Protocolo de sellado inmediato de la dentina

1. Immediate Dentin Sealing
A Fundamental Procedure for Indirect Bonded Restorations

2. Introduction
 The application of a dentin bonding agent
to freshly cut dentin when it is exposed
after tooth preparation for indirect
restorations (inlays/onlays, crowns).
 A procedure recommended before final
impression making to preserve the dentinal
collagen network and develop an adequate
hybrid layer.

3. Dentin exposure after preparation
 Freshly cut dentin is susceptible to bacterial
contamination during provisionalization period.(1-2)
 The colonization of bacteria through the exposed dentinal
tubules leads to post-operative sensitivity and a
compromise in bond strength.
 Whenever dentin is exposed, the application of a dentin
bonding agent is recommended.

4. Cont’d
 Dentin bonding strength is weaker when
subjected to occlusal forces immediately in
direct restoration.
 Demineralized dentin can easily collapse by
the seating pressure of the restoration.(3-6)
 Stress-free dentin bond development
improves restoration adaptation.(6)

5. Main issues in dentin bonding
1.Dentin contamination
2.Susceptibility of the hybrid
layer to collapse until it is
polymerized.

6. Rationale for IDS
 Freshly cut dentin is the ideal substrate for dentin bonding.
 Creating a hybrid layer that both mimics the dentino-enamel junction (DEJ) and
promotes proper adaptation and adherence of the final restoration is the basis of
minimal intervention dentistry.
 Precuring of dentin bonding agent leads to improved bond strength.
 Dentinal tubules are blocked by the movement of dentinal tubule fluids which
hinder the penetration of the resin into them. (1-2)

7. Advantages
 Limits the needs for anesthesia during insertion.
 Reduced post-op sensitivity.(7)
 Significantly increases retention when combined
with GIC, RMGI cements. Exceeding the cohesive
strength of the tooth.(8)
 Improves the retention for teeth with short clinical
crowns and excessively tapered preparations.

8. Clinical Steps

9. How to identify dentin?
A short etching (2-3 secs) followed by thorough drying of the prepared surfaces.
Dentin can be easily recognized because of its glossy aspect, whereas enamel is
frosty.

10. Preparation
When margins terminate in dentin, a marked chamfer (0.7 mm to 0.8 mm) is recommended to provide adequate
margin definition and enough space for the adhesive and overlaying restoration (Figures 2A through 2C). A shallow
chamfer would cause the adhesive resin to pull over the margin and compromise both margin definition and
porcelain thickness.

11. Etching
Immediately after tooth preparation, the uncontaminated dentin surfaces are etched for 5 to 15 seconds (depending on
the adhesive system used). It is recommended to extend etching 1 mm to 2 mm over the remaining enamel to ensure
further adhesion of eventual excess resin.

12. Priming + Bonding

13. Final layers + Glycerin
O. The adhesive is initially cured for
20 seconds.
P. A layer of glycerine is applied on
the sealed dentin to cure the air-
inhibited layer of the resin.
Q. Another technique that has been
suggested to reduce or eliminate
the OIL is to wipe the sealed
surface with a cotton pellet
soaked in 70% ethyl alcohol for 10
s (9). or covering the IDS surface
with a liner (flowable composite)
if space permits.(10)

14. Impression procedure
• Polyether is not recommended
(Impregum Soft)
• The OIL may in turn inhibit the
polymerization of vinyl polysiloxane
(VPS) impression materials,
depending on the type of DBA.(11)
• Air blocking and pumicing was the
best method to reduce the effect of
OIL.(12)

15. Caution with provisionalization
• Sealed dentin surfaces have the potential
to bond to resin-based temporary
cements/materials.
• Usage of non-resin-based cements is
recommended. (Non-eugenol ZnO and
Calcium hydroxide)
• Cover tooth preparation using a
separating medium (e.g petroleum jelly or
Pro-V coat) to avoid locking of
restorations.(13)

16. Summary

17. Final insertion
Various authors have evaluated methods for removal
of provisional cement in vitro. Reviewing these
studies, it was found that the highest bond strength
values were reported with soft-air abrasion(14), air
borne particle abrasion with aluminium oxide and
fluoride-free pumice paste systems.

