Super Dentin

WORLD JOURNAL OF PHARMACEUTICAL RESEARCH
Jana et al. World Journal of Pharmaceutical Research

SJIF Impact Factor 8.084
Volume 10, Issue 1, 368-379. Review Article ISSN 2277 7105
-DENTIN
INTERFACE AND PROTECTION OF TOOTH STRUCTURES
Dr. Sriparna Jana*, Dr. Priti D. Desai, Dr. Debojyoti Das, Dr. Sankalita Pal,
Dr. Raghunath Shil and Dr. Paromita Mazumdar
157/F, Nilgunj Road, Panihati, Kolkata-700114, West Bengal.
ABSTRACT
Article Received on
28 October 2020, Dentin has a limited potential to resist an acid attack of secondary
Revised on 18 Nov. 2020, caries. Even after the restoration of carious lesion leakage at the
Accepted on 08 Dec. 2020
interface between restoration and tooth was a frequent problem which
DOI: 10.20959/wjpr20211-19419
lead to secondary caries. Dentin bonding systems have been
*Corresponding Author
Monomer penetration into dentin and its polymerization creates a
Dr. Sriparna Jana
hybrid layer, which is essential to obtain good bonding to dentin.
157/F, Nilgunj Road,
Panihati, Kolkata-700114, Diffusion of acid monomer beyond the classic hybrid layer and their
West Bengal. ion exchange interactions with the hydroxyapatite results in formation
of stable organic complexes and this modified dentin is termed as
s activity created by the use of self-
etching adhesive resins. Acid base resistance zone is formed beneath the hybrid layer with a
self-etching primer adhesive system, considered to be due to the monomer penetration
esive systems. Natural dentin has a limited potential
to resist an acid attack of secondary caries; however, the acid base resistant zone does not
purely consist of dentin in morphology, it is rather a combination of dentin and the adjacent
hybrid layer. T
ability to prevent primary and secondary caries. Prospectively, the great potential of adhesive
erials
for mechanical, chemical and biological protection of the dental structures. This review
article demonstrates .
KEYWORDS: Acid Base Resistance Zone, All in One Adhesive System, 10-
Methacryloyloxydecyl Dihydrogen Phosphate.
www.wjpr.net Vol 10, Issue 1, 2021. ISO 9001:2015 Certified Journal 368
INTRODUCTION
Dentin has a limited potential to resist an acid attack of secondary caries. Microleakage at the
interface between restoration and tooth is a frequent problem which leads to development of
secondary caries. Secondary caries has been defined as
. Secondary caries is a
complex, multifactorial process, interweaving the various causes of same as primary caries
with the varies characteristics with type of restoration and restorative material involved, i.e.,
secondary caries pathogenesis follows the same concept for any other caries lesions,
involving demineralization and, in case of dentin secondary caries, enzymatic dissolution of
the organic component, but is modified by the presence of a restoration or sealant margin.
Secondary caries may be associated with a defective restoration mainly via gaps between the
restoration and the tooth allowing acidic fluids or biofilm to enter the interface or associated
with an intact restoration e.g., via a lower buffering capacity of the restoration compared with
the tooth hard tissue or because of presence of primary caries adjacent to existing
restorations (mainly when the caries process has not been sufficiently addressed on a patient
level and the surface next to the restoration becomes carious as a result of this ongoing caries
activity).[1] The known factor relevant for caries development is presence of a cariogenic
biofilm, supply with fermentable carbohydrates, imbalance in mineral loss, and loss of dental
hard tissue. A number of in vitro studies, using various secondary caries models, have been
performed, yielding threshold gap sizes of the defect between 60 and 1000 µm.[2] Diffusion of
acid monomers beyond the classic hybrid layer and their ion exchange interactions with the
hydroxyapatite results in formation of stable organic inorganic complexes and prevent
secondary caries. This paper has reviewed the previous studies on assessment of
ultrastructure of the acid base resistance zone (ABRZ) at the adhesive-dentin interface also,
Super dentin
Super dentin is modified dentin of combination of dentin and the adjacent hybrid layer with
superior resistance against caries activity created by the use of self etching adhesive resins.
and improved during the past
decades. A hybrid layer is created after monomer penetration into dentin and its
polymerization in situ, which is needed to obtain good bonding to dentin.[3] Theoretically,
Marginal sealing of the cavity and resistance against acid challenge to prevent secondary
caries can be provided by the hybrid layer.[4] However, it was reported that none of the
adhesives currently available could completely eliminate nanoleakage along the dentin-
restorative interface. The concept of minimal cavity preparation has become widely accepted
for the placement of direct composite restorations by using an adhesive system. But recurrent
caries is still considered to be one of the major reasons for failure of resin composite
restorations. Tsuchiya et al. around restorations
bonded to bovine root dentin, using an SEM.[5] A -base resistant
was found beneath the hybrid layer in SEM observation, which was
completely different from the inhibition zone formed
such as a glass ionomer cement; also, the acid-base resistant zone was formed in spite of the
-free adhesive.[5] It has been shown that thickness of ABRZ is between 500 -1000
Mechanism of action of formation of super-dentin

