Recent advances in the theory and mechanism of adhesive resin bonding to dentin: a critical review.

Dentin bonding issues involving adhesive resins have attracted considerable research interest in recent years. An important advance due to the ongoing research is the concept of hybridization of the tissue with primer/adhesive systems. Hybridization involves permeation of primer monomer into the tissue substrate. Although the mechanism of adhesive permeation and interaction with tissue may be complex, significant advances have been made. In systems where etching precedes priming and bonding steps, the Hoy's solubility parameter compatibility of the primer formulation with that of demineralized dentin matrix may determine adhesive permeability. Monomer permeation brings the primer atoms in closer contact with the substrate atoms, leading to adhesive interactions through van der Waals, hydrogen bonding, and electrostatic interactions. In self-etch primer systems, stronger electrostatic interaction between primer monomers and hydroxyapatite has been used to explain the adhesion process. These interactions have been computer-modeled and analyzed. Such interactions and subsequent polymerization of the monomer promote improved bond strength and efficient margin sealing. Incomplete permeation of monomer into the full depth of demineralized region may, however, leave exposed collagen fibrils and cause nanoleakage of water into these regions through a 20-100 nm sized marginal gap, leading to subsequent hydrolytic degradation of these collagen fibrils and the hybrid layer. Microleakage is also a problem in some single step formulations. In this review, we analyze these current theoretical and mechanism-related issues of interest in adhesive resin bonding to dentin, and outline the continuing problems that need to be overcome in the future. Copyright 2008 Wiley Periodicals, Inc.