Curr Oral Health Rep (2015) 2:81–86

DOI 10.1007/s40496-015-0046-y

CARIOLOGY (J TAGAMI, SECTION EDITOR)

Resin Coating Technique for Protection of Pulp and Increasing

Published online: 9 April 2015

Abstract A resin coating technique has been widely advocated technique may play an important role to protect the dentin phys-
in recent years. A combination of a dentin bonding system and a ically, chemically, and biologically. The coating materials also
flowable composite is applied on the exposed dentin surfaces have the potential to cover exposed sound enamel and dentin,
immediately after tooth preparation and before taking the final leading to maximum tooth structure preservation.
impression. The resin coating is beneficial to both minimize
pulpal irritation and enhance the bond strength of a resin cement Keywords Resin coating technique . Adhesion . Pulp
to dentin. Recently introduced thin-film coating materials based protection . Dentin bonding agent . Indirect restoration .
on all-in-one adhesive technology are used for resin coating of Super dentin
crown restorations. Thin-film coating materials can be applied in
a single clinical procedure and followed by created a barrier-like
film layer on the prepared dentin. Therefore, the resin coating Introduction

This article is part of the Topical Collection on Cariology The concept of minimal cavity preparation has become widely
accepted for the placement of direct composite restorations with
* Toru Nikaido the development of improved materials and adhesive techniques
[email protected] [1]. Although direct composite restorations are the preferred
Go Inoue treatment, indirect restorations have advantages over direct tech-
[email protected] niques for large cavities such as improvements in anatomic form,
Tomohiro Takagaki contour, fracture resistance, and wear resistance [2].
[email protected] Indeed, cavity preparation for an indirect inlay/onlay resto-
Rena Takahashi ration is much more aggressive than that of direct composite
[email protected] restoration. For a conventional indirect restoration, intact tooth
Alireza Sadr structure has to be sacrificed to obtain the retention and resis-
[email protected] tance forms, especially because the conventional luting ce-
Junji Tagami ments have a poor capability of bonding to tooth structure
[email protected] [3]. Dentin exposed after cavity preparation should be consid-
1
Department of Cariology and Operative Dentistry, Division of Oral ered as an indirect pulpal exposure since dentin is connected
Health Sciences, Graduate School of Medical and Dental Sciences, to pulp tissue through dentinal tubules. In indirect restorations,
Tokyo Medical and Dental University (TMDU), 1-5-45, Yushima,
Bukyo-ku, Tokyo 113-8549, Japan temporary sealing of the prepared cavities has routinely been
2 performed. However, the poor sealing with such a temporary
International Exchange Center, Tokyo Medical and Dental
University (TMDU), 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8549, material may easily fail, resulting in accidental exposure of the
Japan prepared dentin in the oral cavity, causing irrigation from
3
Department of Restorative Dentistry, University of Washington physical, chemical, and/or bacterial stimuli [4, 5]. Therefore,
School of Dentistry, 1959 NE Pacific St, Box 357456, the exposed dentin should be protected immediately after the
Seattle, WA 98195-7456, USA preparation.
82 Curr Oral Health Rep (2015) 2:81–86

