MMP=matrix metalloproteinase=zinc-dependent endopeptidase that degrade extracellular matrix proteins. They are present in dentin and when exposed to a weak acid or even water become active so they do help slow decay grow.
galardin (synthetic MMP-inhibitor)
green tea polyphenols (especially epigalolocatechin-3-gallate)
tetracyclines and specifically doxycylcine
Quaternary ammonium compounds
Gluteraldhyde (GLUMA) may also be. I have to wonder if some of these MMP inhibitors aren’t working simply because they act as re-wetting agents, allowing collagen fibers to rebound after etching. Sabatini 2014 Dent Mat
- benzalkonium chloride bac like in Bisco’s uni-etch
- MDPB in clearfil SE Protect
Reference – list of MMPp inhibitors
MMP and Clearfil SE – helps with SE too (article saved)
Effect CHX in SE Adhesion Zhou 2011 – tested up to 1% with no decrease in initial bond strength (article saved)
Total etch article references many more check references 31-44
Studies show that the application of chlorhexidine or benzalkonium chloride solutions before or in conjunction with the placement of both total- and self-etch adhesives has the potential to inhibit MMP activity, resulting in a more durable adhesive interface.31,33,35,36
In any case, based on this(32) and other studies,37,38 the author’s current technique when using a rewetting protocol for total-etch systems is the placement of a 2% chlorhexidine solution after the etching step.
31. Campos EA, Correr GM, Leonardi DP, et al. Chlorhexidine diminishes the loss of bond strength over time under simulated pulpal pressure and thermo-mechanical stressing. J Dent. 2009;37(2):108-114.
32. Brackett MG, Tay FR, Brackett WW, et al. In vivo chlorhexidine stabilization of hybrid layers of an acetone-based dentin adhesive. Oper Dent. 2009;34(4):379-383.
33. Hiraishi N, Yiu CK, King NM, Tay FR. Effect of 2% chlorhexidine on dentin microtensile bond strengths and nanoleakage of luting cements. J Dent. 2009;37(6):440-448.
34. Tezvergil-Mutluay A, Mutluay MM, Gu LS, et al. The anti-MMP activity of benzalkonium chloride. J Dent. 2011;39(1):57-64.
35. Sadek FT, Braga RR, Muench A, et al. Ethanol wet-bonding challenges current anti-degradation strategy. J Dent Res. 2010;89(12):1499-1504.
36. Pashley DH, Tay FR, Yiu C, et al. Collagen degradation by host-derived enzymes during aging. J Dent Res. 2004;83(3):216-221.
37. Breschi L, Cammelli F, Visintini E, et al. Influence of chlorhexidine concentration on the durability of etch-and-rinse dentin bonds: a 12-month in vitro study. J Adhes Dent. 2009;11(3):191-198.
38. Chang YE, Shin DH. Effect of chlorhexidine application methods on microtensile bond strength to dentin in Class I cavities. Oper Dent. 2010;35(6):618-623.en
39. Zhou J, Tan J, Chen Li, et al. The incorporation of chlorhexidine in a two-step self-etching adhesive preserves dentin bond in vitro. J Dent. 2009;37(10):807-812.
40. de Castro FL, de Andrade MF, Duarte Junior SL, et al. Effect of 2% chlorhexidine on microtensile bond strength of composite to dentin. J Adhes Dent. 2003;5(2):129-138.
41. Ersin NK, Candan U, Aykut A, et al. No adverse effect to bonding following caries disinfection with chlorhexidine. J Dent Child. 2009;76(1):20-27.
42. Komori PC, Pashley DH, Tjäderhane L, et al. Effect of 2% chlorhexidine digluconate on the bond strength to normal versus caries-affected dentin. Oper Dent. 2009;34(2):157-165.
43. Zhou J, Tan J, Yang X, et al. Effect of chlorhexidine application in a self-etching adhesive on the immediate resin-dentin bond strength. J Adhes Dent. 2010;12(1):27-31.
44. Soares CJ, Pereira CA, Pereira JC, et al. Effect of chlorhexidine application on microtensile bond strength to dentin. Oper Dent. 2008;33(2):183-188.
CHX after etch how tested here 1
CHX after etch recommended here also Moon
Bryan Bauer, DDS, FAGD