Amalgam or composite resin? Factors influencing the choice of restorative material

Objectives

This study aimed to investigate the patient and tooth factors associated with selection of restorative material in direct posterior restorations in young adults from a population-based birth cohort.

Methods

A representative sample (n = 720) of all 5914 births occurring in Pelotas in 1982 were prospectively investigated, and posterior restorations were assessed in 2006, when the patients were 24 years old. Tooth-related variables (individual level) included restorative material (amalgam or composite), type of tooth, size of cavity, and estimated time in mouth. Data regarding demographic and socio-economic characteristics, oral health, and service utilization patterns during the life course were also assessed (contextual level).

Results

Logistic Regression Multilevel models showed that individuals who have accessed dental services by private insurance by age 15 [odds ratio (OR) = 1.66 (0.93–2.95)] and who had a higher dental caries index at age 15 (high DMFT tertile) [OR 2.89 (1.59–5.27)] presented more amalgam restorations in the posterior teeth. From tooth-level variables, the frequency of amalgams decreases with increasing number of surfaces enrolled in the cavity preparation (p < 0.001) and was almost 5 times greater in molars than in premolars.

Conclusions

The present findings suggest that variables related to type of dental service, dental caries (higher DMFT index), and cavity characteristics (tooth type, size) determine the choice of dentists for restorative materials. Other individual characteristics such as demographic and socioeconomic status have not influenced this choice.

Clinical significance

This is the first population-based study that assesses the determinant factors for the choice of dentists for composite or amalgam in posterior direct restorations, showing that, independently of socioeconomic and demographic characteristics, type of payment of dental services and clinical factors are associated with this choice.     

Clinical guidelines for treating caries in adults following a minimal intervention policy--evidence and consensus based report

Objectives

In 2002, FDI (World Dental Federation) published a policy advocating that caries be treated by minimal intervention (MI). This MI policy has been accepted worldwide and is taught in universities. But acceptance in general dental practice has been slower, especially in Japan where healthcare payment and practice favour drilling and filling. To help disseminate this MI policy into general practice, the Japanese Society of Conservative Dentistry developed an evidence-based clinical guideline for restoring carious permanent teeth in adult patients.

Methods

The guideline was developed by a committee of nine university clinicians and a librarian. The committee selected the most frequent clinical questions in treating caries and used electronic databases to search and assess the best scientific evidence for each. Members then added their clinical experience and discussed to reach consensus on each question on treating caries with MI policy. Graded recommendations and guidance were made for each clinical question. The provisional guideline was strengthened after review and discussion with university researchers and general practitioners.

Results

The guideline addresses the 16 most frequent clinical questions in treating adult caries, including restorative methods and how to tackle root caries. Recommendations for treatment using MI policy were developed using the best scientific evidence and consensus of experienced clinicians.

Clinical significance

The guideline offers a practical expert view of treating caries with the MI policy that incorporates the best scientific evidence, the latest techniques, the most preferable materials and the general consensus of expert clinicians.     

General dental practitioners and hearing impairment

Objective

Hearing impairment (HI) remains a problem among dentists Hearing loss at speech frequencies was recently reported among dentists and dental hygienists. This study aimed to investigate prevalence and factors associated with perceived HI among dentists.

Methods

In 2009–2010, 100 general dental practitioners (GDPs) and 115 general (medical) practitioners (GPs) (mean ages, 43.7 and 44.4 years) from Rome (Italy), who commenced practice ≥10 years ago, were interviewed on a series of occupation- and recreation-related HI risk factors and on HI-associated symptoms (tinnitus, sensation of fullness, hypoacusis). Prevalence of presumptive HI (≥1 symptom perceived during workdays and weekends) was assessed and factors associated with presumptive HI were investigated.

Results

Prevalence was 30.0% (95% confidence interval, 21.0–39.0%) and 14.8% (95% confidence interval, 8.3–21.3%) among GDPs and GPs, respectively. Occupation (GDP vs. GP), family history of hypoacusis, hypertension, ear diseases and smoking were significantly associated with presumptive HI. Within GDPs alone, significant associations were found for frequent use of ultrasonic scalers, use of dental turbines aged ≥ 1 year and prosthodontics as prevalent specialty.

Conclusions

GDPs experienced HI risk than GPs. Such a risk was not generalized to all dentists, but was specific for those who frequently used noisy equipment (aged turbines, ultrasonic scalers) during their daily practice.

