Clinical long-term retention of etch-and-rinse and self-etch adhesive systems in non-carious cervical lesions. A 13 years evaluation.

OBJECTIVES: The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems. METHODS: A total of 337 Class V restorations of three three-step etch-and-rinse, one two-step etch-and-rinse and three self-etch adhesive systems were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline and then every 6 months during a 13 years follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 13 years, 275 restorations could be evaluated. The cumulative loss rate at 13 years was 60.3%, with significant different failures rates for the different systems varying between 26.3 and 94.7%. Three materials fulfilled the ADA 18 months full acceptance criteria. Three systems showed already at 18 months or earlier catastrophical debonding rates. The annual failure rates for the three-step etch-and-rinse systems were: Allbond 2 4.1%, Clearfil LB 2.0% and Denthesive 7.3%. For the two-step etch-and-rinse Gluma 2000 6.5%, and for the self-etch systems ART 3.2%, Denthesive 2 5.7% and PUB 3 4.5% CONCLUSION: A continuous degradation of the resin-dentin bond was observed for all bonding systems during the follow-up expressed by the increasing loss rates. A wide variation of dentin bonding effectiveness was seen between the systems independent to adhesion strategy.     

Effect of air abrasion and thermocycling on resin adaptation and shear bond strength to dentin for an etch-and-rinse and self-etch resin adhesive

This study examined the effect of air abrasion and thermocycling on the adaptation and shear bond strength, of composite resin bonded to dentin using etch-and-rinse and self-etch resin adhesives. Confocal microscopy showed both adhesives closely adapted to dentin and a significantly (p<0.001) greater number of resin tags were observed for the etch-and-rinse adhesive. Air abrasion significantly increased resin tag length (p<0.05) for the etch-and-rinse adhesive and significantly increased the number (p<0.001), length (p<0.001) and thickness (p<0.01) of tags for the self-etch adhesive. However, air abrasion resulted in defect formation within the hybrid layer and thermocycling caused separation of the hybrid layer from adjacent dentin containing resin tags. A significant (p<0.05) reduction in shear bond strength was observed for the etch-and-rinse adhesive following thermocycling. Both adhesive systems adapted well to dentin in vitro and shear bond strengths were similar. The area of tag penetration into dentin was significantly (p<0.0001) enhanced following air abrasion.     

Development of a self-etch adhesive for resin-modified glass ionomers

The favorable self-adhesiveness of resin-modified glass ionomers (RMGIs) might be even further improved if the time-consuming and technically sensitive etch-and-rinse pre-treatment step with polyalkenoic acids could be avoided. We undertook this study to assess the effectiveness of an experimental self-etch adhesive for RMGIs that does not need to be rinsed off. Ultrastructural analysis and micro-tensile bond strength testing to enamel and dentin of a RMGI restorative material and a RMGI adhesive were performed after 4 different surface pre-treatments: no conditioning; 25% polyalkenoic acid; an experimental self-etch adhesive; and 37.5% phosphoric acid followed by the experimental self-etch adhesive. The use of an experimental self-etch adhesive increased the bond strength of RMGIs, especially after an additional conditioning step. Interfacial analysis showed the formation of a thin hydroxyapatite-containing hybrid layer. The self-etch technique enhances the user-friendliness of RMGIs and lowers their technique-sensitivity, while maintaining desirable characteristics of the conventional etch-and-rinse approach with polyalkenoic acids.     

Dentin interaction with universal adhesive containing isopropanol solvent studied by solid-state NMR spectroscopy

ObjectiveThis study investigated the chemical and structural changes in the mineral phase and collagen of dentin during application of a mild universal adhesive. Particular attention was paid to the role of isopropanol and changes in water molecules.MethodsIn vitro application of the mild universal adhesive on dentin with two established etching modes (self-etch and etch-and-rinse) was studied using solid state nuclear magnetic resonance spectroscopy.ResultsIt was evidenced that the etch-and-rinse mode leads to a decrease of the inorganic apatite and a reorganization of the residual mineral phase with a low amount of adhesive phosphate monoesters calcium salt formed, compared to the self-etch mode. In contrast, the adhesive interacts very similarly to the level of dentin collagen in both protocols, with a strong decrease in the amount of the free water molecules induced by the presence of isopropanol as the adhesive solvent, but without significant changes in the initial collagen structure. For both modes, the adhesive acrylates monomers remain mobile and can infiltrate the collagen.SignificanceUnderstanding the molecular interactions between dentin and adhesive solutions is a major challenge for designing products that lead to the formation of ideal dentin resin hybrid layer. Notably, one point considered essential is the presence of unbound water which, over time, is associated with a hydrolytic degradation of the organic matrix. Isopropanol, as an adhesive solvent, leads to a decrease in the amount of the less stable water molecules while the water molecules strongly attached to the collagen are retained, thus preserving the collagen structure.     

