Dental Materials Journal 2018; : –

Review

Concept and clinical application of the resin-coating technique for indirect

restorations
Toru NIKAIDO1, Junji TAGAMI1, Hirofumi YATANI2, Chikahiro OHKUBO3, Tomotaro NIHEI4, Hiroyasu KOIZUMI5,
Toshio MASEKI6, Yuichiro NISHIYAMA3, Tomoyoshi TAKIGAWA7 and Yuji TSUBOTA8

1
Department of Cariology and Operative Dentistry, Division of Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo
Medical and Dental University (TMDU)
2
Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry
3
Department of Removable Prosthodontics, Tsurumi University School of Dental Medicine
4
Division of Clinical Biomaterials, Department of Oral Science, Graduate School of Dentistry, Kanagawa Dental University
5
Department of Fixed Prosthodontics, Nihon University School of Dentistry
6
Department of Adhesive Dentistry, School of Life Dentistry at Tokyo, The Nippon Dental University
7
Department of Operative Dentistry, Nihon University School of Dentistry
8
Tsubota Dental Clinic
Corresponding author, Toru NIKAIDO; E-mail: nikaido.ope@tmd.ac.jp

The resin-coating technique is one of the successful bonding techniques used for the indirect restorations. The dentin surfaces
exposed after cavity preparation are coated with a thin film of a coating material or a dentin bonding system combined with a
flowable composite resin. Resin coating can minimize pulp irritation and improve the bond strength between a resin cement and
tooth structures. The technique can also be applied to endodontically treated teeth, resulting in prevention of coronal leakage of the
restorations. Application of a resin coating to root surface provides the additional benefit of preventing root caries in elderly patients.
Therefore, the coating materials have the potential to reinforce sound tooth (“Super Tooth” formation), leading to preservation of
maximum tooth structures.

Keywords: Resin-coating technique, Resin cement, Bonding to dentin, Indirect restoration, Acid-base resistant zone

Previous studies have demonstrated that the resin-

INTRODUCTION
coating technique improves resin cement-dentin bonding
With the improvement of adhesive materials and their when restorative materials are subsequently placed on
greater reliability, adhesive materials and technology tooth crowns in an indirect restoration procedure7-10).
have been accepted in the clinic and have revolutionized A resin coating applied to the exposed dentin surfaces
clinical procedures in dentistry, especially in operative has an additional advantage of significantly reducing
dentistry, prosthodontics, and orthodontics. The resin- pain caused by external physical stimuli because it
coating technique is a successful bonding technique used seals dentinal tubules and, thus, remarkably decreases
for indirect restorations. The clinical application of the dentinal permeability11-13).
resin-coating technique was proposed in the early 1990s The concept and clinical applications of the resin-
by Japanese clinicians who were experts in adhesive coating technique are reviewed in this paper using the
dentistry. The dentin and enamel surfaces exposed after previous literature.
cavity preparation are coated with a thin film of a coating
material or a dentin bonding system combined with a PROTECTING AND FORTIFYING TOOTH
flowable composite resin. Magne et al.1,2) reported a SUBSTANCES
similar idea, immediate dentin sealing (IDS), to seal the
exposed dentin using a coating material. However, IDS Leaving undercuts in the cavity after the removal
focuses only on the dentin surface but not on the enamel of carious lesions is unacceptable with conventional
surface. In the resin-coating technique, the exposed indirect restorations, including inlays and onlays.
enamel and dentin surfaces after preparation should be Therefore, the undercuts are commonly eliminated
totally covered by the coating layer. The technique can by removing sound tooth structure. In contrast,
be applied not only to vital teeth but also to non-vital the undercuts are filled with a flowable composite
teeth after endodontic treatment. resin as a blockout procedure in the resin-coating
The adhesive resin coating applied to dentin surfaces technique, thereby avoiding excessive removal of tooth
provides protection for dentin and pulp3-5) through the substances14). Sound dentin exposed in the interior of a
formation of a hybrid layer6) because of the superior acid cavity needs to be blocked against external stimuli. It
resistance of resin as compared to tooth substances. has been reported that adhesion between a self-adhesive
resin cement and tooth substance is generally lower
than the adhesion achieved by direct resin composite
Color figures can be viewed in the online issue, which is avail-
able at J-STAGE.
Received Jul 23, 2017: Accepted Aug 21, 2017
doi:10.4012/dmj.2017-253 JOI JST.JSTAGE/dmj/2017-253
2 Dent Mater J 2018; : –

