Immediate Dentin Sealing: What We Know

The concept of immediate dentin sealing (IDS) was first documented in the 1990s, and there is currently a surge in discussion around the topic. The technique was first called the “resin coating technique” and was proposed by Japanese researchers Dr. Ikonoshi and Dr. Nikaido^{1, 2}.

In this article, I will discuss what immediate dentin sealing (IDS) is, as well as outline some of its possible benefits, downsides, and the levels of evidence we have to support the technique.

Immediate Dentin Sealing Defined

In restorative dentistry, the indirect restoration (e.g., crown, onlay, etc.) can either be bonded or conventionally cemented. At the time of delivery, if the restoration is to be bonded, the dentist will apply the bonding agent (commonly referred to as “adhesive”) immediately before delivery. He or she will etch/condition, prime and bond the tooth structure, and simultaneously prepare the intaglio surface. The method for preparing the intaglio surface is dependent on the restorative material. Finally, the cement is applied, and the restoration is cured. This technique for preparing the tooth structure is known as delayed dentin sealing (DDS). In effect, the application of the adhesive system is delayed until the time of delivery.

The second approach to bonding an indirect restoration involves IDS. With IDS, the bonding agent is applied immediately after the tooth is prepared. The final impression is then made, and a provisional/temporary restoration is placed.

Benefits of Immediate Dentin Sealing

There are several proposed benefits to the IDS technique. Perhaps one of the most significant advantages is that it improves bond strength^{3, 4, 5}. An improvement in bond strength is advantageous because it allows for a more minimally invasive preparation design. Mechanical retention features require more preparation of the tooth structure, but with the evolution of adhesive dentistry, those features become less crucial.

The theorized mechanism by which this technique improves bond strength is that it allows the IDS layer to develop stress-free and unchallenged until the time of delivery. It is important to note that polymerization of the adhesive layer is not completed immediately after curing. The polymerization process continues after the restoration has been initially cured and the curing light has been removed. By delaying restoration delivery at least 24 hours, the dentin bond strength may increase by up to 25 percent.^{6, 7}.

The concept of allowing time for a bond to develop and mature does not simply apply to dentistry. This phenomenon is seen in everyday consumer products such as 3M's Command™ Strips. If you have ever used these adhesive wall mounts, you will notice the manufacturer recommends you wait at least one hour before hanging anything on the hook to allow time for the adhesive to build⁸. If you've ever hung something on the hook too soon, you'll notice the Command™ Strip did not withstand the weight because the adhesive didn't completely develop. Although this is an entirely separate technology, the principles still apply.

Unlike enamel bonding, dentin is a considerably more technique-sensitive substrate to bond to⁹. It is a humid substrate, and, by virtue of that characteristic, the bond can eventually succumb to hydrolytic degradation. A second benefit of the technique is that it allows the operator to bond to freshly cut dentin. Because dentin is so technique-sensitive, clean dentin is ideal. If the dentin is not sealed, the dentinal tubules can become contaminated with impression material, temporary material, and material from the oral cavity^{10, 11}.

IDS may also be effective in combating post-operative sensitivity. A randomized control trial involving 25 participants demonstrated that IDS was effective in combating post-operative sensitivity initially after cementation¹². However, post-operative sensitivity can only be accurately measured with clinical data, and to date there is a paucity of in vivo data on the topic. One recent systematic review and meta-analysis reported that there was no statistically significant difference when comparing IDS and DDS in measures of post-operative sensitivity¹³.

Other possible benefits of IDS include decreased bacterial leakage during the provisional phase, improved tooth preparation and restoration adaptation, reinforcement of remaining tooth structure, optimal protection of direct pulp capping, adherence of resin-based provisional materials, etc.¹⁴.

Disadvantages of Immediate Dentin Sealing

There are two disadvantages associated with IDS. One is, as mentioned above, that it's technique-sensitive. And the technique involves multiple steps, which may increase the likelihood that a critical step in the process is inadvertently omitted. What's more, because the technique has a few extra steps, it may add minutes to the procedure. In a busy practice, providers cannot always afford this extra time.

Levels of Evidence

Debate among dentists about the efficacy of IDS continues to ensue. Because IDS may add additional minutes to a procedure, concern for the level of evidence to support the technique has emerged. As with any material, technology, or technique, dentists must evaluate for themselves the available levels of evidence to determine if it's safe and prudent to implement it in their practice.

Qanungo et al. published an article featured in the Journal of Prosthodontic Research evaluating 40 articles investigating IDS¹⁴. The majority of the studies included were in vitro investigations. They evaluated IDS on the grounds of bond strength, adaptation of definitive restorations, interaction with impression materials and post-cementation hypersensitivity. From their literature review, the authors concluded that IDS helps to achieve an improved bond strength, decreases bacterial leakage, reduces dentin sensitivity, and decreases gap formation¹⁵.

Another three-year clinical study involving 30 patients evaluated the efficacy of IDS and determined that there was no significant difference between groups treated with IDS versus DDS. The overall success rate of the restorations was 98.3%¹⁶.