Nakabayashi et al. proposed hybridization concept as a dentin bonding mechanism.[3] In this
concept, monomer penetration into dentin and its polymerization in situ creates a hybrid
layer, which is believed to be essential for good dentin bonding . ABRZ was found beneath
the hybrid layer. The formation of ABRZ has been confirmed only with a self-etching system,
but not with an acid-etching system.[6] The self-etch adhesive systems demineralize dentin
mildly and partially, leaving hydroxyapatite crystals in the base of the hybrid layer. Such
residual apatite crystals may serve as a template for additional chemical reaction with the
functional monomer. Among the functional monomers, 10 Methacryloyloxydecyl dihydrogen
phosphate (MDP) is known to have a high chemical bonding potential to hydroxyapatite
forming a very stable bond and excellent water resistance confirmed by the low dissolution
rate of its calcium salt in water. When the dentin surface is aggressively etched with
phosphoric acid, the underlying dentin may become completely demineralized so deep that
hydroxyapatite in the underlying dentin would disappear and the bottom of the demineralized
dentin would be inaccessible to complete impregnation by the resin. In this case, a functional
monomer may not have the opportunity to react with hydroxyapatite at the base of the hybrid
layer, resulting in lack of the ABRZ formation with an acid-etching system. If the ABRZ is
assumed made of resin-infiltrated dentin, the same chemical reaction of hydroxyapatite and
an acidic monomer in the adhesive may take place in this zone, giving rise to the ability to
resist against demineralization from an acid attack from the microorganisms in primary and
secondary caries. Therefore, the reinforced dentin was proposed to be called as Super Dentin,
which should be superior to the normal dentin mechanically, chemically, and biologically.[6]
F -
containing adhesive system, which may accelerate remineralization reaction of dentin against
oride-free adhesive system.[7]
We know that incorporation of fluoride into hydroxyapatite can result in formation of

fluoroapatite, which has a higher resistance to acid. However, the existence of the ABRZ
should be a different phenomenon than solely reinforcement by fluoride release. In fact, while
fluoride has a positive effect on ABRZ formation, the zone is originally considered to be
associated with adhesive monomer penetration deeper than previously expected. The exact
mechanism is not understood yet; however, there is mounting evidence that the acidic moiety
(carboxylic or phosphate group) of the functional monomers in some self-etching materials
could interact with the calcium of hydroxyl apatite and form an ionic bond.[8] It was reported
that the chemical bonding of the acidic monomers to dentin and enamel could result in
formation of tooth with increased resistance against demineralization by acids and therefore
resistance to caries. One of the most successful acidic monomers in the composition of self-
etch systems is 10 Methacryloyloxydecyl dihydrogen phosphate (MDP; Kuraray Medical,
Tokyo, Japan), with a C=C bond on one end for polymerization and a reactive acidic moiety
on the other end as in.[8] Under transmission electron microscopy (TEM), selected area
electron diffraction (SAED) is a crystallography method that provides information on the
local crystalline structure of thin sections. The TEM/SAED evidence demonstrated that the
ABRZ contained densely arranged apatite crystallites that had different characteristics from
the hybrid layer.[9] Using the self-
become a key strategy in preventive dentistry in the future. Root surface coating with the
dentin bonding systems is considered to be an effective measure for protection against caries,
erosion and abrasion.[10]
SEM image of the dentin-adhesive interface after acid-base challenge. The acid-base resistant
zone (ABRZ) was observed beneath the hybrid layer in a two-step self-etch adhesive system
(5000X magnification).
Super dentin with different adhesive system