Long-term dentin retention of etch-and-rinse and self-etch adhesives and a resin-modified glass ionomer cement in non-carious cervical lesions.

OBJECTIVES: The aim of this study was to evaluate the clinical long-term retention to dentin of seven adhesive systems. METHODS: A total of 270 Class V restorations of four etch-and-rinse, one self-etch adhesive system and a resin-modified glass ionomer cement were placed in non-carious cervical lesions without intentional enamel involvement. The restorations were evaluated at baseline, 6, 12, 18, and 24 months and then every year during a 13-year follow-up. Dentin bonding efficiency was determined by the percentage of lost restorations. RESULTS: During the 13 years, 215 restorations could be evaluated. The cumulative loss rate at 13 years was 53.0%, with significant different failures rates for the different systems varying between 35.6 and 86.8%. Four systems fulfilled the ADA 18-month full acceptance retention criteria. Two systems showed at 18 months and earlier high debonding rates. The annual failure rates for the etch-and-rinse systems were Optibond 3.1%, Permagen 13.0%, Scotchbond MP 4.8%, Syntac classic 2.8%; for the self-etch system P&S 4.4%; and the resin-modified glass ionomer cement Vitremer 2.7%. CONCLUSION: It can be concluded that all systems showed a continuous degradation of the bond with a wide variation, which was independent of the adhesion strategy. Three bonding systems showed a cumulative failure rate after 13 years between 36 and 41% with the best retention for the resin-modified glass ionomer cement and a four-step etch-and-rinse system.     

Bonding CAD/CAM materials with current adhesive systems: An overview

ObjectiveOverview of the updated literature on the classification of adhesives systems and CAD/CAM materials with clinical guidelines to condition various surfaces for bonding to the tooth structure.Data sourcesSearches were conducted in MEDLINE, EMBASE, PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar using specific keywords.Results240 papers were revised, 150 articles were excluded, and 90 were eligible for the review. Most studies concluded the essentiality of bonding E-max, zirconia, and hybrid materials to enhance fracture toughness and fatigue resistance. The success of ceramic bonding depends on the microstructure and surface treatment of the materials. The proper treatment of the intaglio starts with using alumina oxide or hydrofluoric acid. This initial treatment could be followed by monobond salinization, which improves the chemical adhesion. Zirconia-based ceramics have grown lately and become the most prescribed for posterior and anterior teeth. Zirconia can be bonded to the tooth structure using the APC concept and 10 MDP promoting primers. Three hundred adhesive resin systems are currently available in the market, and each is different in chemical composition and clinical bonding strength. Of the three hundred systems, the total-etch system remains the gold standard, especially on the enamel surface. The self-etch adhesive system is favorable on dentin due to lowering the postoperative sensitivity. A new generation of dentin adhesives, called universal or multi-mode adhesives. This system has become popular and can be used either as etch-and-rinse or self-etch adhesives.ConclusionThe chemistry of adhesive systems has changed across generations. The variation of dental tissue is the decisive factor in selecting adhesive systems, resin cement, and ceramic materials. Moreover, a reliable bonding strength necessitates a perfect surface treatment and bonding promoter for tooth and CAD/CAM materials.     

