Critical Appraisal

IMMEDIATE DENTIN SEALING FOR INDIRECT

BONDED RESTORATIONS

Author and Associate Editor

Edward J. Swift, Jr., DMD, MS*

F or laboratory-fabricated, resin-bonded indirect restorations, clinicians usually prepare

the tooth, make an impression, and cement a provisional restoration at an initial
appointment. A few weeks later, after the definitive restoration has been tried in and
adjusted, it is bonded with some combination of adhesive and resin cement. Another
approach—most commonly called “immediate dentin sealing”—has been suggested.
This technique involves placement of a resin coating on the dentin immediately after
preparation. Several advantages have been cited for immediate dentin sealing. Prominent
among those are a reduction in tooth sensitivity during the provisional phase and the
potential for better bonding of the restoration to dentin. This Critical Appraisal reviews
several in vitro research studies on the immediate dentin sealing technique.

I M M E D I AT E D E N T I N S E A L I N G I M P R O V E S B O N D S T R E N G T H O F I N D I R E C T R E S T O R AT I O N S

P. Magne, T.H. Kim, D. Cascione, T.E. Donovan

Journal of Prosthetic Dentistry 2005 (94:511–9)

ABSTRACT composite resin (Z100, 3M ESPE, dentin was cleaned by using

Objective: The purpose of this St. Paul, MN, USA) was bonded to airborne-particle abrasion. Com-
study was to evaluate the effects of the dentin of five teeth by using posite was bonded by using the
immediate versus delayed dentin the OptiBond FL (Kerr, Orange, same OptiBond FL adhesive
sealing on the microtensile bond CA, USA) three-step etch-and-rinse system, but the bonding agent
strengths (MTBS) of a three-step adhesive system. (third step of the system) was not
etch-and-rinse adhesive. light-activated before composite
In one experimental group, a resin- placement. This treatment group
Materials and Methods: The based provisional material (Tempfil represented the delayed dentin
occlusal half of 15 extracted Inlay, Kerr) was applied to the sealing technique.
human molar crowns were dentin and left in place while the
removed to expose mid-coronal teeth were immersed in saline solu- In another experimental group, the
dentin, which was polished flat to tion for 2 weeks. After the provi- OptiBond FL system was applied,
600 grit. For the control group, sional material was removed, the and the bonding agent was

*Professor and Chair, Department of Operative Dentistry, University of North Carolina, Chapel Hill, NC, USA

© 2009, COPYRIGHT THE AUTHOR

J O U R N A L C O M P I L AT I O N © 2 0 0 9 , W I L E Y P E R I O D I C A L S , I N C .
62 DOI 10.1111/j.1708-8240.2008.00232.x VOLUME 21, NUMBER 1, 2009
 SWIFT

activated once and then light- means of the delayed sealing group restoration at the delivery appoint-
activated again under glycerin to and the other two groups were ment. However, this study shows
prevent formation of an air- statistically significant. clearly that the opposite is true.
inhibited layer. The provisional The immediate dentin sealing tech-
material was applied and left in Conclusions: When preparing teeth nique provided a bond strength
place during 2 weeks of storage in for indirect bonded restorations, similar to that of the direct com-
saline. After removal of the provi- freshly cut dentin can be sealed posite control group. In contrast, a
sional material, the surface was with an adhesive system before the delayed application of the adhesive
cleaned by using airborne-particle impression can be made. This system (which mimics the tech-
abrasion. A single coat of the improves bonding of resin material nique used by most clinicians) gave
bonding agent was applied and applied later and eliminates a much lower bond strength. In
was light-cured along with the sub- concerns about thickness of the addition, because the adhesive
sequent layer of composite. adhesive layer. system is applied and light-
activated prior to the impression,
All of the bonded specimens were C O M M E N TA RY
concerns about pooling of the
sectioned into uniform slabs (11 The immediate dentin sealing
adhesive causing problems with
from each tooth) for microtensile technique has been proposed
restoration fit are greatly reduced.
bond-strength testing in a tabletop as a means of sealing the
materials testing device. Represen- dentin—preventing or reducing
SUGGESTED READING
tative fractures from each group problems such as bacterial
Paul SJ, Scharer P. The dual-bonding tech-
were evaluated by using scanning contamination and tooth nique: a modified method to improve
sensitivity—during the provisional adhesive luting procedures. Int J Perio
electron microscopy (SEM). Restor Dent 1997;17:536–45.
phase between tooth preparation
Results: Mean MTBS were and placement of the final restora- Jayasooriya PR, Pereira PRN, Nikaido T,
Tagami J. Efficacy of a resin coating on
55.1 MPa for the control, tion. One logical question concern- bond strengths of resin cement to dentin.
J Esthet Restor Dent 2003;15:105–13.
11.6 MPa for the delayed dentin ing this technique is whether the
sealing group, and 58.3 MPa for application of an adhesive at the Magne P. Immediate dentin sealing: a funda-
mental procedure for indirect bonded res-
the immediate dentin sealing preparation appointment would torations. J Esthet Restor Dent
group. Differences between the adversely affect bonding of the 2005;17:144–55.