Fig. 1 Morphological differences in three types of restorations after acid-base

challenge.
(B: bonding resin, D: dentin, H: hybrid layer, R: Restorative material)15)
Left: Conventional restoration without an adhesive system; A wall lesion
(white arrow) is created along the interface between a restorative material
and the dentin, indicating the formation of secondary caries in the clinic.
Center: Composite restoration with an acid etch adhesive system; A
hybrid layer is created at the interface, which prevents the formation of
secondary caries in the clinic. Right: Composite restoration with a self-etch
adhesive system; A hybrid layer and the ABRZ are created at the interface.
Formation of the ABRZ is beneficial to prevent secondary caries and also
enhances dentin around the restoration from the acid attachment.

restorations7-10). Consequently, the resin-coating On the other hand, it is also possible to use one-
technique is used to protect the dentin-pulp complex12,13). step self-etching systems or materials specifically for
Additionally, the use of self-etching systems produces an coating25); however, these may result in the unsuccessful
acid-base resistant zone (ABRZ) immediately below the formation of an even coating film unless a certain level
hybridized dentin (Fig. 1)15), thereby not only providing of thickness is achieved. Hence, they may not exert a
a cariostatic effect on dentin but also reinforcing the blocking effect against external stimuli or a powerful
tooth substance itself16). Recently, an enamel ABRZ bond strength. Although the maximum thickness of the
has also been recognized at the self-etch adhesive– coating layer achievable by one-step adhesive systems is
enamel interface after acid-base challenge17,18). The 15 µm, even if laminated with a coating material, it has
ABRZ was formed following the application of some been found that the adhesion of resin cements to dentin
acidic monomers, especially phosphoric-acid ester is markedly improved by dual application26) (Fig. 2).
methacrylates incorporated into a few self-etching
dental adhesives17,19). We proposed that the diffusion of CLINICAL PROCEDURE FOR THE RESIN-COATING
such acidic monomers beyond the classic hybrid layer TECHNIQUE
and their ion-exchange interactions with the available
hydroxyapatite could result in formation of stable The procedures for applying a coating by a combination
organic-inorganic complexes, and that the structures of a two-step self-etch system and a low-viscosity
should be termed “super tooth”, as they would in concept composite resin are illustrated in Fig. 3.
withstand major causes of dental caries and tissue
degradation20-22). 1) Cavity preparation
It is highly likely that the application of a coating Characteristics of the smear layer created on
that combines a bonding system with a flowable resin the surface of tooth substances by bur cutting
composite improves adhesion to dentin. The coating not are affected by the type of bur used for the
only reduces pain in patients but also enhances resin preparation27). Application of a coating material
cement-dentin bonding7) as well as the peripheral sealing to the dentin surface prepared only by a coarse
performance of restorations16,23). diamond point bur does not produce adequate
bond strength because a coarse smear layer has
been created on the bonding interface. The dentin
SELECTION OF RESIN-COATING MATERIALS
surface should be finished as smoothly as possible
The desired combination that will ensure optimal using a steel round bur for removing caries and a
adhesion and polymerization with a resin-coating layer fine diamond point finishing bur for preparing an
is one that combines a two-step self-etching system with abutment tooth.
a low-viscosity resin composite (Table 1)24).
 Dent Mater J 2018; : – 3

Table 1 Materials used in the resin-coating technique

Applicable materials Features

Combination of an adhesive with a flowable

• High bond strength to dentin identical
resin composite
to that of a direct resin composite
Bonding systems A two-step self-etch adhesive system selected
• Suitable for inlay cavity preparation
+Flowable resins as the most reliable dentin bonding system
• Thick coating layer unsuitable for
A flowable composite resin selected for easy
crown restorations
handling property

A one-step self-etch (all-in-one) adhesive and a • Bond strength lower than that of a
thin coating material based on an all-in-one two-step self-etch adhesive
Thin film coating adhesive technology
materials • A thin coating layer created (<15 µm)
To create a thin coating layer by double coating
of the material • Coating for abutment teeth for crowns

Fig. 2 Two strategies of the resin-coating technique for

indirect restorations.
Left: A combination technique, including a dentin
bonding system and a flowable resin composite,
is recommended for indirect restorations, such as
inlays and onlays. Right: Double coating technique Fig. 3 Clinical procedures of indirect restoration using
of an all-in-one adhesive creates a thin coating the resin-coating technique.
layer for crown preparation.

