Clinical evaluation of a self-etching and a one-bottle adhesive system at two years
Introduction
The history of polymeric dental adhesives goes back to the early mid-fifties, with Dr Michael Buonocore's1 discovery of resin bonding to enamel as the most prominent milestone. A few years later, the concept of bonding to enamel was broadened to include dentin.
Clinical evidences have proved long lasting adhesion between enamel and resin; however, bonding to dentin was far more challenging compared to enamel. The enhanced bonding between resin and dentin was established by dentin hybridization.2 One major reason why successful bonding to dentin was so difficult to achieve is that dentin is an intrinsically wet substrate. The bonding areas are connected with the pulp by dentin tubules that are filled with fluid. Another obstacle to an intimate contact between resin and dentin is the so-called smear layer consisting of damaged collagen and apatite, which covers the dentin after cavity preparation and caries excavation.3., 4., 5., 6. This layer prevents infiltration of monomers into dentin, and even when it is removed with acid etching followed by bonding agent application, fluid flow from pulp might interfere with a stable bonding.
The new paradigm of minimal preparation was achieved by the introduction and application of caries detecting solutions, as well as the utilization of the dentin adhesives.7 Today, adhesive cavity preparation is being practiced without the traditional concern for mechanical retention form, or extension for prevention. Extensive cavity preparations have been replaced by more conservative techniques, with careful removal of the infected, permanently damaged carious tissue, and preserving sound tooth substance.7 Since minimal cavity preparation is preferred to traditional mechanical retention, the clinical and biological longevity of the final restoration is dependent on the performance of the adhesive, the bonding and the resin composite systems.
Bonding procedures to tooth structures require generally multiple-step clinical applications. Therefore, clinical success with these adhesive systems depends on technique-sensitive and material-related factors.8 In an effort to simplify the bonding procedures, several new adhesive systems rely on simultaneous etching enamel and dentin with a phosphoric acid or a self-etching primer.
Most of the current dentin adhesive systems require two-step procedures and can generally be divided into two groups. One group includes one-bottle adhesive systems with a total etching step (with phosphoric acid) and an application step (primer and adhesive combined). The other group includes self-etching primer systems with a treatment step (with a self-etching primer) followed by an adhesive resin application step.9., 10., 11., 12. Recently, in order to simplify clinical procedures and reduce technique sensitivity, several one-step, so-called ‘all-in-one’, adhesive systems have been developed.13., 14.
In recent years, the increased use of adhesive resin composites in posterior teeth has become more popular in the area of adhesive dentistry. With this trend, it is of importance for the clinicians to recognize the probable longevity and the possible modes of failure of the restorations. Long-term clinical survival of resin composite restoration is apparently dependent on the factors that cause clinical failure of the restorations, such as marginal adaptation, wear, color match, marginal discoloration, fracture and recurrent caries.5., 6., 8., 9., 15. It is recognized that laboratory studies cannot simulate all the clinical conditions to which restorations might be exposed because factors like pH cycling, masticator stresses, food abrasion, hardness of an antagonist tooth, presence of bacteria, etc. are not taken into account when doing an in vitro study. Clinical testing of dentinal adhesive systems remains the ultimate proof of effectiveness, because laboratory studies may only speculate on clinical behavior.5., 6., 8., 9., 11., 15., 16.
The purpose of this study, therefore, was to evaluate the clinical performance of a self-etching two-step adhesive system Clearfil SE Bond and a one-bottle adhesive system Prime&Bond NT in Class V cavities for a period of two years.
Section snippets
Selection criteria
Thirty-two patients, 19 females and 13 males, with an average age of 46 (the range of age was between 26 and 60), referred to the Department of Restorative Dentistry of the Dental School in Ege University (Izmir/Turkey) and who demonstrated good oral hygiene were enrolled in this study. Written patient consents were obtained at the start of the project and the protocol was approved by the Human Ethical Research Committee of Ege University (Izmir/Turkey). A total of 98 restorations were placed
Results
At the two-year follow-up examination, 88 of the 98 restorations were evaluated (90% recall rate) in 28 patients. Four patients were not able to reach for various times of the control period. Those patients were considered to have missing restorations and were scored ‘C’ (Charlie) for the retention rate. The Cvar/Ryge scores for the evaluated restorations were listed in Table 4. Using the ADA guidelines formula,19 we calculated the two-year retention rates to be 93% for the self-etching group
Discussion
At the end of two years, the recall rate was 90%. The clinical evaluation of the 88 available restorations revealed over 90% retention rate for both adhesive system. According to the ‘revised acceptance program guidelines for dentin and enamel adhesive materials’ of the American Dental Association Council on Dental Materials,19 success criteria's are defined by the maximum number of restorations lost and microleakage failures at baseline, 6 and 18 months. A dentin and enamel adhesive material
Conclusion
Within the limits of this study, we can conclude that for a period of two years, the clinical performance of the self-etching and the one-bottle adhesive systems were not different. The utilization of both systems to restore Class V cavities is favorable for two years.
Acknowledgements
The author would thank the companies of Kuraray and Dentsply/De Trey for their generous material support.
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