I M M E D I AT E D E N T I N S E A L I N G O F O N L AY P R E P A R AT I O N S : T H I C K N E S S O F P R E - C U R E D
D E N T I N B O N D I N G A G E N T A N D E F F E C T O F S U R FA C E C L E A N I N G

M.M. Stavridakis, I. Krejci, P. Magne

Operative Dentistry 2005 (30:747–57)

ABSTRACT of cleaning procedures on prepared teeth were divided ran-

Objective: The purpose of this film thickness. domly into two groups for treat-
study was to evaluate the film ment using either the OptiBond FL
thickness of pre-cured adhesive Materials and Methods: Standard- or Syntac Classic (Ivoclar Vivadent,
in the immediate dentin sealing ized onlay preparations were made Schaan, Liechtenstein) adhesive
technique and the effects in 12 extracted human molars. The system, both of which are

VOLUME 21, NUMBER 1, 2009 63

 CRITICAL APPRAISAL

three-step total-etch systems. The more convex areas of the prepara- thickness of the adhesive layer con-
adhesives were applied according tions. Overall, Syntac had a greater sidered before the restoration is
to manufacturers’ directions, while mean thickness (142 mm) than fabricated because it is captured in
the teeth were perfused with fluid OptiBond FL (88 mm). The amount the impression. When the definitive
under normal physiologic pressure. of adhesive removed by surface restoration is placed, a single layer
The treated specimens were sec- treatment also was not uniform. of the bonding agent can be placed
tioned buccolingually by using a For OptiBond, polishing removed and light-activated at the same
low-speed diamond saw. more adhesive than airborne- time as the resin cement, so thick-
particle abrasion (16 vs. 8 mm). ness of this layer is not a concern.
The adhesive layer on each tooth The two methods removed similar
was treated with two methods thicknesses of Syntac (11 mm). The authors point out that the use
commonly used for removing tem- of a glycerin gel to block out
porary cement before try-in and Conclusions: The film thickness of oxygen during light-curing is an
cementation of the final restora- pre-cured adhesives varies greatly important step in the procedure at
tion. One section of each specimen by the specific product and by the preparation appointment. This
was airborne-particle abraded with location on the tooth. Cleaning ensures that no air-inhibited layer
50-mm aluminum oxide particles, methods remove some of the adhe- is formed, and prevents potential
and the other half was cleaned sive layer but not all of it. interaction with the impression or
with prophy paste by using a provisional material.
rotary brush. Impressions and rep- COMMENTARY

licas were made and examined by One concern about bonded indirect SUGGESTED READING

using SEM at a magnification of restorations relates to the film Chieffi N, Sadek F, Monticelli F, et al. Effect
200¥. The thickness of the adhe- thickness of the adhesive and of dentin adhesives used as sealers and
provisional cementation on bond strength
sive layers was measured before whether this could affect the fit or of a resin cement to dentin. Am J Dent
2006;19:91–5.
and after surface treatment. marginal adaptation of the restora-
tion. As this study showed, the
Erkut S, Küçükesmen HC, Eminkahyagil N,
Results: The thickness of the adhe- cured adhesive layer can indeed be et al. Influence of previous provisional
cementation on the bond strength between
sive layers varied greatly by speci- fairly thick, and its thickness can two definitive resin-based luting and
men and location, with a range of vary greatly. However, one advan- dentin bonding agents and human dentin.
Oper Dent 2007;32:84–93.
0–500 mm. Film thickness was tage of the immediate dentin
greater in more concave than in sealing technique is that the

