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Enamel Acid Etching - A Review
Enamel Acid Etching - A Review
CE
Abstract
Guilherme Carpena Lopes, DDS,
MS, PhD
Assistant Professor
Department of Operative Dentistry
Universidade Federal de Santa Catarina
School of Dentistry
Florianpolis, Brazil
Bonding to enamel has over 50 years of history. Efforts have been made to develop or
introduce a simplified alternative, but enamel acid etching remains the most effective
procedure for stable enamel bonding. Although acid etching is considered the most
popular procedure in dentistry, there are characteristics that deserve special attention
because of how crucial they can be in many clinical situations. This article reviews
some of these aspects of enamel bonding using the acid-etching technique.
Research Assistant
Department of Orthodontics
Universidade Federal de Santa Catarina
School of Dentistry
Florianpolis, Brazil
Learning Objectives
Pricila Klauss, MS
Research Assistant
Materials Engineer
Universidade Federal de Santa Catarina
Florianpolis, Brazil
Clinical Instructor
Department of Operative Dentistry
Universidade Federal de Santa Catarina
School of Dentistry
Florianpolis, Brazil
Clinical Instructor
Department of Operative Dentistry
Universidade Federal de Santa Catarina
School of Dentistry
Florianpolis, Brazil
Tooth Enamel
Enamel is the hardest tissue in the
human body. Its mineral portion is
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Figure 1Scanning electron microscope (SEM) micrograph showing a composite-enamel interface. Note the orientation of the enamel prisms. Final magnification 150x.
Figure 3SEM micrograph showing the smooth enamel surface. Final magnification 1000x.
Figure 4SEM micrograph showing the enamel etching pattern type I after a
32% phosphoric acidc etch applied for 15 seconds. Final magnification 4000x.
Acid-Etching Technique
Figure 5SEM micrograph showing the enamel etching pattern type II after a
32% phosphoric acidc etch applied for 15 seconds. Final magnification 4000x.
maturation process that makes it more resistant to demineralization. This maturation consists of mineral deposition from oral fluids in interprism spaces that were previously filled with water.5 Because all hard tissue is in
continuous ionic change with the environment, it could
be expected that human enamel will respond to acid conditioning differently, depending on age and factors related mainly to saliva and diet. Further research should be
During the 32nd Annual Meeting of the International Association for Dental Research in 1954,6
Buonocore suggested that using 85% phosphoric acid
solution resulted in an adhesion of acrylic resin to enamel that lasted 1070 hours to debond when stored in
water.7 Similar to other conceptual and technologic innovations, this procedure was introduced in dentistry ahead
of its time and only 10 years later the bonding mechanism was described,8 Bis-GMA based adhesive systems
and com-posite resins were developed,9 and the first clinical application, as a pit-and-fissure sealant, was reported
in the literature.10
Chemical treatment by acid etching enhances the
topography of enamel, changing it from a low-reactive
surface (Figure 3) to a surface that is more susceptible to
adhesion (Figure 4 and 5). The demineralization is selective because of the morphological disposition of the
prisms. The difference of angulation of the prism crystals
causes the acid to have higher demineralization potential
at certain microregions. After cavitary instrumentation,
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Figure 6SEM micrograph showing the resin-enamel interface after a laboratorial demineralization in hydrochloride 6N for 30 seconds. The low-viscosity fluid resin wets this high-energy surface by capillary attraction into the
microporosities created by the etching. After polymerization, the tags formed
by this extension of resin into the microporosities form a strong micromechanical interlocking with the enamel. Final magnification 1500x.
depending on the angulation of the prisms, demineralization can be greater at the prism head (Figure 4) or at the
periphery (Figure 5). These features are respectively
known as type I and type II acid-etching patterns. This
feature is important in understanding the fundamentals
of adhesion though it is not clinically relevant.
Acid etching removes appoximately 10 m of enamel
surface and creates a morphologically porous layer (5 m
to 50 m deep).11 The surface free energy is doubled,12 and
as a result, the low-viscosity fluid resin contacts the surface
and is attracted to the interior of these microporosities created by conditioning through capillarity (capillary attraction).13 Therefore, resin tags are formed into microporosities of conditioned enamel (Figure 6) that after adequate
polymerization, provide a resistant, long-lasting bond by
micromechanical interlocking with this tissue.8,14,15
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late group of the bonding resin matrix (also called hydrophobic adhesive) or with the composite resin.20
Regarding bonding to enamel, the rapid volatilization of the solvent allows for the complete interdiffusion
of the adhesive system through the extension of the conditioning,21 with a more intimate contact of the composite resin to enamel, which results in high bond strengths
to this tissue18 and adequate marginal sealing,22 even in
moist conditions.19,22
It is not an easy procedure to keep dentin moist and
dry only the enamel. It is possible that acetone-and
ethanol-based solvents, included in mostly 1-bottle adhesives, remove residual moisture and promote a superior
flow of the restorative material to acid-etched enamel.19,21,23
Hydrophilic primers become essential when enamel is
moist and work very well when enamel is dry.18,24 However,
because the presence of residual moisture and organic solvents interferes negatively in the complete polymerization
of monomers, it is important after the application to properly dry with air spray of a triple syringe. Also, it has been
theorized that the stability of bonding to enamel is also
compromised with time because of the formation of adhesive layers similar to semipermeable membranes.25
Isolating the operatory field is important to achieve
a contaminant-free working area. There is a lack of clinical evidence that says that bonding procedures with the
use of rubber dam isolation results in better clinical performance than relative isolation, but it has been the
authors experience that rubber dam isolation should be
preferred to relative isolation because of the interference
of patients breath moisture. A recent study simulating
the oral environment compared the bond strength of 2
bonding agents (hydrophilic and hydrophobic) to enamel under temperature and air humidity conditions of the
oral cavity (35C, 90% to 95% of relative humidity).26 The
simulated contamination with high levels of air moisture
did not compromise the bonding to enamel, whether it
was accomplished with hydrophilic primer or a
hydrophobic adhesive.26
b 3M
Figure 7SEM micrograph showing the enamel etching pattern after a 15%
phosphoric acidd etch applied for 15 seconds. Final magnification 3000x.
