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This article reviews the current concepts for operatively managing carious lesions extending into dentine with minimal removal of tooth structure and restoring with dentine adhesives and direct composite resin. It looks sequentially at the operative steps involved including remineralisation with bioactive cements, bonding to caries-affected dentine including smear-layer modification using HOCl, creation of an acid-base resistance zone,steps to optimise the performance of all-in-one adhesives, and incremental placement of direct composite resin to improve bond strengths to cavity floor dentine. It explores how understanding the phenomenon of colour-shifting at the composite resin-enamel/dentine restoration borders can help in creating near "invisible" restoration margins through a "chameleon" effect. With the increased risks of transmission of Covid-19 when aerosol generating procedures are carried out in Dentistry, following a minimally invasive approach to managing dental caries should be given serious consideration. [ABSTRACT FROM AUTHOR]

Self-etch adhesive (SEA) systems simplify bonding procedures. It is believed that good mechanical retention and chemical bonding are both important factors to obtain reliable bonding to enamel. The enamel acid-base resistant zone (ABRZ) has been confirmed at the adhesive/enamel interface by scanning electron microscopic observation. However, the formation of enamel ABRZ is influenced by the type and components of adhesive systems. Chemical interactions by a functional monomer with hydroxyapatite strongly support the explanation of the mechanism for enamel ABRZ formation. The ABRZ created by MDP-containing SEA systems has shown good potential to resist acid attack from simulated recurrent caries models. In addition, fluoride release may enhance acid resistance. It has been proposed that such a reinforced enamel be termed "Super Enamel". The concept of the formation of super enamel may contribute to protecting enamel, and conserve tooth structure leading to improved restoration longevity. [ABSTRACT FROM AUTHOR]

The resin-coating technique is one of the successful bonding techniques used for the indirect restorations. The dentin surfaces exposed after cavity preparation are coated with a thin film of a coating material or a dentin bonding system combined with a flowable composite resin. Resin coating can minimize pulp irritation and improve the bond strength between a resin cement and tooth structures. The technique can also be applied to endodontically treated teeth, resulting in prevention of coronal leakage of the restorations. Application of a resin coating to root surface provides the additional benefit of preventing root caries in elderly patients. Therefore, the coating materials have the potential to reinforce sound tooth ("Super Tooth" formation), leading to preservation of maximum tooth structures. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of fluoride concentration in adhesives on morphology of acid-base resistant zone (ABRZ). Seven experimental adhesives with different concentrations of NaF (0 wt%; FO to 100 wt%: F100) were prepared based on the formulation of a commercially available adhesive (Clearfil Protect Bond, F100). The resin-dentin interface of the bonded specimen was subjected to deminerahzing solution and NaOCl, sectioned, polished and argon-ion etched for SEM observation. Fluoride release from each adhesive was measured using an ion-selective electrode. Fluoride ion release from the adhesive linearly increased with higher NaF concentration. The ABRZ area increased significantly with higher NaF concentration except for F0, F10, and F20 (p<0.05). F100 showed the largest ABRZ, where a slope of acid-resistant dentin was clearly observed at the bottom of the ABRZ. The concentration of NaF in the two-step self-etching adhesive resin influenced the amount of dentin structure remaining after acid-challenge. [ABSTRACT FROM AUTHOR]

This study investigated the influence of the composition of self-etching primer adhesive systems on the morphology of acid-base resistant zones (ABRZs). One-step self-etching primer systems (Clearfil Tri-S Bond, G-Bond, and One-Up Bond F Plus) and two-step self-etching primer systems (Clearfil SE Bond, Clearfil Protect Bond, UniFil Bond, and Mac Bond II) were used in this study. Each adhesive was applied on prepared dentin disk surfaces, and a resin composite was placed between two dentin disks. All resin-bonded specimens were subjected to acid-base challenge. Observation under a scanning electron microscope (SEM) revealed the creation of an ABRZ adjacent to the hybrid layer for all the self-etch primer adhesive systems, even when non-fluoride releasing adhesives were used. The presence of fluoride in two-step self-etching adhesive significantly increased the thickness of ABRZ created. Results suggested that an ABRZ was created with the use of self-etching primer adhesive systems, but its morphology differed between one-and two-step self-etching primer adhesive systems and was influenced by fluoride release activity. [ABSTRACT FROM AUTHOR]

This study aimed at evaluating the effect of functional monomers in all-in-one adhesive systems on formation of acid-base resistant zone (ABRZ) in enamel and dentin. Experimental adhesive systems containing one of three functional monomers; MDP, 3D-SR and 4-META were applied to enamel or dentin surface and light-cured. A universal resin composite was then placed. The specimens were subjected to a demineralizing solution (pH 4.5) and 5% NaC1O for acid-base challenge and then observed by SEM. The ABRZ was clearly observed in both enamel and dentin interfaces. However, enamel ABRZ was thinner than dentin ABRZ in all adhesives. Morphology of the ABRZ was different between enamel and dentin, and also among the adhesives. Funnel-shaped erosion was observed only in the enamel specimen with the 4-META adhesive. The formation of enamel/dentin ABRZ was confirmed in all adhesives, but the morphology was influenced by the functional monomers. [ABSTRACT FROM AUTHOR]