The sealing property of modern dentin adhesive systems is categorized according to the design and mechanism of the
superior to those of the conventional temporary sealing mate- adhesive systems. However, not all these adhesive systems
rials [6]. A recent dentin bonding system has good biocom- are considered to be suitable for use of the resin coating tech-
patibility to pulp tissue [7]. nique. In general, contemporary dentin bonding systems can
be classified into two main categories: self-etching systems
and acid etching systems. However, the category of self-
Resin Coating Technique etching systems itself consists of two subcategories, namely
the two-step self-etch and the one-step self-etch systems. The
A resin coating technique was proposed in the early 1990s in latter is also called the Ball-in-one^ adhesive. More, recently,
order to protect the exposed dentin surface after cavity prepa- universal adhesives have been introduced to the market, which
ration for indirect restorations [8, 9]. The clinical procedures can be categorized under the all-in-one adhesives in terms of
of the resin coating technique are illustrated in Fig. 1a. For the their mechanism. The category of acid-etching or etch-and-
resin coating technique, a combination of a dentin bonding rinse systems included the conventional phosphoric acid etch-
system and a flowable resin composite was applied on the ing in either three-step etching, priming and bonding systems,
preparation just after cavity preparation and before taking or two-step etching and priming/bonding systems.
the final impression, producing a hybrid layer and tight sealing In the case of two-step self-etching systems, there are two
film on the dentin surface [10]. The resin coating technique components in two separate bottles of the self-etching primer
allows for protection and coverage of the prepared dentin im- and the bonding agent. One or several acidic monomers are
mediately after cavity preparation reducing postoperative sen- included in the components of the self-etch primer, along with
sitivity [11]. In addition, the resin coating can enhance dentin water and solvents. The self-etch agent can perform both etch-
bonding strength of a resin cement and provide good interfa- ing or conditioning and priming functions simultaneously. On
cial adaptation and marginal seal [12, 13]. Paul et al. and the other hand, in the case of all-in-one systems, the roles of
Bertschinger et al. reported Bdual application^ [14, 15]. the two agents are combined into a single application step.
Magne et al. proposed Bimmediate dentin sealing (IDS)^ The 30–40 % concentration of phosphoric acid in the etch-
[16, 17]. These ideas are believed to share a similar concept and rinse-systems removes the smear layer from a prepared
with the proposed resin coating technique. dentin surface and widens the tubule orifices of the dentin
surface, demineralizing dentin and exposing the collagen fi-
brils over a depth of 3–5 μm [18]. In this regard, phosphoric
Selection of Dentin Bonding System as a Resin acid etching results in severe demineralization of dentin sur-
Coating Material face when compared to the self-etching systems, particularly
milder systems that have a pH of around 2.0 and higher. More-
Nowadays, a lot of different types of dentin bonding systems over, in the selection of the adhesive system as a resin coating
are available in the market. These dentin bonding systems are material, protection of dentin and pulp tissue is very

