Review of Matrix Metalloproteinases’ Effect on the Hybrid Dentin Bond Layer Stability and Chlorhexidine Clinical Use to Prevent Bond Failure

This review describes the relationship between dentin collagen hybrid bond layer degradation and the Matrix Metalloproteinases (MMPs) after their release by acid etch and rinse adhesives and self etching bonding adhesives that can reduce the bond stability over time. MMP-2, MMP-8 and MMP-9 are indicated as the active proteases that breakdown the collagen fibrils in the hybrid bond layer. Phosphoric acid in the acid etch and rinse bonding process and acid primers in the self etch process are implicated in the release of these proteases and their activation by several non-collagen proteins also released from dentin by the etching. MMPs are released in saliva by salivary glands, by cells in the gingival crevices to crevicular fluid and by pulpal odontoblasts cells to the dentinal fluids. These sources may affect the hybrid layer also. Evidence of the bond strength deterioration over time and the ability of Chlorhexidine to prevent bond deterioration by inhibiting MMP action are discussed. Dentin Bonding procedure utilizing Chlorhexidine for different application times and concentrations are being developed. The application of 2% Chlorhexidine to the phosphoric acid etch surface after rinsing off the acid is the only procedure that has been clinically tested for a longer period of time and shown to prevent bond strength degradation so far. The adoption of this procedure is recommended as means of improving bond stability at this time

Overview of Clinical Alternatives to Minimize the Degradation of the Resin-dentin Bonds

The incorporation of hydrophilic and acidic resin monomers substantially improved the initial bonding of contemporary etch-and-rinse (ER) and self-etch (SE) adhesives to intrinsically wet dental substrates, providing quite favorable immediate results, regardless of the bonding approach used. However, in the long term, the bonding effectiveness of most simplified ER and SE adhesives drop dramatically. This review examines the fundamental processes that are responsible for the aging mechanisms involved in the degradation of the resin-bonded interfaces and some possible clinical approaches that have been effective in minimizing or even preventing the degradation of the adhesive interfaces produced with simplified adhesives. The incorporation of some of the feasible approaches - described in this review - may improve the quality of the adhesive restorations performed in clinical practice, while manufacturers develop bonding materials that are less susceptible to the aging mechanisms present in the oral environment