Clinical significance

GDPs with 10 or more years of practice who routinely use potentially noisy equipment, could be at risk of HI. In order to prevent such condition, daily maintenance and periodical replacement of dental instruments is recommended.     

Selection of dental materials and longevity of replaced restorations in Public Dental Health clinics in northern Sweden

Objectives

To investigate the selection of direct restorative materials and longevity of replaced restorations in relation to operator and patients characteristics.

Methods

A cross-sectional study of treatment in practice, recording all new placements and replacements of direct restorations was performed during 2 weeks comprising all dentists within the Public Dental Health clinics in the county council of Västerbotten.

Results

A total of 2834 data collection sheets, one for each placed restoration, were received with a dropout of 10%. Restorations analyzed in the study were placed in permanent teeth in patients older than 15 years. First restorations placed due to primary caries were 671 and replacements 1536. Class II was the most frequently treated cavity followed by class I. The median longevity of replaced restorations was for amalgam, resin based composite and glass ionomer 16, 6 and 11 years, respectively. High caries risk patients showed shorter longevity for resin based composite restorations than low or moderate risk patients. Secondary caries as reason for failure for class II resin based composite restorations occurred significantly later than loss or fracture. Significantly longer longevity was observed for replaced restorations executed by more experienced dentists.

Conclusions

The use of amalgam was negligible and the material was predominantly replaced by resin based composites in first and replaced restorations. Class II was the most frequent placed and replaced restorations. Caries risk and experience of operator influenced longevity of replacements.     

Quantitative light-induced fluorescence (QLF): A tool for early occlusal dental caries detection and supporting decision making in vivo

Objectives

This study reports the development and assessment of a novel method using quantitative light-induced fluorescence (QLF), to determine whether QLF parameters ΔF and ΔQ were appropriate for aiding diagnosis and clinical decision making of early occlusal mineral loss by comparing QLF analysis with actual restorative management.

Methods

Following ethical approval, 46 subjects attending a dental teaching hospital were enrolled. White light digital (WL) and QLF images/analyses of 46 unrestored posterior teeth with suspected occlusal caries were made after a clinical decision had already been taken to explore fissures operatively. WL and QLF imaging/analysis were repeated after initial cavity preparation. The type of restorative treatment was determined by the supervising clinician independent of any imaging performed. Actual restorative management carried out was recorded as fissure sealant/preventive resin restoration (F/P) or class I occlusal restoration (Rest.) thus reflecting the extent of intervention (=gold standard). All QLF images were analysed independently.

Results

The results showed statistically significant differences between the two treatment groups ΔF (p = 0.002) (mean 22.60 – F/P and 28.80 – Rest.) and ΔQ (p = 0.012) (mean 230.49 – F/P and 348.30 – Rest.).

Conclusions

ΔF and ΔQ values may be useful in aiding clinical diagnosis and decision making in relation to the management of early mineral loss and restorative intervention of occlusal caries.

Clinical significance

QLF has the potential to be a valuable tool for caries diagnosis in clinical practice.     

Present and future of glass-ionomers and calcium-silicate cements as bioactive materials in dentistry: Biophotonics-based interfacial analyses in health and disease

Objective

Since their introduction, calcium silicate cements have primarily found use as endodontic sealers, due to long setting times. While similar in chemistry, recent variations such as constituent proportions, purities and manufacturing processes mandate a critical understanding of service behavior differences of the new coronal restorative material variants. Of particular relevance to minimally invasive philosophies is the potential for ion supply, from initial hydration to mature set in dental cements. They may be capable of supporting repair and remineralization of dentin left after decay and cavity preparation, following the concepts of ion exchange from glass ionomers.

Methods

This paper reviews the underlying chemistry and interactions of glass ionomer and calcium silicate cements, with dental tissues, concentrating on dentin–restoration interface reactions. We additionally demonstrate a new optical technique, based around high resolution deep tissue, two-photon fluorescence and lifetime imaging, which allows monitoring of undisturbed cement–dentin interface samples behavior over time.

Results

The local bioactivity of the calcium-silicate based materials has been shown to produce mineralization within the subjacent dentin substrate, extending deep within the tissues. This suggests that the local ion-rich alkaline environment may be more favorable to mineral repair and re-construction, compared with the acidic environs of comparable glass ionomer based materials.

