Title	Immediate Dentin Sealing (IDS) Combined with a Resin Cement Improves Bond Strength in Indirect Ceramic Restorations
Clinical Question	In patients who need indirect bonded restorations, do the combined effects of immediate dentin sealing (IDS) with resin cement improve bond strength when compared to traditional methods using resin cement alone?
Clinical Bottom Line	For patients requiring indirect bonded restorations, immediate dentin sealing (IDS) combined with resin cement produces greater bond strength than resin cement alone. Studies provide credible evidence of significant value that IDS does improve the overall bond strength of resin cement, in addition to other clinical benefits. IDS is particularly technique sensitive but is within the capability of the dental professional who is properly trained. Given the benefits to patient comfort and restoration success, IDS is likely to be accepted and used for the average patient.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 27131858 Qanungo/2016 40 studies reviewed Literature review Key results Due to the significant amount of dentin exposure during tooth preparation for indirect bonded restorations, the creation of an interphase similar to the natural DEJ by means of application of a dentin bonding agent in the form of ‘immediate dentin sealing’ show numerous clinical benefits. In addition to improved overall bond strength, improvements are noted in reducing micro gap formation, a decreased and more uniform film thickness at time of bonding, decreased bacterial leakage and permeability of dentin, improvements in shear bond strength, improved bonded seal both internally and at the margin, and reduced sensitivity both post-operatively and post-cementation. “IDS [immediate dentin sealing] technique might provide a better long-term bonding to dentin than that provided by resin cement alone.” 15996383 Magne/2005 30 articles reviewed Literature review Key results To maximize bond strength, freshly cut dentin is the ideal surface for superior dentin bonding. IDS allows for stress-free dentin bonds to develop progressively over time before final restorations are made and the tooth is put under function. Additional advantages of decreased dentinal sensitivity by reducing dentinal permeability are noted. In addition to benefits of increased bond strength and decreased dentinal sensitivity, the removal of undercuts with a flowable composite resin by means of “resin coating” during the IDS protocol leads an overall sound tooth structure conservation, especially in regards to sound dentin which would otherwise need to be removed for adequate smoothness and preparation draw in a traditional non-dentin sealed preparation design. Following the final polymerization of the IDS composite material, including the inhibition layer, the enamel margins of the preparation are re-prepared before final impressions are made, excessive adhesive resin is removed, and ideal taper of the preparation is achieved. 31084533 Van den Breemer/2019 48 extracted human molars, 8 groups, 4 different IDS strategies Laboratory study Key results In general, all IDS protocols demonstrated higher bond strengths, independent of surface conditioning method, when compared to the control. Regardless of the IDS protocol, application of a heated adhesive system directly to freshly cut dentin is integral to achieving higher bond strengths. Results demonstrate that by means of IDS, bond strengths at the adhesive interface are stable over time, showing no statistical differences between results at 1 week and 6 months. In general, differences in bond strength appeared to be seen based more on the IDS protocol utilized rather than the surface conditioning method to clean the preparation surfaces.
Evidence Search	(IDS) AND (bond strength)
Comments on The Evidence	Validity: The truth and believability of the evidence appears adequate. The three included studies do answer specific questions as they relate to their observed outcomes and the questions proposed. The three articles were selected from a larger group of applicable articles and chosen based on their focus to IDS, resin bonding, and ceramic restorations. The three articles were chosen under the same MESH terms and results appears to be similar and supportive when compared. Each article provides an adequate discussion pertaining to the results and the applicability of their findings. Shortcomings in regard to validity would include that these studies are not considered the highest levels of evidence, and the availability of evidence regarding this specific question is limited. A large majority of the studies commonly encountered involving this topic are laboratory studies, indicating need for current systematic reviews and meta analyses as they relate specifically to IDS and its affect on bond strength. Perspective: As the research pertains to IDS and bond strength, there is adequate research to draw reasonable conclusions to support the benefits of clinical use. Particular attention should be paid to the adhesive protocol utilized within different studies.
Applicability	The availability of an IDS protocol is not limited and is easily obtained. Protocols usually include materials normally used in adhesive dentistry, with the addition of particular resin composites depending on the IDS protocol desired. The most significant limitation hindering the use of IDS in a clinical practice, especially among the inexperienced practitioner, is the technique sensitivity of dentinal bonding in general. The benefits of IDS in terms of longevity and success significantly outweigh increased material costs. When appropriate, there is no reason IDS should not be incorporated into a traditional bonding protocol.
Specialty	(General Dentistry) (Prosthodontics) (Restorative Dentistry)
Keywords	IDS, Resin Coating, Dentin Bonding, Bond Strength, Biomimetics
ID#	3447
Date of submission	12/03/2020
E-mail	wilburnb1@uthscsa.edu
Author	Brandon M. Wilburn, DMD
Co-author(s)	Satoru Kataoka, DDS
Co-author(s) e-mail	kataoka@uthscsa.edu
Faculty mentor	Robert M. Taft, DDS, FACP
Faculty mentor e-mail	taftr@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available