fine diamond point finishing bur, or something

2) Moisture control similar, to clearly distinguish the margin.
Maximum moisture exclusion should be ensured
by a rubber dam or an intraoral vacuum suction 5) Provisional sealing
device. In an internal cavity after the application The prepared cavity should be temporized,
of self-etching primer, the solvent tends to collect not with resin-based filling materials but with
in concave angles. Therefore, sufficient air a water-setting temporary sealing material.
blowing should be applied28). When fabricating a provisional restoration using
autopolymerizing resin, it should be produced
3) Coating treatment after applying a water-soluble separator to the
A bonding material and a low-viscosity composite interior of the cavity, and it should be temporarily
resin, applied using a syringe applicator and a placed using non-eugenol or polycarboxylate
disposable applicator brush, are then adequately cement14).
light cured.
6) Placement of a restoration
4) Removal of excess resin The cavity and restoration should be pretreated
The low conversion layer on the resin-coated individually in accordance with the method
surface should be wiped and removed with an indicated by the manufacturer. The restoration
alcohol cotton swab. Overhangs projecting over should then be placed using self-adhesive resin
the cavity margin should be removed using a cement.
4 Dent Mater J 2018; : –

Thus, the resin-coating technique is a very

effective procedure in clinical settings for reinforcing
dentin and protecting pulp14). The technique also helps
protect against secondary caries because the dentin
remains protected by the coating material should the
restoration fall off29-31). Thus, the resin-coating technique
is efficacious for improving the long-term prognosis of
restorative treatments, since it helps reduce the risk of
caries adjacent to restorations32,33).
Fig. 5 Protection of the root dentin surface by a root
surface coating.
APPLICATION TO TEETH TREATED BY ROOT The root dentin surface is covered by the application
CANAL of an adhesive coating material to prevent bacterial
attachment and accumulation and also to enhance
The resin-coating technique is effective for teeth treated
the acid resistance of root dentin from bacterial
by root canal as well (Fig. 4)34). For the additional
acid attack (super dentin).
purpose of preventing coronal leakage, it is highly
effective to apply a resin coating to root canal dentin
after preparing the cavity for restoration. When applied
to a tooth treated by root canal, a resin-coating material technique, when used on the surfaces of exposed roots of
for vital teeth should be used31). older adults and sound teeth, helps not only protect but
also reinforce tooth substances (super tooth), thereby
ROOT SURFACE COATING promising broader application to preventive dental care
in the future.
Root dentin is more prone to bacterial invasion and
caries than is enamel35). In view of the population’s
rapid aging, applying a resin coating to root surfaces CONCLUSION
provides the additional benefit: it prevents root caries When restoring a missing tooth’s structures by an
in older adults (Fig. 5). In fact, previous studies have indirect restoration technique, the resin-coating
reported that a thin root coating of as little as 10 µm technique not only improves pulp protection and bond
inhibits the demineralization of root surfaces36,37). The strength but also reduces pain during the insertion
root dentin surface covered by the application of an and removal of a provisional restoration or restorative
adhesive coating material can also prevent bacterial material. It also facilitates the removal of temporary
attachment and accumulation35). Toothbrush abrasion bonding material adhering to the side of the abutment
tests have also demonstrated the excellent durability tooth. The resin-coating technique is also effective for
of thin film coating materials38). Thus, the resin-coating self-adhesive cement, which has become more widely
used in recent years39). In Japan, where society is
aging rapidly, the problem of root caries needs to be
addressed; the resin-coating technique may be useful for
this purpose in clinical applications. Additionally, as a
variety of coating agents are available on the market,
it is essential to select appropriate materials, as well as
self-adhesive resin cements for bonding, on the basis of
scientific data.

ACKNOWLEDGMENTS
This study was partly supported by a grant from
the Japanese Dental Science Federation, JDSF-
DSP1-2016-000-1 and a grant from the Japan Society
for the Promotion of Science, KAKENHI, Grant Number
15K11105.