EFFECT OF TIME ON TENSILE BOND STRENGTH OF RESIN CEMENT BONDED TO DENTINE AND
L O W- V I S C O S I T Y C O M P O S I T E

R.M. Duarte, M.F. de Goes, M.A.J.R. Montes

Journal of Dentistry 2006 (34:52–61)

ABSTRACT immediate dentin sealing tech- on the tensile bond strength of a

Objective: The aim of this study nique, using a low-viscosity com- resin cement to dentin at various
was to evaluate the effects of the posite (Protect Liner F, Kuraray), times after application.

© 2009, COPYRIGHT THE AUTHOR

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Materials and Methods: The labial the other three groups. All C O M M E N TA RY

surfaces of 60 bovine incisors were bond failures were evaluated by The results of this study suggest
ground to 600 grit to obtain using SEM. that immediate dentin sealing,
uniform dentin smear layers. The using a self-etch primer adhesive
teeth were randomly assigned to Results: Mean tensile bond system and low-viscosity composite
six groups of 10. In three groups, strengths of the six groups were in liner, might provide a better long-
the self-etching ED Primer a fairly narrow range—from term seal of the dentin than that
(Kuraray, Osaka, Japan) and the 8.5 MPa to 11.3 MPa. Higher provided by the resin cement
adhesive resin cement Panavia F bond strengths occurred at 24 alone. Although bond strengths
(Kuraray) were applied, and a hours and on specimens that were were not dramatically different, the
composite rod was bonded to each coated with the low-viscosity com- adhesive and low-viscosity sealing
surface by light-activating the resin posite. SEM analysis showed that composite provided a more defined
cement. Tensile bond strengths failures occurred primarily at the and more durable hybrid layer.
were measured at 10 minutes, 24 resin–dentin interface for speci- Although it is difficult to extrapo-
hours, or 12 months after polymer- mens that did not include the low- late these results to the clinical
ization of the cement. Specimens viscosity composite and within the situation, it is possible that the
were stored in water at 37°C. resin layers (cement or low- immediate dentin sealing technique
viscosity composite) for those could provide better long-term
In the remaining three groups, the specimens with the low-viscosity adhesion and hence more durable
self-etch primer adhesive system composite. A more distinct hybrid indirect restorations.
Clearfil Liner Bond 2V (Kuraray) layer was observed in the latter
was applied and used to bond a as well. SUGGESTED READING
low-viscosity composite to the Tay FR, Pashley DH. Water treeing—a poten-
dentin surface. The composite was Conclusions: Resin–dentin inter- tial mechanism for degradation of dentin
adhesives. Am J Dent 2003;16:6–12.
light-activated under a matrix strip faces degraded over time, as evi-
and glass slide, so presumably no denced by decreasing bond Carvalho RM, Pegoraro TA, Tay FR, et al.
Adhesive permeability affects coupling of
air-inhibited layer formed. ED strengths and changes in failure resin cements that utilise self-etching
Primer, Panavia F, and a composite modes. However, a layer of low- primers to dentine. J Dent 2004;32:55–65.
rod were applied to the treated viscosity composite helped to
Okuda M, Nikaido T, Maruoka R, et al.
surfaces. Tensile bond-strength protect the underlying hybrid layer Microtensile bond strengths to cavity
floor dentin in indirect composite restora-
tests were performed by using the and would be expected to better tions using resin coating. J Esthet Restor
same method and intervals as in preserve the dentin seal. Dent 2007;19:38–48.

I M M E D I AT E D E N T I N S E A L I N G S U P P O R T S D E L AY E D R E S T O R AT I O N P L A C E M E N T

P. Magne, W.-S. So, D. Cascione

Journal of Prosthetic Dentistry 2007 (98:166–74)

ABSTRACT microtensile bond strength to different adhesives and delays

Objective: The objective of human dentin using the immediate of up to 12 weeks before
this study was to determine the dentin sealing method with two restoration placement.

