Dental adhesion review: aging and stability of the bonded interface.
OBJECTIVE
Most of current dental adhesive systems show favorable immediate results in terms of retention and sealing of bonded interface, thereby counteracting polymerization shrinkage that affects resin-based restorative materials. Despite immediate efficacy, there are major concerns when dentin bonded interfaces are tested after aging even for short time period, i.e. 6 months.


METHODS
This study critically discusses the latest peer-reviewed reports related to formation, aging and stability of resin bonding, focusing on the micro and nano-phenomena related to adhesive interface degradation.


RESULTS
Most simplified one-step adhesives were shown to be the least durable, while three-step etch-and-rinse and two-step self-etch adhesives continue to show the highest performances, as reported in the overwhelming majority of studies. In other words, a simplification of clinical application procedures is done to the detriment of bonding efficacy. Among the different aging phenomena occurring at the dentin bonded interfaces, some are considered pivotal in degrading the hybrid layer, particularly if simplified adhesives are used. Insufficient resin impregnation of dentin, high permeability of the bonded interface, sub-optimal polymerization, phase separation and activation of endogenous collagenolytic enzymes are some of the recently reported factors that reduce the longevity of the bonded interface.


CONCLUSIONS
In order to overcome these problems, recent studies indicated that (1) resin impregnation techniques should be improved, particularly for two-step etch-and-rinse adhesives; (2) the use of conventional multi-step adhesives is recommended, since they involve the use of a hydrophobic coating of nonsolvated resin; (3) extended curing time should be considered to reduce permeability and allow a better polymerization of the adhesive film; (4) proteases inhibitors as additional primer should be used to increase the stability of the collagens fibrils within the hybrid layer inhibiting the intrinsic collagenolytic activity of human dentin.
Breschi
Lorenzo
L
Department of Biomedicine, Unit of Dental Sciences and Biomaterials, University of Trieste, Via Stuparich 1, Trieste, Italy. lbreschi@units.it
Mazzoni
Annalisa
A
Ruggeri
Alessandra
A
Cadenaro
Milena
M
Di Lenarda
Roberto
R
De Stefano Dorigo
Elettra
E
D000134:Acid Etching, Dental / Q000379:methods; D003094:Collagen / Q000737:chemistry; D001840:Dental Bonding; D003804:Dentin / Q000737:chemistry; D003806:Dentin Permeability; D017220:Dentin-Bonding Agents; D006461:Hemolysis; D006801:Humans; D011480:Protease Inhibitors; D019279:Resin Cements; D016369:Smear Layer; D013997:Time Factors
D017220:Dentin-Bonding Agents; D011480:Protease Inhibitors; D019279:Resin Cements; D003094:Collagen