REFERENCES
1) Magne P. Immediate dentin sealing: a fundamental procedure
Fig. 4 Application of the resin-coating technique to an for indirect bonded restorations. J Esthet Restor Dent 2005;
endodontically treated tooth. 17: 144-154.
2) Magne P, Kim TH, Cascione D, Donovan TE. Immediate
a: conventional cavity for metal core build-up,
dentin sealing improves the bond strength of indirect
causing risk of coronal leakage; b: application of the
restorations. J Prosthet Dent 2005; 94: 511-519.
resin-coating technique to protect coronal leakage. 3) Inokoshi S. Temporary sealing-pulp and dentin protection
 Dent Mater J 2018; : – 5

using low viscosity composite. Adhes Dent 1992; 10: 250. (in J. Ultra-morphological and nanomechanical characterization
Japanese) of reinforced enamel and dentin by self-etch adhesives: The
4) Sato M, Goto H, Inai N, Nikaido T, Tagami J, Inokoshi S, super tooth. J Nano R 2011; 16: 131-140.
Yamada T, Takatsu T. How to use “Liner Bond System” as 23) Turkistani A, Sadr A, Shimada Y, Nikaido T, Sumi Y, Tagami
a dentin and pulp protector in indirect restorations. Adhes J. Sealing performance of resin cements before and after
Dent 1994; 12: 41-48. (in Japanese) thermal cycling: evaluation by optical coherence tomography.
5) Otsuki M, Yamada T, Inokoshi S, Takatsu T, Hosoda H. Dent Mater 2014; 30: 993-1004.
Establishment of a composite resin inlay technique. Part 7. 24) Udo T, Nikaido T, Ikeda M, Weerasinghe DS, Harada N,
Use of low viscous resin. Jpn J Conserv Dent 1993; 36: 1324- Foxton RM, Tagami J. Enhancement of adhesion between
1330. (in Japanese) resin coating materials and resin cements. Dent Mater J
6) Nakabayashi N, Nakamura M, Yasuda N. Hybrid layer as a 2007; 26: 519-525.
dentin-bonding mechanism. J Esthet Dent 1991; 3: 133-138. 25) Nikaido T, Nakaoki Y, Ogata M, Foxton R, Tagami J. The
7) Jayasooriya PR, Pereira PN, Nikaido T, Tagami J. Effect of resin-coating technique. Effect of a single-step bonding
resin coating on bond strengths of resin cement to dentin. J system on dentin bond strengths. J Adhes Dent 2003; 5: 293-
Esthet Restor Dent 2003; 15: 38-45. 300.
8) Nikaido T, Cho E, Nakajima M, Tashiro H, Toba S, Burrow 26) Takahashi R, Nikaido T, Ariyoshi M, Kitayama S, Sadr A,
MF, Tagami J. Tensile bond strengths of resin cements Foxton RM, Tagami J. Thin resin coating by dual-application
to bovine dentin using resin coating. Am J Dent 2003; 16: of all-in-one adhesives improves dentin bond strength of resin
41A-46A. cements for indirect restorations. Dent Mater J 2010; 29: 615-
9) Okuda M, Nikaido T, Maruoka R, Foxton RM, Tagami J. 622.
Microtensile bond strengths to cavity floor dentin in indirect 27) Ogata M, Harada N, Yamaguchi S, Nakajima M, Tagami J.
composite restorations using resin coating. J Esthet Restor Effect of self-etching primer vs phosphoric acid etchant on
Dent 2007; 19: 38-46. bonding to bur-prepared dentin. Oper Dent 2002; 27: 447-
10) Sultana S, Nikaido T, Matin K, Ogata M, Foxton RM, Tagami 454.
J. Effect of resin coating on dentin bonding of resin cement in 28) Yahagi C, Takagaki T, Sadr A, Ikeda M, Nikaido T, Tagami
Class II cavities. Dent Mater J 2007; 26: 506-513. J. Effect of lining with a flowable composite on internal
11) Pashley EL, Comer RW, Simpson MD, Horner JA, Pashley adaptation of direct composite restorations using all-in-one
DH, Caughman WF. Dentin permeability: sealing the dentin adhesive systems. Dent Mater J 2012; 31: 481-488.
in crown preparations. Oper Dent 1992; 17: 13-20. 29) Nikaido T, Takahashi R, Ariyoshi M, Sadr A, Tagami J.
12) Momoi Y, Akimoto N, Kida K, Yip KH, Kohno A. Sealing Protection and reinforcement of tooth structures by dental
ability of dentin coating using adhesive resin systems. Am J coating materials. Coatings 2012; 2: 210-220.
