How to do Immediate Dentin Sealing [Increase Bond Strength]

In this article, I’ll discuss how to perform the biomimetic technique of immediate dentin sealing. This technique has a number of advantages in dentistry, but one of the most notable is that it increases the bond strength. There are a few different approaches to immediate dentin sealing, but here I’ll discuss how Dr. Pascal Magne performs IDS.^1,2 In this article, I’ll write with the assumption that I’m using a three-step dentin bond system, such as Optibond FL (I have no financial interest/conflict of interest with Kerr).

First of all, if you are completing IDS on a tooth that has formerly been endo-treated, a glass ionomer barrier must first be placed over the orifice. Otherwise, the solvent within the primer may dissolve the gutta percha.

immediate dentin sealing, increase bond strength — Figure 1: Photo used with the permission of the very talented, Michael Sielski. Follow him here: @magicfstop

Next, Dr. Magne advocates for slight roughening of the dentin with a rough diamond bur. This is done with the intent of roughening the dentin so it mimics the dentin enamel junction/dentin enamel complex (DEJ/DEC). By roughening the surface, you’re increasing the surface area for bonding and mimicking the DEJ/DEC.³

Fascinatingly, at the microscopic level, the DEJ/DEC has an egg-carton-like shape. This scalloping allows for increased surface area for the adhesion of dentin to enamel. Click here to listen to this episode of the Dental Digest dental podcast to learn why the DEJ/DEC is my favorite “organ.”

Magne then recommends etching the freshly cut dentin for 5-15 seconds with phosphoric acid etch. In this article, he cautions against “excessive drying and excessive wetting” because it “can cause an inferior bond owing to demineralized collagen collapse and nanoleakage/water, respectively. Accordingly, air drying should be avoided. Excess moisture removal can be achieved by use of suction drying.” ¹

IDS – Primer Application

After etching, he then recommends thoroughly applying a primer. Careful consideration must be taken to not only apply the primer but scrub it into dentin. If you’d like to listen to my interview with him in which he describes this technique, click here.

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Following application of the primer, air dry the primer. I create a laminar air flow when I air dry my primer. I do so with a technique in which I air dry the primer and my assistant puts the high-speed suction 2 cm away from my air tip.

Meticulous application of the primer cannot be stressed enough. Prior to my interview with Dr. Magne, I overlooked the significance of this step. Now, I scrub the dentin, or “massage” as Dr. Magne would say, for at least 20 seconds.

You can be sure that you’ve correctly applied your primer when the surface is still shiny, but yet when you air dry the dentin you aren’t seeing moving fluid.

Next, the adhesive is painted on. Dr. Magne commonly references using Optibond FL adhesive in his lectures and work. He does not have a conflict of interest, but references it because Optibond FL does afford particular advantages. For one, it is filled and therefore won’t appear radiolucent on radiographs. Even more, Optibond FL can behave like a liner. For this reason, the operator does not have to apply a thin layer of flowable resin after apply Optibond FL. The disadvantage of unfilled adhesives, Stavridakis reports, is that their thickness throughout the preparation can dramatically differ.⁶With unfilled adhesives, the adhesive may pool in the isthmus and yet be unacceptably thin along the cavity wall.

If using a three-step system (such as Optibond FL) for your IDS, the upmost consideration must be taken to NOT thin the bond. Why? Because if the adhesive is air dried, it will be thinned. And, if the adhesive in thinned, all that may be left is the oxygen inhibited layer (OIL)^.4,5 If you’d like to learn more about the OIL, click here. Please note that if you’re using a universal adhesive system (also known as an all-in-one or one-step-system) the adhesive must be air dried because of the solvent within the adhesive.

Once the adhesive is applied, it can then be cured.

After completing this step of IDS, if you are going to take a traditional impression, the oxygen inhibited layer (OIL) must first be cured. Failure to do so will cause the OIL to interact with the impression material. To cure this layer, glycerine jelly is applied all over the prep and then cured again. Finally, in order to remove any remaining bit of the OIL that was not fully cured, Magne advocates for cleaning the surface with pumice.

From personal stories, I have had colleagues tell me of instances when they did not remove the OIL and then their PVS impression material did not set around the prep because of the interaction between the PVS and OIL.

Once the adhesive is applied, the enamel margins are refined with a fine diamond. When I first read that enamel margins are refined I was confused – why would you use a fine diamond bur on enamel margins you already created? In Dr. Magne’s work he states the purpose of this is to eliminate excessive adhesive resin. From personal experience, I have learned the hard way that if you don’t refine your enamel margins, they will turn out jagged and unusual because of the adhesive (reference figure 2). This makes it difficult for the CAD/CAM to detect the margins.

Please note, this technique for IDS is written with the assumption that a filled adhesive is used (i.e. Optibond FL), this approach would be slightly different if a non-filled adhesive were used (such as Clearfil SE). There are other approaches available for how to complete IDS. Would you like to hear about this other technique for IDS? Would you like to hear why IDS increases bond strength? Email me at hello@dentaldigestinstitue.com

P.S. I hope this article is of service to you. As a dentist myself, I want to be apart of creating value for our community. Did you know you can earn CE through the Dental Digest podcast? Click here to get started. You’re busy. Earning CE through the dental podcast makes it possible to stay at the forefront of dentistry while you multitask. Good luck, my friend!

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