According to the concept and mechanism of the adhesive systems, the classification of recent
bonding system can be done into two main categories: self-etching primer systems and acid-
etching systems. The category of self-etching primer systems is further divided into two sub-
categories: two-step self-etching primer systems and one-step self-etching primer systems,
including the so- -in-
been introduced to the market, which can be categorized under the all-in-one adhesives in
terms of their mechanism.[11] A two-step self-etching primer system is composed of a self-
etching primer and an adhesive. The self-etching primer contains one or several acidic
monomers in their components that can condition and prime dentin surface simultaneously.
In the one-step adhesive systems, the roles of the self-etching primer and the adhesive are
combined into one application step.[6]
The category of acid-etching systems contains conventional acid-etching systems, three-step

etching/priming/bonding systems. Current acid-etching systems usually use 30-40%
phosphoric acid, which removes the smear layer from a prepared dentin surface, which
demineralizes dentin and exposes the collagen fibrils over a depth of 3 5 µm.[18] Therefore,
phosphoric acid etching results in severe demineralization of dentin surface when compared
to the self-etching systems. Milder form of phosphoric acid have a pH of around 2.0 and
higher.[11]
Super dentin with all-in-one adhesive system

To simplify the bonding procedures, all-in-one adhesive systems have been developed and
commercialized. All-in one adhesives contain acidic monomers, water, and solvents in order
to create a bond between tooth substrate and resin composite by a single step. These systems
have advantages for clinicians in saving time. However, the adhesive resin layer of the all-in-
one adhesives is permeable and allows the formation of a water channel or water tree.[12] Two
well-known examples for these systems are Clearfil Tri-S Bond (Kuraray Medical) and G-
-free all-in-one adhesive systems,
which contain acidic monomers of 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)
and 4-methacryloxyethyl trimellitate anhydride (4-META), respectively. Acidic monomers
play roles to condition and prime dentin simultaneously. The acidity of these adhesive
systems did not reach that of the etchants in the acid-etching systems, such as phosphoric and
citric acids.[13] So, all-in-one adhesive systems demineralize dentin partially, leaving mineral
-S Bond and G-Bond the thickness of both
adhesives was less than 10 mm. It was observed approximately 1 mm thick ABRZ beneath
the hybrid layer, for both materials. In all-in-one adhesives, hydrophobic and hydrophilic
resin components are intermixed prior to polymerization. Phase separation can occur as the
solvent alcohol or acetone is evaporated. The larger portion of adhesive solvents is removed
by air drying after adhesive application, but residual water still persists due to lowering of the
vapour pressure of water by 2-hydroxyethyl methacrylate (HEMA). Knowing that monomers
adhesives. So it is possible to speculate that a weak area beneath the hybrid layer and ABRZ
may be created, which is partially demineralized, while the penetrated monomers are not
completely polymerized,[14] due to the phase separation and water existence. In contrast to the
ABRZ, it is reasonable to assume that this area is probably more vulnerable to acid challenge,
resulting in the formation of typical erosion areas beneath the ABRZ in some adhesive
systems.[15]
Super Dentin with acid etching adhesive system
adhesives that do not require acid etching of dentin. In order to probe this speculation and
further clarify the attributes of this zone, Takagaki et al. evaluated the ultrastructural change