One-day bonding effectiveness of new self-etch adhesives to bur-cut enamel and dentin

Self-etch adhesives try to solve difficulties commonly associated with the clinical application of etch-and-rinse adhesives. Their application procedure is considered less time-consuming and, more importantly, less technique-sensitive. The main objective of this study was to determine the bonding effectiveness to and the interaction with enamel/dentin of three contemporary one- and two-step self-etch adhesives by microtensile bond strength testing (microTBS), Fe-SEM and TEM when compared to a control two-step self-etch and a three-step etch-and-rinse adhesive. The one-step self-etch adhesive, Adper Prompt (3M ESPE), scored the lowest microTBS of all experimental and control adhesives tested. Conversely, the two-step self-etch adhesives Clearfil SE (Kuraray) and OptiBond Solo Plus Self-Etch (Kerr) approached the values obtained by the three-step etch-and-rinse control (OptiBond FL, Kerr) when bonded to enamel and dentin. Ultramorphological characterization showed that interfacial morphology and the pH of the self-etch primer/adhesive are strongly associated. The interaction with dentin varied from the formation of a submicron, hydroxyapatite-containing hybrid layer for the "mild" self-etch adhesive Clearfil SE to a 3-5 microm thick, hydroxyapatite-depleted hybrid layer for the "strong" self-etch adhesive Adper Prompt. The two-step self-etch adhesives AdheSE and OptiBond Solo Plus Self-Etch presented with a hybrid layer with a hydroxyapatite-depleted top part and a hydroxyapatite-containing base part and were therefore classified into a new group of self-etch adhesives, namely "intermediary strong" self-etch adhesives.     

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.     

Bonding effectiveness of a new 'multi-mode' adhesive to enamel and dentine

ObjectivesSelf-etch adhesives are well adopted in general practice, obviously primarily thanks to their ease of use and fast application time. Nevertheless, phosphoric acid is still often recommended to beforehand etch enamel following a so-called ‘selective’ enamel-etch technique, this in particular when most cavity margins end in enamel. The purpose of this study was to test if a new one-step adhesive can be applied in a multi-mode manner, this following different, either ‘full’ or ‘selective’, self-etch and etch-and-rinse approaches. Specific research hypotheses tested were that prior phosphoric-acid etching did not affect the bonding effectiveness of the one-step adhesive to enamel and dentine, and that the bonding effectiveness to dentine was also not affected when the adhesive was applied either following a ‘dry-bonding’ or ‘wet-bonding’ etch-and-rinse technique.MethodsThe micro-tensile bond strength (μTBS) of the one-step self-etch adhesive G-Bond Plus (GC, Tokyo, Japan; 1-SEA) was measured when it was bonded to bur-cut enamel following either a ‘self-etch’ or an ‘etch-and-rinse’ adhesive protocol, and to bur-cut dentine when applied following either a ‘self-etch’, a ‘dry-bonding’ or a ‘wet-bonding’ etch-and-rinse adhesive protocol. Bond-strength testing was corroborated by ultra-structural analysis of the interfacial interaction at enamel and dentine using transmission electron microscopy (TEM).ResultsPrior phosphoric-acid etching significantly increased the bonding effectiveness of the 1-SEA to enamel. A clearly enhanced micro-retentive surface was revealed by TEM. To dentine, no statistically significant difference in bonding effectiveness was recorded when the 1-SEA was either applied following a self-etch or both etch-and-rinse approaches. The ‘dry-bonding’ etch-and-rinse protocol was significantly more effective than its ‘wet-bonding’ version. TEM however revealed indications of low-quality hybridisation following both etch-and-rinse approaches, in particular in the form of a porous and poorly resin-infiltrated collagen mesh.ConclusionsWhile phosphoric-acid etching definitely improved bonding of the one-step self-etch adhesive to enamel, one should be more careful with additional phosphoric-acid etching of dentine. Although the bond strength was not reduced, the resultant adhesive interface appeared ultra-structurally more vulnerable to biodegradation.     

Current aspects on bonding effectiveness and stability in adhesive dentistry

Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel-dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch-and-rinse and a self-etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two-step etch-and-rinse and one-step (self-etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user-friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one-step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi-step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.     

Effect of cavity configuration and aging on the bonding effectiveness of six adhesives to dentin.