Significance

The advantages of this potential re-mineralization phenomenon for minimally invasive management of carious dentin are self-evident. There is a clear need to improve the bioactivity of restorative dental materials and these calcium silicate cement systems offer exciting possibilities in realizing this goal.     

Methods to evaluate and strategies to improve the biocompatibility of dental materials and operative techniques

Objective

The general aim of this article is to describe the state-of-the-art of biocompatibility testing for dental materials, and present new strategies for improving operative dentistry techniques and the biocompatibility of dental materials as they relate to their interaction with the dentin–pulp complex.

Methods

The literature was reviewed focusing on articles related to biocompatibilty testing, the dentin–pulp complex and new strategies and materials for operative dentistry. For this purpose, the PubMed database as well as 118 articles published in English from 1939 to 2014 were searched. Data concerning types of biological tests and standardization of in vitro and in vivo protocols employed to evaluate the cytotoxicity and biocompatibility of dental materials were also searched from the US Food and Drug Administration (FDA), International Standards Organization (ISO) and American National Standards Institute (ANSI).

Results

While there is an ongoing search for feasible strategies in the molecular approach to direct the repair or regeneration of structures that form the oral tissues, it is necessary for professionals to master the clinical therapies available at present. In turn, these techniques must be applied based on knowledge of the morphological and physiological characteristics of the tissues involved, as well as the physical, mechanical and biologic properties of the biomaterials recommended for each specific situation. Thus, particularly within modern esthetic restorative dentistry, the use of minimally invasive operative techniques associated with the use of dental materials with excellent properties and scientifically proved by means of clinical and laboratory studies must be a routine for dentists. This professional and responsible attitude will certainly result in greater possibility of achieving clinical success, benefiting patients and dentists themselves.

Significance

This article provides a general and critical view of the relations that permeate the interaction between dental materials and the dentin–pulp complex, and establish real possibilities and strategies that favor biocompatibility of the present and new products used in Dentistry, which will certainly benefit clinicians and their patients.     

A study to determine the added value of 740 screening panoramic radiographs compared to intraoral radiography in the management of adult (>18 years) dentate patients in a primary care setting

Objectives

To measure the added value of panoramic radiography in new dentate patients attending for routine treatment.

Methods

Thirty-seven general dental practitioners using panoramic radiographs routinely were recruited. Twenty dentate patients were identified prospectively by each participating dentist if they were new to the practice, attending for an examination and requesting any treatment deemed necessary. A panoramic radiograph was taken with appropriate intraoral radiographs in line with national guidelines. Each dentist completed a radiological report for the panoramic radiograph only and these 20 reports were forwarded to the researchers along with the 20 panoramic radiographs, their accompanying bitewing and periapical radiographs and twenty completed clinical assessment sheets.

Results

740 panoramic, 1418 bitewing and 325 periapical radiographs were assessed by the researchers. Only 32 panoramic films provided any additional diagnostic value when compared to intraoral films when guidelines had been observed resulting from the poor technical and processing quality of the accompanying intraoral films. Assessment of the number of caries and periapical lesions and the degree of periodontal bone loss from the intraoral films provided a greater diagnostic yield at the p < 0.001 level of significance. The research found that dentists underestimated the number of caries lesions present and level of periodontal bone loss when compared to the researchers but overestimated the presence of periapical pathology, at the level of significance at p < 0.001.

Conclusions

The study found that there was no support for the use of panoramic radiographs in routine screening as there was no net diagnostic benefit to the patient.     

How does triangular-shaped radiolucency affect caries diagnosis?

Objectives

Dental radiographs provide valuable information for dentists. However, during radiographic evaluation, dental practitioners may come across radiolucent shadows that closely mimic carious lesions and lead to false-positive diagnoses. Among these is triangular-shaped radiolucency (TSR), which can occur on the mesial surface of maxillary deciduous and permanent molars and arises from their anatomic structures. Because of its resemblance to dentinal caries, this study aimed to evaluate dental practitioners’ knowledge of TSR and the effect of clinical experience on TSR diagnosis.

Methods

Ninety-four observers (47 final-semester dental students and 47 dentists with >4 years of clinical experience) evaluated four digital images of 11 extracted human teeth (nine deciduous molars and two first permanent maxillary molars), among which six proximal surfaces showed TSR. Histologic sectioning was used as the gold standard for differentiating between caries and TSR. Two oral and maxillofacial radiologists defined TSRs with agreement. Custom-made software was used for image display.