Dent 2003; 16: 105-111. 30) Nikaido T, Inoue G, Takagaki T, Waydeasekera K, Iida Y,
13) Qiao H, Takahashi R, Nikaido T, Nakashima S, Sadr A, Ikeda Shinohara SM, Sadr A, Tagami J. New strategy to create
M, Tagami J. Change of dentin permeability in different “Super Dentin” using adhesive technology; Reinforcement of
storage media after resin coating. Asian Pac J Dent 2015; 15: adhesive-dentin interface and protection of tooth structures.
33-40. Jpn Dent Sci Rev 2011; 47: 31-42.
14) Nikaido T, Yoda A, Foxton RM, Tagami J. A resin coating 31) Nikaido T, Inoue G, Takagaki T, Takahashi R, Sadr A,
technique to achieve minimal intervention in indirect resin Tagami J. Resin coating technique for protection of pulp and
composites: a case report. Int Chin J Dent 2003; 3: 62-68. increasing bonding in indirect restoration. Curr Oral Health
15) Takagaki T, Nikaido T, Tsuchiya S, Ikeda M, Foxton RM, Rep 2015; 2: 81-86.
Tagami J. Effect of hybridization on bond strength and 32) Kitasako Y, Burrow MF, Nikaido T, Tagami J. Effect of resin-
adhesive interface after acid-base challenge using 4-META/ coating technique on dentin tensile bond strengths over 3
MMA-TBB resin. Dent Mater J 2009; 28: 185-193. years. J Esthet Restor Dent 2002; 14: 115-122.
16) Jayasooriya PR, Pereira PNR, Nikaido T, Burrow MF, Tagami 33) Nikaido T, Kitasako Y, Burrow MF, Umino A, Maruoka R,
J. Effect of a “Resin-coating” on the interfacial adaptation of Ikeda M, Tagami J. Effect of resin coating on dentin bond
composite inlays. Oper Dent 2003; 28: 28-35. durability of a resin cement over 1 year. Am J Dent 2008; 21:
17) Li N, Nikaido T, Takagaki T, Sadr A, Makishi P, Chen J, 64-68.
Tagami J. The role of functional monomers in bonding to 34) Maruoka R, Nikaido T, Ikeda M, Ishizuka T, Foxton RM,
enamel: acid-base resistant zone and bonding performance. J Tagami J. Coronal leakage inhibition in endodontically
Dent 2010; 38: 722-730. treated teeth using resin coating technique. Dent Mater J
18) Sato T, Takagaki T, Matsui N, Hamba H, Sadr A, Nikaido T, 2006; 25: 97-103.
Tagami J. Morphological evaluation of the adhesive/enamel 35) Daneshmehr L, Matin K, Nikaido T, Tagami J. Effects of root
interfaces of two-step self-etching adhesives and multimode dentin surface coating with all-in-one adhesive materials on
one-bottle self-etching adhesives. J Adhes Dent 2016; 18: 223- biofilm adherence. J Dent 2008; 36: 33-41.
229. 36) Kaneshiro AV, Imazato S, Ebisu S, Tanaka S, Tanaka Y, Sano
19) Nikaido T, Ichikawa C, Li N, Takagaki T, Sadr A ,Yoshida H. Effects of a self-etching resin coating system to prevent
Y, Suzuki K, Tagami J. Effect of functional monomers in all- demineralization of root surfaces. Dent Mater 2008; 24: 1420-
in-one adhesive systems on formation of enamel/dentin acid- 1427.
base resistant zone. Dent Mater J 2011; 30: 576-582. 37) Tajima K, Nikaido T, Inoue G, Ikeda M, Tagami J. Effects of
20) Waidyasekera K, Nikaido T, Weerasinghe DS, Ichinose coating root dentin surfaces with adhesive materials. Dent
S, Tagami J. Reinforcement of dentin in self-etch adhesive Mater J 2009; 28: 578-586.
technology: A new concept. J Dent 2009; 37: 604-609. 38) Gando I, Ariyoshi M, Ikeda M, Sadr A, Nikaido T, Tagami J.
21) Nikaido T, Weerasinghe DDS, Waidyasekera K, Inoue G, Resistance of dentin coating materials against abrasion by
Foxton RM, Tagami J. Assessment of the nanostructure toothbrush. Dent Mater J 2013; 32: 68-74.
of acid-base resistant zone by the application of all-in-one 39) Giannini M, Takagaki T, Bacelar-Sá R, Vermelho PM,
adhesive systems: Super dentin formation. Bio-Med Mater Ambrosano GM, Sadr A, Nikaido T, Tagami J. Influence of
Eng 2009; 19: 163-171. resin coating on bond strength of self-adhesive resin cements
22) Sadr A, Nikaido T, Takagaki T, Hariri I, Nazari A, Tagami to dentin. Dent Mater J 2015; 34: 822-827.