Summary: Dentin bonding systems have been dramatically simplified and improved during the recent decades. Monomer penetration into dentin and its polymerization in situ creates a hybrid layer, which is essential to obtain good bonding to dentin. Moreover, the presence of an acid–base resistant zone below the hybrid layer has been documented with self-etching adhesive systems in an artificial secondary caries attack. When ultrastructure of the acid–base resistant zone is assessed by SEM and TEM observations, formation of the acid–base resistant zone is considered to be due to the monomer penetration potential and fluoride release in the adhesive 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. Therefore, the reinforced dentin has been called “Super Dentin” bearing the ability to prevent primary and secondary caries. Prospectively, the great potential of adhesive technology in creation of the “Super Dentin” would lead to the development of new materials for mechanical, chemical and biological protection of the dental structures. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the ultrastructure of the dentin-adhesive interface using two all-in-one adhesive systems (Clearfil Tri-S Bond, TB; Tokuyama Bond Force, BF) after different acid-base challenges. Three solutions were used as acidic solutions for the acid-base challenges: a demineralizing solution (DS), a phosphoric acid solution (PA), and a hydrochloric acid solution (HCl). After the acid-base challenges, the bonded interfaces were examined by scanning electron microscopy. Thickness of the acid- base resistant zone (ABRZ) created in PA and HCl was thinner than in DS for both adhesive systems. For BF adhesive, an eroded area was observed beneath the ABRZ after immersion in PA and HCl, but not in DS. Conversely for TB adhesive, the eroded area was observed only after immersion in PA. In conclusion, although the ABRZ was observed for both all-in-one adhesive systems, its morphological features were influenced by the ingredients of both the adhesive material and acidic solution. [ABSTRACT FROM AUTHOR]

An acid-base resistant zone has been found to exist after acid-base challenge adjacent to the hybrid layer using SEM. The aim of this study was to examine the acid-base resistant zone using three different bonding systems. Dentin disks were applied with three different bonding systems, and then a resin composite was light-cured to make dentin disk sandwiches. After acid-base challenge, the polished surfaces were observed using SEM. For both one- and two-step self-etching primer systems, an acid-base resistant zone was clearly observed adjacent to the hybrid layer - but with differing appearances. For the wet bonding system, the presence of an acid-base resistant zone was unclear. This was because the self-etching primer systems etched the dentin surface mildly, such that the remaining mineral phase of dentin and the bonding agent yielded clear acid-base resistant zones. In conclusion, the acid-base resistant zone was clearly observed when self-etching primer systems were used, but not so for the wet bonding system. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate dentin bond strengths and to observe the adhesive-dentin interface after acid-base challenge using fluoride-free and fluoride-releasing self-etching adhesive systems; Clearfil SE Bond (SE), FL-Bond (FL) and FL-Bond II(FL II). Fifteen dentin surfaces from human molars were ground and bonded with one of three adhesive systems. The microtensile bond strength (pTBS) test was performed at a crosshead speed of 1 mm/mm. The interface of the bonded specimens after acid-base challenge were also examined by a SEM. The pTBS of SE were significantly higher than those of FL and FL II (p<0.05), however, there were no significant differences between FL and FL II (p>0.05). An acid-base resistant zone (ABRZ) was observed in all the groups, however, formation of the ABRZ was material dependent. Fluoride-release from the adhesive is a key factor to create thick ABRZ. [ABSTRACT FROM AUTHOR]

The purposes of this study were twofold, namely to evaluate: (1) the effect of hybridization on microtensile bond strength (μTBS) to dentin, and (2) the ultrastructure of the dentin-adhesive interface with 4-META/MMA-TBB resin after acid-base challenge. Dentin surfaces, which received no treatment (NT), 65% phosphoric acid (PA), or 10% citric acid-3% ferric chloride (10-3), were bonded with a 4-META/MMA-TBB resin. To evaluate dentin bond strength, μTBS test was performed at a crosshead speed of 1 mm/mm. For ultrastructural evaluation of the adhesive interfaces, SEM was used to examine the interfaces of the bonded specimens after acid-base challenge. The μTBS of NT was not determined, while that of 10-3 was significantly higher than that of PA (p<0.05). With PA and 10-3, the hybrid layer was clearly observed, but no so for the acid-base resistant zone. Wall lesion was found in NT only. In conclusion, hybridization is vital to improving μTBS to dentin and enhancing resistance at the adhesive interface against acid-base challenge. [ABSTRACT FROM AUTHOR]