Fig. 1 Clinical procedures of the

important. Therefore, self-etching adhesive systems are the durability [30, 31]. A dentin bonding system contains sev-
preferred materials for the resin coating technique rather than eral different ingredients for each adhesive system,
an acid-etching adhesive system. influencing its dentin bonding performance and durability.
Therefore, selection of dentin bonding systems is the first
step for success of the resin coating technique. The com-
New Concept of Dentin Bonding Mechanism bination of the two-step self-etch adhesive and a low
viscosity-resin could provide the highest bond strength of
Dentin bonding systems have been simplified and improved cement to dentin [32, 33]. The additional application of a
dramatically during the past decades. Hybridization concept low-viscosity resin plays an important role in the resin
was proposed as a dentin bonding mechanism by coating technique. A flowable resin composite can protect
Nakabayashi et al. [19]. In this concept, monomer penetration dentin bonding system from tearing during removal of
into dentin and its polymerization in situ creates a hybrid temporary restoration. It also enhances the adhesive poly-
layer, which is believed to be essential for good dentin bond- merization through the diffusion of its free radicals that
ing [19]. However, a new zone, the so-called acid-base resis- polymerize uncured resin in the oxygen inhibited layer
tant zone (ABRZ), was found beneath the hybrid layer [20]. [33, 34]. Moreover, the flowable resin composite layer in
The formation of ABRZ has been confirmed only with a self- the coating technique would prevent possibly adverse in-
etching system, but not with an acid-etching system [20–22]. teractions that have been reported to occur between resid-
The self-etch adhesive systems demineralize dentin mildly ual uncured acidic monomers within the self-etch adhesive
and partially, leaving hydroxyapatite crystals in the base of the and the aromatic tertiary amine derived from chemical-
hybrid layer [23•].Such residual apatite crystals may serve as a and dual-cured resin composites. In addition, the low-
template for additional chemical reaction with the functional viscosity resin with lower filler content combined with a
monomer. Among the functional monomers with different bonding agent with low modulus of elasticity form a
chemical formulae developed for the dentin bonding systems, stress-breaking resin layer relieving the polymerization
10-methacryloxydecyldihydrogen phosphate (MDP) is stresses of cement and leading to better adaptation of the
known to have a high chemical bonding potential to hydroxy- resin inlays [34]. The association of these factors has con-
apatite forming a very stable bond and excellent water resis- tributed to achieve significantly higher adaptation of resin
tance confirmed by the low dissolution rate of its calcium salt cements to dentin.
in water [24–26]. In the dentin bond testing of the bonded specimens, exam-
On the other hand, when the dentin surface is aggressively ination of the debonded specimens after tensile bond testing is
etched with phosphoric acid, the underlying dentin may be- important. In comparison of the resin-coated specimens with
come completely demineralized so deep that hydroxyapatite the non-coated specimens, the fracture mode in the resin coat-
in the underlying dentin would disappear and the bottom of ed specimens shifted adhesive failure to cohesive failure with-
the demineralized dentin would be inaccessible to complete in the cement [34]. This points out the clinical significance of
impregnation by the resin [27]. In this case, a functional the resin coating on the sealing of dentin, as even if the resto-
monomer may not have the opportunity to react with hydroxy- ration fractures.
apatite at the base of the hybrid layer, resulting in lack of the The use of resin coating technique has been demonstrated
ABRZ formation with an acid-etching system [23•]. to improve overall interfacial sealing of the resin cements.
If the ABRZ is assumed made of resin-infiltrated dentin, Different methods have been conventionally used to evaluate
the same chemical reaction of hydroxyapatite and an acidic the marginal integrity and sealing of restorations. The com-
monomer in the adhesive may take place in this zone, giving mon method is detecting dye penetration depth under a ste-
rise to the ability to resist against demineralization from an reoscopic microscope and/or confocal laser scanning micro-
acid attack from the microorganisms in primary and secondary scope (CLSM). However, these conventional methods are
caries. Therefore, the reinforced dentin was proposed to be considered as destructive methods since they require sample
called as BSuper Dentin,^ which should be superior to the sectioning and may be subjective. More recently, three-
normal dentin mechanically, chemically, and biologically dimensional and in-depth imaging methods have been intro-
[28]. duced and utilized for the characterization of restorations [35•,
36–40]. Optical coherence tomography (OCT) is a noninva-
sive diagnostic imaging technique that can give real-time,
In Vitro Evidence for the Benefits of the Resin high-resolution images using a safe broadband light source.
Coating Technique Imaging of indirect bonded restorations by OCT demonstrated
that treatment of dentin surface with resin coating improves
Selection of the coating material influences immediate long-term interfacial sealing of indirect restorations placed
dentin bonding performance [29] and also dentin bonding with resin cements [41••].
84 Curr Oral Health Rep (2015) 2:81–86