Results

Overall, 20 ± 9.34 % of observers mistakenly diagnosed TSR as a carious surface, 79.37 ± 10.53 % diagnosed it as a sound surface or Mach band effect, and only a few observers (0.53 ± 1.31 %) correctly diagnosed it as TSR. There was no significant difference between students and dentists for number of caries misdiagnoses of TSR (P = 0.859).

Conclusions

Dental practitioners and students have hardly any knowledge about TSR, leading to a considerable rate of false-positive caries diagnosis. It is highly likely that training dental practitioners in this phenomenon will improve their diagnostic performance and subsequent treatment plans.

     

Effect of fluoride-releasing restorative materials on bacteria-induced pH fall at the bacteria–material interface: An in vitro model study

Objectives

Inhibition of bacterial acid production by dental restorative materials is one of the strategies for secondary caries prevention. This study aimed to evaluate the effect of fluoride-releasing restorative materials on bacteria-induced pH fall at the bacteria–material interface.

Methods

Four fluoride-releasing restorative materials, glass-ionomer cement (GIC), resin-modified glass-ionomer cement (RMGIC), resin composite (RC) and flowable resin composite (FRC) were used. Each specimen was immersed in potassium phosphate buffer at pH 7.0 for 10 min and 4 weeks, and in potassium acetate buffer at pH 5.5 for 4 weeks. An experimental apparatus was made of polymethyl methacrylate and had a well with restorative materials or polymethyl methacrylate (control) at the bottom. The well was packed with cells of Streptococcus mutans, and the pH at the interface between cells and materials was monitored using a miniature pH electrode after the addition of 1% glucose for 90 min, and the fluoride released into the well was quantified using a fluoride ion electrode.

Results

The pH of GIC (4.98–5.18), RMGIC (4.77–4.99), RC (4.62–4.75) and FRC (4.54–4.84) at 90 min were higher than that of control (4.31–4.49). The fluoride amounts released from GIC were the highest, followed by RMGIC, RC and FRC, irrespective of immersion conditions. Saliva coating on materials had no significant effect.

Conclusions

The fluoride-releasing restorative materials inhibited pH fall at the bacteria–material interface. The degree of inhibition of pH fall seemed to correspond to the amount of fluoride detected, suggesting that the inhibition was due to the fluoride released from these materials.

Clinical significance

A little amount of fluoride actually released from the fluoride-releasing materials may have caries preventive potential for oral bacteria.     

Comprehensive dental treatment under general anaesthesia

Objectives

Patients unable to tolerate routine dental treatment in an ordinary dental setting may undergo a wide range of dental procedures under general anaesthesia. This report describes a practical protocol for providing full dental treatment under general anaesthesia.

Matherials and Metods

The importance of adequate treatment planning and safety measures is illustrated through the presentation of clinical cases.

Results

Suggestions are provided as to the use of techniques managing difficult treatment settings that allow the implementation of high-quality dental care in long sessions.

Conclusions

Complete treatment can be achieved in a single visit, thus avoiding repeated risk of anxiety for the patient associated with the treatment as well as subsequent further sessions with related schedule adjustment.     

Evaluation of micro-tensile bond strength of caries-affected human dentine after three different caries removal techniques

Objective

This study evaluated the effect that different techniques for removing dental caries had on the strength of the microtensile bond to caries-affected human dentine created by three bonding agents.

Materials and methods

Forty-five human molar teeth containing carious lesions were randomly divided into three groups according to the technique that would be used to remove the caries: a conventional bur, an Er:YAG laser or a chemo-mechanical Carisolv^® gel (n = 15). Next, each of the three removal-technique groups was divided into three subgroups according to the bonding agents that would be used: Clearfil^® SE Bond, G-Bond^®, or Adper^® Single Bond 2 (n = 5). Three 1 mm² stick-shaped microtensile specimens from each tooth were prepared with a slow-speed diamond saw sectioning machine fitted with a diamond-rim blade (n = 15 specimens). For each removal technique one dentine sample was analysed using scanning electron microscopy.

Results

There were statistically significant differences in the resulting tensile strength of the bond among the techniques used to remove the caries and there were also statistically significant differences in the strength of the bond among the adhesive systems used. The etch-and-rinse adhesive system was the most affected by the technique used to remove the caries; of the three techniques tested, the chemo-mechanical removal technique worked best with the two-step self etch adhesive system.

