYQRMSURFHGXULPRUDELWLXNORQMHQPRGLILNRYDQ
LOLLPSUHJQLUDQVPRORPDSRYUãLQDGHQWLQDSUHDSOLNRYD
QMDNRPSR]LWQRJPDWHULMDODPRUDELWLSULSUHPOMHQDRGQR
VQRNRQGLFLRQLUDQD

1DMYHüLEURMLVWUDåLYDþDVHVODåH
GDMH]DXVSRVWDYOMDQMHGREUHDGKH]LYQHYH]HL]PHÿXGYD
UD]OLþLWDPDWHULMDODQHRSKRGQRREH]EHGLWLþLVWXSRYUãLQX
SDRGWRJDQHWUHEDRGXVWDWLQLNDGMHSRYUãLQDGHQWLQDX
SLWDQMX
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