OBJECTIVES: The purpose of this study was to determine the effect polymerization contraction stress may have on bond durability. METHODS: Bonding effectiveness was assessed by micro-tensile bond strength testing (muTBS) and electron microscopy. The muTBS to flat dentin surfaces and in standardized cavities was determined (this after 1 day as well as 1 year water storage). Six adhesives representing all current classes were applied: two etch-and-rinse (OptiBond FL, Kerr; Scotchbond 1, 3M ESPE), two self-etch (Clearfil SE Bond, Kuraray; Adper Prompt, 3M ESPE) and two glass-ionomer (Fuji Bond LC, GC; Reactmer, Shofu) adhesives. RESULTS: The conventional 3-step etch-and-rinse adhesive OptiBond FL bonded most effectively to dentin, and appeared insensitive to polymerization shrinkage stress and water degradation. The 2-step self-etch adhesive Clearfil SE Bond most closely approached this superior bonding effectiveness and only slightly lost bond strength after 1-year water exposure. The 2-step etch-and-rinse adhesive Scotchbond 1 and the 'strong' 1-step self-etch adhesive Adper Prompt appeared very sensitive to cavity configuration and water-aging effects. The 2-step resin-modified glass-ionomer adhesive Fuji Bond LC only suffered from shrinkage stress, but not from 1-year water-exposure. Remarkable also is the apparent repairability of the 'mild' 1-step glass-ionomer adhesive Reactmer when stored for 1 year in water, in spite of the very low 1-day muTBS. SIGNIFICANCE: Simplified bonding procedures do not necessarily imply improved bonding performance, especially in the long term.     

Bond strength of glass-ceramics on the fluorosed enamel surfaces

OBJECTIVES: Effect of different adhesive luting systems on the shear bond strength of IPS Empress 2 ceramic restorations to fluorosed enamel surface was investigated. METHODS: Forty-eight ceramic discs (2 mm x 3 mm; IPS Empress 2) were fabricated. Twenty-four non-carious extracted human molar teeth with fluorosis and 24 without fluorosis were cleaned with pumice using a plastic brush and then they were divided into two main groups. The IPS Empress 2 ceramic discs were luted to the teeth of four subgroups with two different adhesive luting systems, Variolink 2/Excite DSC (etch-and-rinse) and Clearfil Esthetic Cement/ED Primer II (self-etch), thermocycling was performed 5000 times. Shear bond strengths were tested using Shimadzu Universal Testing Machine until failure. An optical microscope and image analyzer were used at 10x and 1000x magnification to analyze the surfaces for adhesive, cohesive and mixed failure percentages. Data was analyzed with one-way ANOVA and Tukey test at a significance level of p<0.05. RESULTS: Mean shear bond strength data of the groups in MPa were; Variolink 2/Excite DSC on fluorosed enamel: 18.3+/-3.08, Variolink 2/Excite DSC on non-fluorosed enamel: 18.79+/-2.65, Clearfil Esthetic Cement/ED Primer II on fluorosed enamel: 8.43+/-2.45, Clearfil Esthetic Cement/ED Primer II on non-fluorosed enamel: 13.53+/-1.68. Mixed failure was the most prevalent type of failure in moderate fluorosed and non-fluorosed teeth with etch-and-rinse dentin bonding system, and in fluorosed teeth with self-etch dentin bonding system. CONCLUSIONS: The use of an etch-and-rinse adhesive luting procedure produced higher bond strengths of glass-ceramics bonded to fluorosed and non-fluorosed enamel surfaces than the self-etch bonding system.     

Bond strength of self-etch adhesives to dentin prepared with three different diamond burs.

OBJECTIVES: To evaluate the micro-tensile bond strength (mu TBS) of a control etch-and-rinse and three self-etch (strong, mild, ultra-mild) adhesive systems to dentin prepared with three different grit size of diamond burs. METHODS: Dentin surfaces were created from mid-coronal sound dentin in extracted, human third molars. The teeth were ground with high-speed medium grit (100 microm), fine grit (30 microm), or extra-fine grit (15 microm) diamond bur. Resin composite (Z100) was bonded to the surfaces using Optibond FL, Adper Prompt L-Pop, Clearfil SE Bond, or Clearfil S3 Bond. Rectangular micro-specimens were prepared using the slow-speed diamond saw and tested in tensile to determine the mu TBS. Failure analysis was performed using a stereo-microscope and Fe-SEM. Data were analyzed by two-way analysis of variance and Tukey's HSD test (p<0.05). RESULTS: The etch-and-rinse adhesive yielded high micro-tensile values (58-69 MPa), irrespective of the diamond burs used. The bond strength values were comparable for Adper Prompt L-Pop and Clearfil SE Bond irrespective of the burs used. The mu TBS values were significantly higher as the particle size of diamond burs is smaller for Clearfil S3 Bond. Most failures were recorded as interfacial failure when the fine and extra-fine diamond burs were used. SIGNIFICANCE: Overall, different grit-sized diamond burs did not affect the mechanical properties of the interface, except for the ultra-mild one step self-etch adhesive. This adhesive performed significantly better when a smaller grit size was used to prepare dentin surface.     

