Adhesion to Enamel and Dentin: Current Status and Future Challenges
SUMMARY
Bonding to tooth tissue can be achieved through an “etch&rinse,” “self-etch” or “glass-ionomer” approach.
In this paper, the basic bonding mechanism to enamel and dentin of these three approaches is demonstrated by means of ultramorphological
and chemical characterization of tooth-biomaterial interfacial interactions. Furthermore,
bond-strength testing and measurement of marginal-sealing effectiveness (the two most commonly employed methodologies to determine “bonding effectiveness”
in the laboratory) are evaluated upon their value and relevance in predicting clinical performance.
A new dynamic methodology to test biomaterial-tooth bonds in a fatigue mode is introduced with a recently developed micro-rotary fatigue-testing device.
Eventually, today’s adhesives will be critically weightedupon their performance in diverse laboratory studies and clinical trials.
Special attention has been given to the benefits/drawbacks of an etch&rinse versus a
self-etch approach and the long-term performance of these adhesives.
Correlating data gathered in the laboratory with clinical results clearly showed that laboratory research CAN predict clinical effectiveness.
Although there is a tendency to simplify bonding procedures, the data presented confirm that conventional three-step etch&rinse adhesives still perform most favorably and are most reliable in the long-term.
Nevertheless, a self-etch approach may have the best
future perspective.
Clinically, when adhesives no longer require an “etch&rinse” step, the application
time, and probably more importantly, the techniquesensitivity are substantially reduced. Especially “mild,” two-step self-etch adhesives that bond through a combined micromechanical and chemical interaction with tooth tissue closely approach conventional threestep systems in bonding performance.
Adhesion to Enamel and Dentin: Current Status and Future ChallengesSUMMARYBonding to tooth tissue can be achieved through an “etch&rinse,” “self-etch” or “glass-ionomer” approach.In this paper, the basic bonding mechanism to enamel and dentin of these three approaches is demonstrated by means of ultramorphologicaland chemical characterization of tooth-biomaterial interfacial interactions. Furthermore,bond-strength testing and measurement of marginal-sealing effectiveness (the two most commonly employed methodologies to determine “bonding effectiveness”in the laboratory) are evaluated upon their value and relevance in predicting clinical performance.A new dynamic methodology to test biomaterial-tooth bonds in a fatigue mode is introduced with a recently developed micro-rotary fatigue-testing device.Eventually, today’s adhesives will be critically weightedupon their performance in diverse laboratory studies and clinical trials. Special attention has been given to the benefits/drawbacks of an etch&rinse versus aself-etch approach and the long-term performance of these adhesives. Correlating data gathered in the laboratory with clinical results clearly showed that laboratory research CAN predict clinical effectiveness.Although there is a tendency to simplify bonding procedures, the data presented confirm that conventional three-step etch&rinse adhesives still perform most favorably and are most reliable in the long-term.Nevertheless, a self-etch approach may have the bestfuture perspective. Clinically, when adhesives no longer require an “etch&rinse” step, the applicationtime, and probably more importantly, the techniquesensitivity are substantially reduced. Especially “mild,” two-step self-etch adhesives that bond through a combined micromechanical and chemical interaction with tooth tissue closely approach conventional threestep systems in bonding performance.
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