Type of Enamel
An important clinical factor in bonding to enamel is
the tissue to be bonded. The surface instrumentation, the
patients age, and environmental factors can lead to subtle
differences in enamel characteristics and influence the
ability of an acid conditioner to properly demineralize.
Several materials have been analyzed in studies on instrumented enamel surfaces.45 However, it should be taken into
account that restorations are commonly extended beyond
the margins of the cavity preparation. Also, a number of
conservative restorative treatments (eg, diasthema closure,
tooth recontouring, restoration of fractured teeth, pit-andfissure sealing, and bonding of orthodontic devices) are all
performed without tissue instrumentation. Because of
higher inorganic content, the intact enamel surface presents some unique features. First, young patients teeth have
an aprismatic layer of approximately 30 m that covers the
entire crown.4 This layer is lost with time; however, the
hard tissue of the teeth becomes more mineralized when
exposed to the oral environment in patients with equilibri-
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Figure 8SEM micrograph showing the cervical enamel before (A) and after (B) etched with 35% phosphoric acidb for 15 seconds. Note the presence of
hypermineralized enamel not removed. (A) Final magnification 2000x. (B) Final magnification 3000x.
um in the demineralization process. This causes the surface layer of enamel to present hypermineralization features when compared with the innermost enamel.46 These
2 differences can influence the feature of the etching pattern and result in less homogeneous etching patterns,40
compromising the quality of bonding. Figure 8 shows cervical enamel before and after etching with 35% phosphoric acidb for 15 seconds.
The instrumentation of the tissue by a cavity preparation, microetching, or placement of a bevel can change
the response of the tissue to the acid etching. Several
studies report that the removal of the surface layer of
enamel enhances the etching result, and consequently,
the bond strength.47,48 A recent study showed that optimal bond strength to aprismatic enamel is achieved by
increasing the time of acid etching suggested by the manufacturer from 15 seconds to 30 seconds (with 35%
phosphoric acidb).49 It is the authors belief that the
chemical and morphological characteristics of intact
enamel would influence this difference. Further studies
must be performed to identify the response of enamel
with different mineral features when acid etched.
Cleaning Enamel
A relevant factor in bonding to enamel is the cleaning of the substrate to be bonded. Some advantages clinicians attribute to acid etching are bactericidal action and
cleansing potential. Phosphoric acid has an antibacterial
effect.50 To potentiate this effect, some acid conditioners
with antibacterial agents (eg, 3% cetypyridinium chloridec) have been made available. Without questioning
the confidence of this fact, this is not the objective of the
acid etching when taking into consideration exclusively
bonding to enamel. For a proper etching, the surface of
enamel must be clean. This cleaning must be accomplished before etching using cotton pellets soaked in
agents such as chlorhexidine gluconate and benzalkonium chloride. Alternatively, the air/water spray of a triple
syringe is an option in easy access locations. When the
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3.
Conclusion
Bonding to enamel is a simple procedure in the dental
practice; however, some details can influence its durability.
High enamel bond strengths are achieved with previous
acid etching. This bonding is sufficiently high to compensate for the polymerization shrinkage of composite resins
and an effective marginal seal. This is paramount to obtain
a suitable clinical performance of composite resin restorations, preventing marginal leakage, and allowing for adequate retention. Knowing the factors that can influence
bonding to enamel is essential when selecting the most
appropriate materials and techniques for each situation.
For exampe, it was recently observed that when enamel
prisms are exposed perpendicularly, the bond strength is
reduced to 50% compared with the parallel exposure of the
prisms.76 Therefore, extreme caution is recommended in
the gingival margins of Class II restorations, with the
smoothing of enamel with manual instruments, rubber
dam isolation, application of etchant beyond all margins,77
and insertion and polymerization of composite resin in
small increments.78 Taking these details into consideration,
more predictable restorations will be obtained.
Acknowledgment
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Quiz1
1. Enamels mineral portion is approximately:
a. 96% of its weight.
b. 16% of its weight.
c. 4% of its weight.
d. 75% of its weight.
2. Chemical treatment by acid etching does which
of the following, changing it from a low-reactive surface into a surface that is more susceptible to adhesion?
a. enhances the topography
b. lowers the free energy
c. minimizes the micromechanical interlocking
with the enamel
d. increases its free energy
3. Acid etching removes approximately 10 m of
enamel surface and creates a morphologically
porous layer with how much depth?
a. 0.5 m to 5 m
b. 0.05 m to 0.5 m
c. 5 m to 50 m
d. less than 0.5 m
4. Most adhesive systems that use the total-etch
technique have in their formulation:
a. water.
b. acetone.
c. low-viscosity hydrophilic monomers.
d. fluoride.
5. In the early 1990s, it was common to find
etchants such as:
a. 10% maleic acid.
b. 10% citric acid.
c. 2.5% nitric acid.
d. all of the above
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