Effect of interim cement application on bond strength between resin cements and dentin: Immediate and delayed dentin sealing

Statement of problem

Despite the advances in materials and techniques, adhesion to dentin is challenging because of the complex composition of dentin’s mineral, organic, and fluid phases.

Critical appraisal. Dentin bonding: matrix metalloproteinases and chlorhexidine

Contemporary resin-dentin bonding is initiated by systems that use phosphoric acid or acidic resin monomers to remove mineral, exposing the superficial dentin collagen matrix. Collagen-associated proteins, including enzymes known as matrix metalloproteinases (MMPs), also are exposed. The collagen matrix is subsequently infiltrated with resins that are polymerized to establish an adhesive attachment to the dentin. Exposed collagen matrix that is not infiltrated with the adhesive can be degraded by associated MMPs, which might result in deterioration of the adhesive-dentin bond over time. Chlorhexidine (CHX) is able to inhibit MMPs by binding calcium and zinc ions necessary for proteolytic activity. This Critical Appraisal presents salient publications on research that evaluate CHX and its ability to limit MMP degradation of dentin bonds created by etch-and-rinse and self-etch adhesive systems.     

羟基磷灰石脱敏剂对通用型粘接剂粘接性能的影响

目的探讨含羟基磷灰石(hydroxyapatite,HA)的脱敏剂对不同粘接模式下通用型粘接剂粘接性能的影响,为脱敏处理后粘接剂的使用提供依据。方法选取因阻生而拔除的第三磨牙60颗(西安交通大学口腔医院口腔颌面外科提供)。将4颗牙制备为1 mm厚牙本质片,1%柠檬酸处理建立牙本质敏感模型,分为对照组(无任何处理)、脱敏牙膏A和B组(分别用含HA的脱敏牙膏Biorepair和Dontodent Sensitive处理)、脱敏糊剂组(HA糊剂处理)(每组2片),扫描电镜观察各组牙本质表面形貌。剩余牙暴露冠中部牙本质并建立牙本质敏感模型,分入上述4组进行相应处理。每组再分为2个亚组,使用中强酸型通用型粘接剂(G-Premio Bond)分别在酸蚀-冲洗模式或自酸蚀模式下进行粘接,堆塑树脂,制备树脂-牙本质片状试件(每亚组4个)、微拉伸试件(每亚组20个)和片状试件(每亚组6个),分别进行粘接界面微观结构和纳米渗漏情况扫描电镜观察、微拉伸强度(粘接强度)测试及断裂模式记录、粘接界面水渗透情况激光扫描共聚焦显微镜观察。结果扫描电镜显示,脱敏牙膏和脱敏糊剂处理均可部分或完全封闭多数牙本质小管。对于酸蚀-冲洗模式,脱敏牙膏A、B组和脱敏糊剂组粘接强度[分别为(40.98±4.60)、(40.89±4.64)和(41.48±3.65)MPa]均显著大于对照组[(38.58±4.28)MPa](F=3.89,P<0.05);对于自酸蚀模式,4组粘接强度差异均无统计学意义(F=0.48,P>0.05);各组自酸蚀粘接模式粘接强度均显著大于同组酸蚀-冲洗粘接模式(P<0.05)。4组总体断裂模式主要为混合破坏和界面破坏。扫描电镜观察显示,酸蚀-冲洗模式下粘接界面银染颗粒沿混合层底部呈斑点状分布,自酸蚀模式几乎不存在银染颗粒沉积。激光扫描共聚焦显微镜显示酸蚀-冲洗模式混合层内存在连续线状渗透,自酸蚀模式混合层内呈不连续线状渗透。结论含HA的脱敏剂处理对中强酸型通用型粘接剂的粘接性能无不利影响,搭配自酸蚀粘接模式可获得良好的粘接效果。     