Conclusion

The bond strength values of the etch-and-rinse adhesive system were affected by the caries removal techniques used in the present study. However, in the one- and two-step self etch adhesive systems, bond strength values were not affected by the caries removal techniques applied. While a chemo-mechanical caries removal technique, similar to Carisolv^®, may be suggested with self etch adhesive systems, in caries removal techniques with laser, etch-and-rinse systems might be preferred.

Clinical significance

Caries removal methods may lead to differences in the characteristics of dentine surface. Dentine ultra structure generally affects the bonding of adhesive materials commonly used in restorative dentistry. Whereas etch-and-rinse system, like the ones used in the present study, are affected by these changes, the self etch systems are not affected. Hence, clinicians may opt for caries removal methods and systems appropriate for each patient and practice.     

Does dental disease presence equate to treatment need among care home residents?

Objectives

This study aimed to explore the relationship between dental disease, complexity and dental treatment needs of care home residents.

Methods

Survey of residents in care homes in Wales. Random sample of participants from a random selection of care homes across Wales, UK. Data collection involved questionnaires and dental examinations.

Results

Data were collected from 655 care home residents in 213 care homes. Half of all residents reported good or very good oral health but most had dental treatment needs. 73% of dentate residents had active caries, of those, 53% required restorations and 37% needed extractions. All were deemed to require dental examination. 60% of dentate residents and 50% of edentate residents had case complexity, which influenced the delivery of care.

Conclusions

There is significant unmet dental treatment need amongst care home residents. Dental disease presence alone is a poor indicator of the need for care and does not account for case complexity or the shift towards a patient centred rather than disease focussed approach to care. Measures for treatment needs and complexity are required when undertaking assessments of oral health needs in care homes.

Clinical Significance

Traditional oral health surveys measuring dental disease do not necessarily equate to treatments required for care home residents and do not reflect the complexity and difficulties involved in delivering dental care. This survey highlights dental needs in care homes, and the difficulties involved in delivering care to address these needs.     

Intake of dairy products and the prevalence of dental caries in young children

Objectives

In vitro studies show that milk or milk components may have cariostatic properties. However, the results of epidemiological studies on the association between intake of dairy products and dental caries have been inconsistent. The purpose of this cross-sectional study was to examine the association between intake of dairy products and the prevalence of dental caries in young children.

Methods

Study subjects were 2058 Japanese children aged 3 years. Information on diet was assessed with a self-administered brief diet history questionnaire for children. The consumption of dairy products was categorized into 3 levels in order to represent the tertiles as closely as possible. Dental caries was assessed by a visual examination. Adjustment was made for sex, toothbrushing frequency, use of fluoride, between-meal snack frequency, maternal smoking during pregnancy, environmental tobacco smoke exposure at home, and paternal and maternal educational levels.

Results

Compared with yogurt consumption at the lowest tertile (<1 time/week), its intake at the highest level (≥4 times/week) was significantly associated with a lower prevalence of dental caries, showing a clear dose–response relationship (adjusted prevalence ratio = 0.78, 95% confidence interval: 0.62–0.98, P for trend = 0.04). There were no material associations between intake of cheese, bread and butter, or milk and the prevalence of dental caries.

Conclusions

These data suggest that a high consumption of yogurt may be associated with a lower prevalence of dental caries in young children.     

The teaching of posterior resin composites: Planning for the future based on 25 years of research

Objectives

The restoration of posterior teeth affected by caries, trauma or wear remains one of the commonest procedures in the practice of dentistry. Over the past 20 years the first author and latterly the second author have led a series of surveys around the world to capture information on the teaching of posterior resin composites. The aim of this paper is to identify trends, reflect on the findings and make recommendations for the further development of this important aspect of the curriculum for primary dental qualifications.

Methods

Surveys on the teaching of posterior resin composites were completed in 1986, 1997–99, 2004–05 and 2007–2009. The findings from these surveys were reviewed and drawn together to allow historical and contemporary international trends to be identified. Recommendations for further developments in the teaching of posterior resin composites were formulated from the cumulated data and trends identified.

Results

Information was available from a total of 679 survey returns. Increased teaching of posterior resin composites has been observed over the period of the surveys: while 90% of dental school curricula did not include any didactic teaching of posterior resin composites in the mid-1980s, this dropped to 4% or less in the late 1990s, and to 0% in the early 2000s. In the late 2000s, however, 21% of dental schools still did not teach the placement of resin composites in three-surface cavities in permanent molar teeth. Areas of confusion were reported in the teaching of certain aspects of cavity design, notably the use of bevels, and in the protection of operatively exposed dentine.

