Mechanisms of degradation of the hybrid layer in adhesive dentistry and therapeutic agents to improve bond durability - A literature review

Success in adhesive dentistry means long lasting restorations. However, there is substantial evidence that this ideal objective is not always achieved. Current research in this field aims at increasing the durability of resin-dentin bonds. The objective of this paper is to examine the fundamental processes responsible for the aging mechanisms involved in the degradation of resin-bonded interfaces and the potential approaches to prevent and counteract this degradation. METHODS: PubMed searches on the hybrid layer degradation were carried out. Keywords were chosen to assess hybrid layer degradation for providing up-dated information on the basis of scientific coherence with the research objective. Approaches to prevent and counteract this degradation were also reviewed. RESULTS: 148 peer-review articles in the English language between 1982 and 2015 were reviewed. Literature shows that resin-dentin bond degradation is a complex process, involving the hydrolysis of both the resin and the collagen fibril phases contained within the hybrid layer. Collagen fibers become vulnerable to mechanical and hydraulic fatigue, as well as degradation by host-derived proteases with collagenolytic activity (matrix metalloproteinases and cysteine cathepsins). Inhibition of the collagenolytic activity and the use of cross-linking agents are the two main strategies to increase the resistance of the hybrid layer to enzymatic degradation. SIGNIFICANCE: This review analyzes the issues regarding the durability of the adhesive interface, and the techniques to create stable resin-dentin bonds able to resist the collagenolytic hydrolysis that are currently studied.