VOLUME 21, NUMBER 1, 2009 65

 CRITICAL APPRAISAL

Materials and Methods: The immersed in saline solution for 2, similar to those obtained using a
occlusal portions of 50 extracted 7, or 12 weeks. After the provi- freshly placed adhesive, and those
human molars were removed to sional material was removed, the bond strengths are not affected
expose mid-coronal dentin, which dentin was cleaned by using by up to a 12-week delay
was polished to a flat 600-grit airborne-particle abrasion. One before placement of the
surface. A three-step etch-and-rinse coat of bonding agent was applied definitive restoration.
adhesive (OptiBond FL) and a two- and cocured with the subsequent
step, self-etching primer system composite restorative material. All
(Clearfil SE Bond) were used. Ten specimens were sectioned into C O M M E N TA RY

specimens constituted the control uniform slabs for MTBS testing in This study is a continuation of the
groups, in which composite (Z100) a materials testing device. Four 2005 study reviewed at the begin-
was bonded to the dentin as fractured beams from each group ning of this Critical Appraisal. It
direct restorations. were evaluated by using SEM. indicates that immediate dentin
sealing provides excellent bond
Ten teeth were restored with a pro- Results: For OptiBond FL, mean strengths for the final restoration,
visional material (Tempfil Inlay) MTBS values were 55.1 MPa for not only at the relatively short
for 2 weeks. After the provisional the control, 11.6 MPa for the interval of 2 weeks but also with
material was removed, the dentin delayed dentin sealing group, and delays as long as 12 weeks
was cleaned by airborne-particle 58.3 MPa for the immediate dentin following tooth preparation and
abrasion. The adhesives and com- sealing group at 2 weeks. At 7 and resin sealing.
posite were applied. The final step 12 weeks, means for immediate
of each adhesive system was light- dentin sealing were 66.6 MPa and
SUGGESTED READING
activated along with the composite 59.1 MPa, respectively. For Clearfil
resin. These specimens represented SE Bond, the mean MTBS was Johnson GH, Hazelton LR, Bales DJ, Lepe X.
The effect of a resin-based sealer on
a delayed dentin sealing method. 54.8 MPa for the control and crown retention for three types of cement.
1.8 MPa for the delayed dentin J Prosthet Dent 2004;91:428–35.

In the remaining teeth, the adhe- sealing group. Immediate dentin

Islam MR, Takada T, Weerasinghe DS, et al.
sives were applied to freshly cut sealing means were 55.1, 52.0, and Effect of resin coating on retention of
dentin and light-activated under a 45.8 MPa at 2, 7, and 12 composite crown restoration. Dent Mater
J 2006;25:272–9.
lubricant to prevent formation of weeks, respectively.
an oxygen-inhibited layer. The pro-
visional material was applied and Conclusions: Immediate dentin
left in place, while the teeth were sealing provides bond strengths

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 SWIFT

THE BOTTOM LINE

The immediate dentin sealing technique offers several advantages. First, resin adhesion can be improved
by bonding to freshly cut dentin and by polymerization of the resin adhesive without any stresses related
to curing of the resin cement that will overlie it. Second, the adhesive provides a seal that reduces bacte-
rial contamination, tooth sensitivity, and the need for anesthesia at the delivery appointment.

Several variations of the technique have been described in the literature—for example, the use of a self-
etch adhesive rather than an etch-and-rinse adhesive. However, Magne recommends a three-step, etch-and-
rinse adhesive as the type having best clinical track record. In addition, he recommends the use of a filled
adhesive because it can provide the most consistent and uniform film thickness.

While the clinical technique is not particularly complicated, two precautions must be taken to avoid
potential problems. When the adhesive is placed after preparation, it should be light-activated twice, the
second time under a glycerin coating to prevent formation of an oxygen-inhibited layer that could interact
with the impression material. Also, before the provisional restoration is fabricated, the preparation should
be coated liberally with a separating medium, such as petroleum jelly, to prevent bonding of the provi-
sional to the treated tooth surface.

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