Clinical Factors Influencing Bonding Properties agent for the hypersensitive dentin. Such coating materials are
of the Resin Coating Technique clinically accepted for sealing the exposed dentin of the crown
preparation. The thin-film coating material is easily removed
Dentin bond strength is affected by many clinical factors [42, after curing even in the gingival sulcus in comparison with the
43]. Just after application of the resin coating, the coating layer cured adhesive resin in other categories of bonding systems.
has a potential to suffer from various types of contaminations The thin-film coating material demonstrated to improve the
during the succeeding clinical procedures. The material select- dentin bonding performance of resin cement and prevent mar-
ed for impression making [9, 44] and the provisional restora- ginal leakage beneath the restorations [5, 50, 51]. However,
tion [9] after application of the resin coating play a pivotal role the combinational method of applying a dentin bonding
in the success of the final restoration. The incompletely poly- system and a flowable resin composite still provides more
merized resin coating can inhibit the polymerization reaction reliable dentin bonding performance than the thin-film coating
of impression materials, which depends on selection of the alone.
materials [44, 45]. Removal of the oxygen inhibition layer
on the cured coating material prevents interaction of the coat-
ing layer with the impression material. In the indirect restora- Application of Resin Coating to the Endodontically
tions, the preparations have to be temporarily protected for the Treated Teeth
patient’s functional and esthetic needs. The contamination of
the resin coating by the temporary filling material also remains The resin coating technique can be applied not only for the
an issue, as it may alter the bond between the existing resin preparations of vital tooth but also for root canal dentin of the
coating and the resin cement [9, 29, 46]. A water-setting tem- endodontically treated tooth (as shown in Fig. 1c). The goal of
porary material is recommended for temporization for the endodontic obturation is to provide an effective apical seal to
coated surface because this material does not influence the prevent bacterial invasion from the oral cavity through the root
bond strength to resin-coated cavities [4, 9]. Sealed dentin canals. However, the apical seal can be adversely affected by
surfaces have the potential to bond to resin-based provisional coronal leakage once the coronal restoration is lost or becomes
materials and cements. As a result, retrieval and removal of defective [52]. Dissolution of the sealer allows access of
provisional restorations can prove extremely difficult. Tooth periapical fluids, proteins, and bacteria into the root canal.
preparations must be rigorously isolated with a separating me- Fractured teeth and leaking/lost temporary restorations are
dium (such as water-soluble Vaseline) during fabrication of often encountered clinically, which can leave the root canal
the provisional restoration. Given the potential exposure of filling open to the oral cavity. Therefore, the quality of the
the cured adhesive to the oral fluids as well as the water sorp- coronal seal is very important for the ultimate success of any
tion mechanism, it is recommended to keep the root canal obturation. The application of a resin coating to the
provisionalization period as short as possible up to a maxi- coronal opening of the endodontically treated tooth could
mum of 2 weeks [47, 48]. minimize coronal leakage [52]. Perfect sealing was achieved
by coating with a combination of a self-etch adhesive and a
flowable resin composite [52].
Thin-Film Coating Materials For successful adhesive restorations of non-vital teeth, it is
important to obtain good dentin bonding to endodontically
The resin coating technique is applicable to both anterior and treated dentin. Ariyoshi et al. (2008) demonstrated that resin
posterior bonded restorations. However, the combination of a coating significantly enhanced the microtensile bond strengths
dentin bonding system and a low-viscosity micro-filled resin of indirect composite cores to pulpal floor dentin [34].
creates a thick coating layer on the dentin surface, raising
concerns about the thickness of the coating [49]. Thickness
of the cured dentin bonding agent can vary significantly Surface Coating for Tooth Structure Preservation
according to the composition of adhesive system and
also surface geometry [7, 48]. A thick coating is not Sealing of pit and fissure of occlusal enamel with composite
suitable especially for a crown preparation because of resins has been widely accepted to prevent enamel caries in
the possibility of deformation of the preparation by the children and adolescents [53]. Nowadays, approaches of this
resin coating [49]. preventive concept are made to expand to smooth enamel
Recently, a thin-film coating material has been developed surfaces [54, 55]. In order to protect enamel from dissolution,
by using the all-in-one adhesive technology, which can create the superficial penetration and surface coating of the
a thin coating layer with less than 10 μm in thickness on the adhesive and/or caries infiltrant is considered as one of
dentin surface (see Fig. 1b). An all-in-one adhesive with mild the most optimal treatment options [56]. The MDP
acidity has already been marketed for use as a desensitizing functional monomer in the two-step self-etch adhesive
Curr Oral Health Rep (2015) 2:81–86 85

has shown to resist adjacent enamel at the enamel/ Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
adhesive interface against acid attack [57••]. This fact
of the authors.
suggests application of the coating materials can rein-
force the tooth surface, BSuper Tooth^, and contribute
to tooth structure preservation (see Fig. 1d). A recent
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