Distinct photopolymerization efficacy on dentin of self-etch adhesives

The effect of application mode on polymerization effectiveness of self-etch adhesives with different pHs has rarely been studied. We applied 2 self-etch adhesives-Adper Prompt L-Pop (APLP, pH ~ 0.8) and Adper Easy-Bond (AEB, pH ~ 2.5)-to dentin with or without agitation (dynamic or static application), to investigate photopolymerization efficacy on dentin, and to understand the role of chemical interaction/reaction between adhesives and dentin. Micro-Raman spectra and imaging were acquired across the dentin/adhesive (D/A) interface. The degree of conversion (DC) of each adhesive as a function of position was calculated. SEM-EDS was used to obtain the elemental distribution along the interface. Photopolymerization efficacies of the two self-etch adhesives on dentin were apparently different. APLP exhibited decreasing DCs as the distance from the D/A interface became greater for both application modes, while the DCs for the dynamic mode were much higher than those for the static mode. As for AEB, the DCs remained almost constant across the adhesive layer and showed no significant difference between two modes. Raman spectral analysis disclosed that the chemical interaction between dentin and adhesives was responsible for the observations. We also verified this by tracking the distribution of the elements Ca and P in the adhesive layers.     

Retention of tooth-colored restorations in non-carious cervical lesions—a systematic review

Objectives

The aim of this review was to assess the effect of different adhesive systems and tooth preparation on the retention of tooth-colored restorative materials placed in non-carious cervical lesions (NCCLs).

Methods

Randomized clinical trials with a minimum of 3 years of follow-up that evaluated the effectiveness of tooth-colored materials, adhesive systems, and preparation techniques for the restoration of NCCLs were selected. The Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (OVID), the Latin American and Caribbean Health Sciences Literature database (LILACS), and Medline (OVID) electronic databases were searched from 1990 to 2013.

Results

Twenty-seven randomized clinical trials were included and reviewed. Meta-analysis was used to determine the relative risk of loss of tooth-colored NCCL restorations between different categories of adhesive systems. The effect of tooth preparation could not be similarly analyzed.

Conclusion

The current best evidence indicates that a glass ionomer cement has a significantly lower risk of loss of a NCCL restoration compared to either a three-step etch-and-rinse or a two-step etch-and-rinse adhesive system; a three-step etch-and-rinse adhesive system has a significantly lower risk of loss of a NCCL restoration compared to a two-step etch-and-rinse adhesive system. No significant difference could be observed in the risk of loss of a tooth-colored NCCL restoration between a three-step etch-and-rinse adhesive system and either a two-step self-etch or a one-step self-etch adhesive system.     

In vivo degradation of resin-dentin bonds produced by a self-etch and an etch-and-rinse adhesive

Resin-dentin bonds are known to degrade in the relatively aggressive oral environment. In order to obtain greater insight into the interfacial degradation process, we examined, by using transmission electron microscopy (TEM), the interfacial ultrastructure of two adhesives bonded to dentin after 1 yr in vivo. Class V cavities were prepared on the buccal surfaces of 14 intact teeth of two monkeys and then restored by using either the two-step self-etch adhesive, Unifil Bond, or the two-step etch-and-rinse adhesive, Single Bond, in combination with the restorative microhybrid composite, Z250. After 1 yr, 10 other teeth were restored by using the same materials (controls). One day later, the monkeys were killed, following which the microtensile bond strength to dentin was determined and the interfacial ultrastructure was examined by TEM. Whereas no noticeable changes in the morphology of the resin-dentin interface were observed between the 1-d and 1-yr specimens for Unifil Bond, Single Bond exhibited signs of interfacial degradation, in particular at the bottom of the 3 microm-deep hybrid layer. In conclusion, the adhesive interface produced by the etch-and-rinse adhesive was less resistant to degradation than that produced by the self-etch system.     

OPTIONS FOR DENTIN/ENAMEL BONDING: PART I

Four categories of resin-based dentin/enamel adhesives are currently available. These include the three-step etch-and-rinse, "one-bottle" etch-and-rinse, two-step self-etch primer systems, and "all-in-one" self-etch adhesives. In consecutive issues of the Journal, the Critical Appraisal series will present salient publications on research in each of the categories, beginning with this issue's piece on the three-step etch-and-rinse systems.