Ask the Experts

DENTIN/ENAMEL BONDINGjerd_365 352..353

Author and Associate EditorEdward J. Swift, Jr., DMD, MS*

QUESTION: The last few issues ofJERD have addressed the questionof which resin-based dentin/enameladhesives are the “best.” So basedon the input of the various expertswho have responded to this ques-tion, can you tell me whether thereis a consensus response?

ANSWER: Although opinions of theexperts varied somewhat, I believethat a clear consensus has emerged.When we consider bonding to bothdentin and enamel, the three-stepetch-and-rinse materials (e.g.,OptiBond FL, Kerr Corporation,Orange, CA, USA) remain the goldstandard. These versatile materialsprovide an excellent bond toenamel and a very good bond todentin. More importantly, theyhave demonstrated excellentclinical performance inlong-term studies.

If we consider bonding to dentinonly, the mildly acidic two-step

self-etch systems (e.g., Clearfil SEBond, Kuraray, Tokyo, Japan)appear to provide the most durablebonds. Although controlled clinicaltrials have not proven that self-etchmaterials reduce the incidence ofpostoperative sensitivity, plenty ofanecdotal evidence suggests thatthey do. The main drawback ofthese materials is their relativelyweak bond to enamel. However,this can be overcome by selectiveetching of enamel before the appli-cation of the self-etch primer.

The one-bottle (combined primerand bonding agent) etch-and-rinseadhesives provide an excellentbond to enamel and a reasonablebond to dentin. However, theirdentin bonds are not as stable aseither of the previously describedcategories, especially when thedentin is not protected by a rim ofenamel. Despite the fact that theyhave generally not performedas well as their three-step

predecessors in either long-termlaboratory testing or clinical trials,they remain a viable option forbonding, especially when enamel ispresent and proper techniques arefollowed. They may not measureup to the gold standard, but in myopinion, they have done very wellin the “real world” of dentistryoutside of the laboratory andclinical trials.

One category of adhesiveremains—the “all-in-one” self-etchmaterials. By definition, thesematerials are easy to use; after all,the three necessary functions foradhesion (condition, priming, andbonding) are delivered simulta-neously. However, despite theirease of use and increasing popular-ity, these materials are the leastlikely to provide a durable bond todentin and enamel. At the moment,they are generally the poorestoption for bonding. Admittedly,there are some exceptions (e.g.,

*Professor and Chair, Department of Operative Dentistry, University of North Carolina,Chapel Hill, NC, USA

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restoration of a deciduous tooth ina difficult pediatric patient), andthe materials are definitely improv-ing. Nevertheless, this category ofadhesives is the least proven andhas the most negatives.

A C K N O W L E D G E M E N T S

Claus-Peter Ernst, Dr Med DentJorge Perdigão, DMD, MS, PhDPatricia N.R. Pereira, DDS, PhDBart Van Meerbeek, DDS, PhD

S U G G E S T E D R E A D I N G S

Swift EJ. Dentin/enamel bonding. J EsthetRestor Dent 2010;22:4–6.

Perdigão J. Dentin/enamel bonding. J EsthetRestor Dent 2010;22:82–5.

Van Meerbeek B. Dentin/enamel bonding.J Esthet Restor Dent 2010;22:157.

Ernst CP. Dentin/enamel bonding. J EsthetRestor Dent 2010;22:210–2.

Pereira PNR. Dentin/enamel bonding. J EsthetRestor Dent 2010;22:280–1.

Editor’s Note: If you have a question on any aspect of esthetic dentistry,please direct it to the Associate Editor, Dr. Edward J. Swift, Jr. We will forwardquestions to appropriate experts and print the answers in this regular feature.

Ask the ExpertsDr. Edward J. Swift, Jr., DMD, MSDepartment of Operative DentistryUniversity of North CarolinaCB#7450, Brauer HallChapel Hill, NC 27599-7450Telephone: 919-966-2770; Fax: 919-966-5660E-mail: ed_swift@dentistry.unc.edu

A S K T H E E X P E R T S

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