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Immediate Dentin Sealing (IDS): Rationale and Step-by-Step Clinical Protocol

By Biomimetic Dentistry Club Editorial TeamPublished 8 min read

Summary

Immediate dentin sealing (IDS) is the application and polymerisation of a dentin bonding agent to freshly cut dentin immediately after tooth preparation and before the impression or scan for an indirect restoration. It protects the dentin during the provisional phase and has been shown in laboratory studies to improve the bond strength of the final restoration.

  • Freshly cut dentin is the best substrate for bonding; IDS uses it before it is contaminated.
  • The adhesive is pre-polymerised without the pressure of a seated restoration, avoiding collapse of the uncured hybrid layer.
  • IDS reduces post-operative sensitivity and bacterial leakage during the provisional phase.
  • The sealed surface must be cleaned (for example by air abrasion) before final adhesive luting.

Why seal dentin immediately?

With the conventional "delayed dentin sealing" approach, dentin is exposed during preparation, contaminated by impression materials and provisional cements, and only bonded at the final appointment, when the adhesive is often cured under the restoration itself. Magne described several problems with that sequence: contaminated dentin bonds less predictably, and an adhesive layer that is not light-cured before seating may be compressed and incompletely polymerised.

By bonding immediately after preparation, IDS hybridises the dentin while it is clean, allows the adhesive to mature before it is loaded, and turns the exposed dentin into a sealed resin surface for the provisional period. In laboratory testing, Magne and colleagues found higher microtensile bond strengths for IDS than for delayed sealing.

Indications

  • Indirect bonded restorations (inlays, onlays, overlays, veneers with dentin exposure, bonded crowns) where dentin is exposed during preparation.
  • Cases where post-operative sensitivity during the provisional phase is a concern.
  • As part of deep margin elevation, where the dentin is sealed before the proximal margin is relocated.

Armamentarium

  • Rubber dam or equivalent isolation.
  • A dentin bonding system: filled three-step etch-and-rinse adhesives are the most studied for IDS; two-step self-etch systems are also widely used.
  • Optionally a thin layer of flowable composite (the "resin coating" technique) to protect the adhesive layer.
  • Glycerin gel (air block) to polymerise the oxygen-inhibited layer.
  • Pumice or an intraoral air-abrasion unit with fine alumina for cleaning at delivery.
  • A separating medium for the provisional restoration.

Step-by-step IDS protocol

  1. Isolate the tooth and complete the preparation of the dentin; avoid final refinement of the enamel margins at this stage.
  2. Identify exposed dentin and, if needed, gently re-roughen it with a bur so the surface is freshly cut.
  3. Apply the adhesive according to the manufacturer's instructions (etch, prime and bond for etch-and-rinse; prime and bond for self-etch), confining it to dentin as far as possible.
  4. Light-cure the adhesive.
  5. Optionally apply a thin layer of flowable composite over the sealed dentin and light-cure it.
  6. Cover the sealed surface with glycerin gel and light-cure again to polymerise the oxygen-inhibited layer.
  7. Remove the superficial resin from the enamel margins and refine the preparation outline in enamel.
  8. Take the impression or intraoral scan.
  9. Place the provisional using a separating medium so it does not bond to the IDS layer.
  10. At delivery, remove the provisional, clean the IDS surface (air abrasion or pumice), then proceed with the adhesive luting protocol for the definitive restoration.

Common pitfalls

  • Leaving adhesive on enamel margins, which obscures the finish line in the impression or scan.
  • Skipping the air-block step, leaving an uncured, sticky surface that can interact with impression materials.
  • Provisional material bonding to the resin coating because no separating medium was used.
  • Failing to reactivate the aged IDS surface before final cementation.

Frequently asked questions

Does IDS affect the fit of the final restoration?

The IDS layer is thin and is recorded in the impression or scan, so the restoration is fabricated to fit the sealed preparation. Excessively thick resin coatings should be avoided, particularly on margins.

Which adhesive is best for immediate dentin sealing?

Filled three-step etch-and-rinse adhesives have the largest body of IDS research, but two-step self-etch systems are also used successfully. Follow the manufacturer's protocol and use the same principles consistently.

References

  1. Pashley EN, Comer RW, Simpson MD, Horner JA, Pashley DH, Caughman WF. Dentin permeability: sealing the dentin in crown preparations. Oper Dent. 1992;17(1):13-20. Find on PubMed (opens in a new tab)
  2. Magne P. Immediate dentin sealing: a fundamental procedure for indirect bonded restorations. J Esthet Restor Dent. 2005;17(3):144-154. Find on PubMed (opens in a new tab)
  3. Magne P, Kim TH, Cascione D, Donovan TE. Immediate dentin sealing improves bond strength of indirect restorations. J Prosthet Dent. 2005;94(6):511-519. Find on PubMed (opens in a new tab)
  4. Magne P, So WS, Cascione D. Immediate dentin sealing supports delayed restoration placement. J Prosthet Dent. 2007;98(3):166-174. Find on PubMed (opens in a new tab)
  5. Samartzi TK, Papalexopoulos D, Sarafianou A, Kourtis S. Immediate dentin sealing: a literature review. Clin Cosmet Investig Dent. 2021;13:233-256. Find on PubMed (opens in a new tab)

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