However, Gresnigt et al. completed a prospective clinical trial involving a total of 104 patients receiving 384 feldspathic ceramic laminate veneers on maxillary teeth. The trial took place over the course of eleven years. The author concluded that teeth with over 50% dentin exposure significantly benefited from IDS, with a survival rate of the teeth of 96.4% compared to 81.8% for the teeth without IDS¹⁷.

In summary, more long term clinical data on the topic may be beneficial. Immediate dentin sealing offers the possibility of increasing bond strength, decreasing bacterial microleakage, and decreasing post operative-sensitivity among other benefits. However, in a busy practice this technique-sensitive procedure may cost the provider time. All things considered, the provider must evaluate the levels of evidence available to determine if they would like to implement it in their practice.

Dr. Melissa N.R. Seibert is the creator and host of the dental podcast, Dental Digest. She is a board member for the Academy of Biomimetic Dentistry and Industry Thought Leader for Crest and Oral-B.

References

1. Inokoshi, S. (1992). Temporary sealing-pulp and dentin protection using low viscosity composite.Adhes. Dent,10, 250.
2. Nikaido, T., Koh, Y., Satoh, M., Takakura, H., Inokoshi, S., Takatsu, T., & Hosoda, H. (1993). Effect of temporary filling materials on adhesion of dual cured resin cement to low viscosity resin. J Jpn Dent Mater,12, 655-661.
3. Magne, P., Kim, T. H., Cascione, D., & Donovan, T. E. (2005). Immediate dentin sealing improves bond strength of indirect restorations.The Journal of prosthetic dentistry,94(6), 511-519. https://doi.org/10.1016/j.prosdent.2005.10.010
4. Gailani, H. F. A., Benavides-Reyes, C., Bolaños-Carmona, M. V., Rosel-Gallardo, E., González-Villafranca, P., & González-López, S. (2021). Effect of Two Immediate Dentin Sealing Approaches on Bond Strength of Lava™ CAD/CAM Indirect Restoration.Materials,14(7), 1629.
5. Choi, Y. S., & Cho, I. H. (2010). An effect of immediate dentin sealing on the shear bond strength of resin cement to porcelain restoration.The journal of advanced prosthodontics,2(2), 39-45.
6. Reis, A., de Oliveira Carrilho, M. R., Schroeder, M., Tancredo, L. L. F., & Loguercio, A. D. (2004). The influence of storage time and cutting speed on microtensile bond strength.Journal of Adhesive Dentistry,6(1).
7. Dolinski, N. D., Page, Z. A., Discekici, E. H., Meis, D., Lee, I. H., Jones, G. R., ... & Hawker, C. J. (2019). What happens in the dark? Assessing the temporal control of photo‐mediated controlled radical polymerizations.Journal of Polymer Science Part A: Polymer Chemistry,57(3), 268-273.
8. United States. How to Use All Other Strips & Hooks│Command™. (n.d.). Retrieved July 15, 2022.
9. Meerbeek, B. V., Yoshihara, K., Van Landuyt, K., Yoshida, Y., & Peumans, M. (2020). From Buonocore's Pioneering Acid-Etch Technique to Self-Adhering Restoratives. A Status Perspective of Rapidly Advancing Dental Adhesive Technology.Journal of Adhesive Dentistry,22(1).
10. Sinjari, B., D'Addazio, G., Xhajanka, E., Caputi, S., Varvara, G., & Traini, T. (2020). Penetration of different impression materials into exposed dentinal tubules during the impression procedure.Materials,13(6), 1321.
11. Frankenberger, R., Lohbauer, U., Taschner, M., Petschelt, A., & Nikolaenko, S. A. (2007). Adhesive luting revisited: influence of adhesive, temporary cement, cavity cleaning, and curing mode on internal dentin bond strength.Journal of Adhesive Dentistry,9(2).
12. Hu, J., & Zhu, Q. (2010). Effect of immediate dentin sealing on preventive treatment for postcementation hypersensitivity.International Journal of Prosthodontics,23(1).
13. Josic, U., Sebold, M., Lins, R. B., Savovic, J., Mazzitelli, C., Maravic, T., ... & Breschi, L. (2022). Does immediate dentin sealing influence postoperative sensitivity in teeth restored with indirect restorations? A systematic review and meta‐analysis.Journal of Esthetic and Restorative Dentistry,34(1), 55-64.
14. Magne, P., & Belser, U. (2022). Biomimetic Restorative Dentistry. Quintessence Publishing.
15. 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.
16. Van den Breemer, C. R. G., Cune, M. S., Özcan, M., Naves, L. Z., Kerdijk, W., & Gresnigt, M. M. M. (2019). Randomized clinical trial on the survival of lithium disilicate posterior partial restorations bonded using immediate or delayed dentin sealing after 3 years of function.Journal of Dentistry,85, 1-10.
17. Gresnigt, M. M., Cune, M. S., Schuitemaker, J., van der Made, S. A., Meisberger, E. W., Magne, P., & Özcan, M. (2019). Performance of ceramic laminate veneers with immediate dentine sealing: An 11-year prospective clinical trial.Dental Materials,35(7), 1042-1052.