of the adhesive-dentin interface after acid-base challenge using an acid etching adhesive
system, 4-META/MMA-TBB resin with three different conditions.[16] Super Bond C&B is
methylmethacrylate (MMA)-based, and contains a chemical initiator of a tri-n-butyl borane
(TBB) derivative and a functional monomer of 4-methacryloxyethyl trimellitate anhydride (4-
META), giving an excellent adhesion to dentin, when dentin surface is pretreated with citric
acid solution containing ferric chloride.[17] The dentin surfaces received one of the following
pretreatments: no treatment, 65% phosphoric acid for 10 s or 10% citric acid and 3% ferric
chloride for 10 s. After application of phosphoric acid or 3% ferric chloride, the dentin
surfaces were rinsed with water and gently air-dried. The mixture of liquid and powder of
Superbond C&B was applied on dentin surface with a brush-on technique according to the
temperature for 30 min to secure the initial polymerization, and then stored in distilled water
at 370C for 24 h. In the no treatment group, the hybrid layer was not created at the interface,
however, wall lesion was observed along the interface. Formation of the hybrid layer was
observed in both the ferric sulphate and phosphoric acid groups; however, no detection of
ABRZ in any of the groups. Nevertheless, without surface conditioning, 4-META/ MMA-
TBB resin could not bond to dentin, because smear layer on the ground dentin surface
prevented monomer penetration into underlying dentin. In the SEM observation after acid-
base challenge, no hybrid layer formation was observed. Formation of wall lesion suggested
that the interface without hybrid layer could not resist against acid-base challenge, indicating
that a dentin margin without a hybrid layer would suffer secondary caries in the oral
environment. The hybrid layer was recognized in both ferric sulphate and phosphoric acid.
However, thickness of the hybrid layer with phosphoric acid was 2 mm, while thickness with
the 3% ferric chloride was 1 mm because of different acidity in two solutions. Based on the
results of the previous studies an ABRZ was formed beneath the hybrid layer with a self-
etching primer adhesive system. The ABRZ was not observed in the acid-etching system.[16]
So it was suggested that the existence of the ABRZ could be related to monomer penetration
into the partially demineralized dentin, only when a self-etching primer adhesive system was
used.
Clinical application
Thin-Film coating materials
The resin coating technique is applicable to both anterior and posterior bonded restorations.
However, the combination of a dentin bonding system and a low-viscosity micro-filled resin
creates a thick coating layer on the dentin surface.[18] Thickness of the cured dentin bonding
agent can vary significantly according to the composition of adhesive system and also surface
geometry.[19] A thick coating is not suitable especially for a crown preparation because of the
possibility of deformation of the preparation by the resin coating. But the all-in-one adhesive
technology provides a thin film coating, less than10µm in thickness on the dentin surface. An
all-in-one adhesive with mild acidity has already been marketed for use as a desensitizing
agent for the hypersensitive dentin. Such coating materials are clinically accepted for sealing
the exposed dentin of the crown preparation. The thin-film coating material demonstrated to
improve the dentin bonding performance of resin cement and prevent marginal leakage
beneath the restorations.[20] However, the combinational method of applying a dentin bonding
system and a flowable resin composite still provides more reliable dentin bonding
performance than the thin-film coating alone.
Application of resin coating to the endodontically treated teeth