Conclusions

While there has been steady growth in, and trends towards evidence-based teaching of posterior resin composites in dental schools around the world over the last 20–25 years, there is a need for further developments and harmonisation in this important aspect of curricula for primary dental qualifications. This need is now pressing, subsequent to the signing of the Minamata Convention. It is recommended that all new graduates, from no later than 2020, should have the knowledge, skills, competences and confidence to effectively restore damaged and diseased posterior teeth with state-of-the-art resin composite systems.     

The relationship between education debt and career choices in professional programs: The case of dentistry

Background

The authors examined the relationship between education debt and career choice, particularly dentists’ decisions to specialize, participate in public health insurance programs, and join dental management service organizations (DMSOs).

The influence of different restorative materials on secondary caries development in situ

Objectives

The effect of direct restorative materials on caries lesion formation was investigated with an 8-week in situ study with split-mouth design, testing the hypothesis that no difference in mineral loss next to a restoration would be found between different composite-based-materials and amalgam.

Methods

Six groups (n = 18) of restored dentine samples were prepared using amalgam, a microhybrid, a nanohybrid and a silorane composite. The composites were adhesively bonded with systems with or without an antibacterial monomer (Clearfil-SE-Protect, Clearfil-SE-bond, respectively), except for the silorane group (Silorane-System-Adhesive). Non-restored dentine samples were used as control (primary caries). Samples were inserted into slots, in lower prosthesis especially made for the experiment. Subjects were instructed to dip the lower prosthesis in a sucrose solution 4 times per day. At baseline and 8 weeks, samples were radiographed extra-orally and the integrated mineral loss was calculated. Data were statistically analyzed using multiple linear regression with a multilevel model (p = 0.05).

Results

Nine subjects were selected, and only outer lesions were observed. The hypothesis was partially rejected, as the microhybrid composite bonded with the antibacterial system and the nanohybrid composite presented statistically significant lower mineral loss compared to amalgam. Also, no significant differences were seen for these groups compared to control.

Conclusion

Within the limits of this study, the restorative material may influence outer lesion progression. Amalgam was not found to be related to lower secondary caries progression in dentine compared to composite-based materials after 8 weeks in situ.

Clinical Significance

Although patient factors play a major role in caries progression, the restorative material may affect outer secondary lesion progression.     

Long-term performance of resin based fissure sealants placed in a general dental practice

Objectives

The aim of the present retrospective study was to evaluate the long-term performance of resin based fissure sealants applied in a general dental practice.

Methods

Regularly attending patients visiting the practice between July 2006 until November 2007 and who had received sealants before 1st of January 2000 were included in the study. Date of placement of a sealant in posterior non-discoloured permanent teeth and replacement by a restoration was recorded. In a clinical examination occlusal surfaces were scored for (partial) sealant loss and fissure discolouration. The restoration profile of the patient was assessed as low or high, based on the number of restorations placed per year since the first sealant. Sealants had been applied by four dentists and a dental hygienist.

Results

1204 sealants were placed in 148 patients. After a mean follow-up time of 11.6 years, 41.3% of placed sealants were still fully retained and 11.4% were replaced by a restoration. Failure rates were significantly higher in high than in low restoration profile patients and in molars compared to premolars. In those fissures with lost or partially lost sealants, discolouration frequently occurred (40% of all surfaces) irrespective of restoration profile of the patient.

Conclusions

In this retrospective practice based study, long-term performance of sealants depended on restoration profile of the individual patient and the tooth type (molar versus premolar).     

Sistemi adesivi self-etch: revisione della letteratura

Objectives

This literature review summarizes the main aspects involved in the process of adhesion to enamel and dentin and focuses the reader's attention on the evolution of self-etch systems, highlighting their chemical and bond properties and applications in the clinical practice.

Materials and methods

An online search of keywords on the PubMed database was performed to search for scientific articles (reviews, original articles) published in recent years regarding self-etch adhesives.

Results

Multiple laboratory and clinical studies described adhesion mechanisms of self-etch adhesives. The majority of these publications found a higher bond quality of self-etch adhesive to dentin, while the bond to enamel remained questionable, especially for single step adhesives.

Conclusions

The self-etch technique is considered a valid dental adhesion approach from a restorative standpoint.