18. Question time!
The ideal time to seal the dentinal tubules is?
A.After tooth preparation before blocking undercuts
B.After tooth preparation after blocking undercuts
C.After taking the impression
D.All of the above

19. Case report

20. Pre-operative condition

21. (A) Intraoral condition immediately after restoration removal; (B) self-etch primer application for
20 seconds; (C) gentle air blowing for solvent evaporation; (D) bond layer application; (E)
adhesive layer light curing for 40 seconds; and (F) flowable composite resin coat application

22. (A) Undercut filling with composite resin; (B) enamel margins finished with fine diamond bur; (C)
preparation finished and ready for impression; (D) negative mold of the prepared tooth; (E)
glycerin application; (F) temporary restoration

23. (A) Virtual design of the restoration; (B) final restoration on stone model; and (C) final intraoral condition of the restored tooth

24. (A) Clinical condition of the restored tooth after 15 months of follow-up; and (B) radiographic condition of the restored tooth
after 15 months of follow-up

25. Conclusion
Immediate application and polymerization of the dentin bonding agent to
the freshly cut dentin, before impression taking, is recommended. The
immediate dentin sealing appears to achieve improved bond strength, fewer
gap formations, decreased bacterial leakage, and reduced dentin sensitivity.

26. References
1. Bertshinger C, Paul SJ, Luthy H, Schaerer P. Dual application of dentin bonding agents: its effect on the bond strength. Am J Dent.
1996;9:115-119.
2. Paul SJ, Schaerer P. Effect of provisional cements on the bond strength of various adhesive bonding systems on dentine. J Oral
Rehabil. 1997;24:8-14.
3. Paul SJ, Schaerer P. The dual bonding technique: a modified method to improve adhesive luting procedures. Int J Periodontics
Restorative Dent. 1997;17:536-545.
4. Magne P, Douglas WH. Porcelain veneers: dentin bonding optimization and biomimetic recovery of the crown. Int J Prosthodont.
1999;12:111-121.
5. Dietshi D,Hertzfeld D. In-vitro evaluation of marginal and internal adaptation of ClassII resin composite restorations after thermal
and occlusal stressing. Eur J Oral Sci. 1998;106:1033-1042.
6. Pashley EL, Comer RW, Simpson MD, et al. Dentin permeability: sealing the dentin in crown preparations. Oper Dent. 1992;17:13-
20.
7. Cagidiaco MC, Ferrari M, Garberoglio R, et al.Dentin contamination protection after mechanical preparation for veneering. Am J
Dent. 1996;9:57-60.

27. References
8. Johnson GH, Hazelton LR, Bales DJ, et al. The effect of a resin-based sealer on crown retention for three types of cement. J Prosthet Dent.
2004;91:428-435.
9. Van Meerbeek B, De Munck J, Yoshida Y, et al. Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future
challenges. Oper Dent. 2003;28:215-235.
10. De Munck J, Van Meerbeek B, Satoshi I, et al. Microtensile bond strengths of one and two-step self-etch adhesives to bur-cut enamel and
dentin. Am J Dent. 2003;16:414-420.
11. Paul SJ. Scanning electron microscopic evaluation of the influence of the oxygen-inhibited layer of resins on the polymerization of impression
materials. In: Paul SJ, editor. Adhesive luting procedures. Chicago: Quintessence; 1997. p. 99–110.
12. Magne, P., & Nielsen, B. (2009). Interactions between impression materials and immediate dentin sealing. Journal of Prosthetic Dentistry,
102(5), 298–305. https://doi.org/10.1016/S0022-3913(09)60178-5
13. Qanungo, A., Aras, M. A., Chitre, V., Mysore, A., Amin, B., & Daswani, S. R. (2016). Immediate dentin sealing for indirect bonded restorations.
Journal of Prosthodontic Research, 60(4), 240–249. https://doi.org/10.1016/J.JPOR.2016.04.001
14. Rocca GT, Gregor L, Sandoval MJ, Krejci I, Dietchi D. In vitro evaluation of marginal and internal adaptation after occlusal stressing of indirect
class II composite restorations with different resinous bases and interface treatments. Post-fatigue adaptation of indirect composite
restorations. Clin Oral Investig 2012;5:1385–93.
15. Leite, M. M., de Souza, D. R., Carvalho, M. A., Lopes, L. G., & de Torres, É. M. (2017). Immediate dentin sealing with self-etch dentin
bonding agent for indirect restoration. World Journal of Dentistry, 8(6), 490–495. https://doi.org/10.5005/jp-journals-10015-1492

28. Thank you!