The resin coating technique can be applied not only for the preparations of vital tooth but also
for root canal dentin of the endodontically treated tooth. The goal of endodontic obturation is
to provide an effective apical seal to prevent bacterial invasion from the oral cavity through
the root canals. The apical seal can be adversely affected by coronal leakage once the coronal
restoration is lost or becomes defective. Dissolution of the sealer allows access of periapical
fluids, and bacteria into the root canal. Fractured teeth and leaking/lost temporary restorations
are often encountered clinically, which can leave the root canal filling open to the oral cavity.
Therefore, the quality of the coronal seal is very important for the ultimate success of any
root canal obturation. The application of a resin coating to the coronal opening of the
endodontically treated tooth could minimize coronal leakage.[21] Perfect sealing was achieved
by coating with a combination of a self-etch adhesive and a flowable resin composite. For
successful adhesive restorations of non-vital teeth, it is important to obtain good dentin
bonding to endodontically treated dentin. Ariyoshi et al. (2008) demonstrated that resin
coating significantly enhanced the microtensile bond strengths of indirect composite cores to
pulpal floor dentin.[22]
Surface coating for tooth structure preservation

Sealing of pit and fissure of occlusal enamel with composite resins has been widely accepted
to prevent enamel caries in children and adolescents. Nowadays, preventive concept
approaches expand to smooth enamel surfaces. In order to protect enamel from dissolution,
the superficial penetration and surface coating of the adhesive and/or caries infiltrate is
considered as one of the most optimal treatment options. The MDP functional monomer in
the two-step self-etch adhesive has shown to resist adjacent enamel at the enamel/adhesive
interface against acid attack. This fact suggests that application of the coating materials can
.A
recent study showed that these resin coating materials could sufficiently protect enamel
against aggressive acid challenge.[23] Soft tissue recession because of age, inappropriate
toothbrush habits, periodontal disease, or surgical periodontal treatment will cause exposure
of susceptible root surface and high incidence of root caries and dentin hypersensitivity.
Simple single-visit methods to protect the exposed root surfaces from long-term caries attack
are advantageous. Root surface coating with the dentin bonding systems is considered to be
an effective measure for protection against caries, erosion, and abrasion, as it provides a
strong physical barrier with the formation of Super Dentin. However, a promising approach
to prevent root caries has not become available yet. From the clinical stand point, to control
the biofilm adherence on the coating material is also important to reduce caries risk in the
oral environment. A series of experimental coating materials with self-cleaning surface
property has been developed, containing good potential to inhibit biofilm adherence.[24] If
such materials with a surface property could be combined with the current adhesive
technology, the surface coating will become a promising therapy in preventive dentistry in
the future.
Current challenges
Despite the promising results and concepts, several challenges still remain in adhesive
dentistry. Bonding to the clinical substrate is more challenging than that in laboratory
conditions as the dentin may undergo various alterations due to aging, caries or other
conditions which influence its permeability and bonding potential. Bonding to enamel may
still require micromechanical interlocking through an increased surface porosity by stronger
acids followed by monomer diffusion compared to the naturally permeable dentin. In addition
to the substrate, the most recent adhesive materials accepted as golden standards still face
challenges ranging from pre-usage shelf life and usage technique sensitivity to the loss of
long-term integrity and durability of the resin. Even if dentin is protected, polymerization
shrinkage of the dental composites and stress developed thereby along with other adaptation
factors may deteriorate longevity due to gap or marginal disintegration. Also, the hydrophilic-
hydrophobic balance of formulations is a major obstacle for the all-in-one adhesives,
challenging the adhesion to both dental hard tissue and direct composite resins. Last but not
least, more biocompatible and nontoxic materials which can biomineralize tissue are desired
in the future to further realize the super dentin.
REFERENCES
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WORLD JOURNAL OF PHARMACEUTICAL RESEARCH

Jana et al. World Journal of Pharmaceutical Research

Volume 10, Issue 1, 368-379. Review Article ISSN 2277 7105

157/F, Nilgunj Road, Panihati, Kolkata-700114, West Bengal.

Mechanism of action of formation of super-dentin

We know that incorporation of fluoride into hydroxyapatite can result in formation of

Super dentin with different adhesive system

The category of acid-etching systems contains conventional acid-etching systems, three-step

Super dentin with all-in-one adhesive system

Super Dentin with acid etching adhesive system

Application of resin coating to the endodontically treated teeth

Surface coating for tooth structure preservation

View publication stats

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