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Total-etch versus self-etch adhesive: Effect on

postoperative sensitivity
JORGE PERDIGÃO, SAULO GERALDELI and
JAMES S. HODGES
J Am Dent Assoc 2003;134;1621-1629

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They are technique rather than on the type of dentin composed of aqueous mixtures of acidic functional adhesive used. The authors placed 30 restorations with the SE material (Clearfil SE Bond.). is now considered the statistically significant differences in postop- sensitivity and fundamental mechanism for retention of erative sensitivity between the SE and TE materials at any recall time. December 2003 1621 Copyright ©2003 American Dental Association. Only one tooth two strategies to interact with the dentin smear layer: the TE technique or displayed sensitivity to occlusal forces at six the self-etch. as well as the total-etch to etched enamel and dentin while for marginal discoloration. adhesive. Del. with a pH JADA. Etching dentin removes the smear layer and opens sitivity and marginal discoloration.4-6 The improvements seen in Matrix Restorative for Prime & Bond NT. Milford.. technique3 followed by application of the corresponding and recent developments in the chemistry of dentin dentin adhesive.ada... Downloaded from jada.10 Recent dentin adhesives use one of coloration was rated as “absent” for all discoloration. and do not remove the smear layer. The introduction of the total-etch. .2 cent phosphoric acid (for Prime & Bond NT). differ from the TE adhesive in regard to sen- tion. Kuraray America. Bonding (ice). relying on the entanglement of resin adhesive in Results. 2011 JAMES S. an self-etch adhesive SE adhesive would result in poorer enamel marginal integrity than a TE adhesive. or TE. B Buonocore introduced the acid-etch technique Upon rubber dam isolation. adhe- sive would result in less postoperative sensi- tivity than a total-etch.11 TE materials use 30 to months. 40 percent phosphoric acid to etch dentin and enamel Conclusion. Patients were selected on the basis of requiring Class I and II restorations sensitivity in molars and premolars. or regard to hybridization.D. monomers. The SE adhesive did not before the clinician applies the adhesive to the prepara. M.D. The self-etch the laboratory have been confirmed in The restored teeth were evaluated preopera- tively and at two weeks.S.. or SE. the self-etching primer (for Clearfil SE ture and organic composition of the dentin Bond) or etched with the proprietary 34 per- substrate.9. restorations at six months.. D. Self-etching adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based com- posite restorations. or SE. D.S.12.D. All rights reserved. Vol. Preparations were of standard design.D.M. The authors tested a Total-etch versus twofold hypothesis: a self-etch. or TE. Ph. Postoperative used increasingly. Analysis of variance revealed no monomers with dental substrates. COSMETIC & R E S T O R AT I V E C A R E ABSTRACT Background. which are being Clinical Implications. with onding to enamel has been successful since all margins in enamel without beveling. Ph. Ph.1 Bonding to dentin has been less pre. Marginal dis- marginal resin-based composite restorations.D. York) and 36 restorations with Prime & SAULO GERALDELI.org on March 30. M. eight weeks and six adhesive did the clinical setting with the recent gen- 7. Teeth were restored with adhesives have made resin-based composite restorative the proprietary hybrid resin-based composite materials almost resistant to microleakage. up the dentinal tubules. SE adhesives. 134.8 months postoperatively for sensitivity to cold not differ from eration of adhesive systems. which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously. Bond NT (Dentsply Caulk. ditioned the enamel and dentin walls with dictable because of the wet tubular ultrastruc. the authors con- in 1955. HODGES.S. New JORGE PERDIGÃO. with bond indicated for posterior restorations: Clearfil strengths that approach those of enamel AP-X for Clearfil SE Bond or Esthet·X Micro bonding.13 do not require a separate acid-etch sensitivity may depend on the restorative step.. air and masticatory forces. Effect on postoperative Methods. generally phosphoric acid esters. technique.

a microexposure of the which they used a TE dentin adhesive and resin.21 For some clinicians. S. including desensitizing dentifrices or other adhesive would result in greater enamel marginal over-the-counter products discoloration than a TE adhesive. pulp was to be suspected. Two of us (J.) placed at least two postoperative sensitivity remains a problem for restorations in simulated Class II preparations to Class I.17-20 even between the cusp tips. patients signed Downloaded from jada.) Few clinical studies have focused on postopera. conventional amalgam design and cavosurface however. followed by a thin layer of resin- additional 14 percent of the teeth experienced modified glass ionomer cement (Vitrebond.) in teeth resulted in sensitivity on loading. except for ongoing restorative procedures in unre- lated and unopposed quadrants. Minneapolis. II and V resin-based composite practice this technique before we placed the first restorations. analgesic and psychotropic drugs Before participating in the study..ada.15. 2011 dPregnancy or breast-feeding a consent form. The director of the study (J. They found that should place a thin layer of calcium hydroxide up to 56 percent of the restorations in posterior liner (Dycal. However. postoperative sensitivity does not seem angles were entirely within enamel. Del. Milford. The average Postoperative sensitivity after placing posterior faciolingual width of each preparation was composite restorations has been a problem experi. ates specific exclusion criteria. dMedical. The box enumer- relatively higher than that of phosphoric acid. For other dentists. and the operators based composite to restore teeth. psychiatric or pharmacotherapeutic history that might compromise the protocol. pulpal or axial wall of the preparation after cari- Opdam and colleagues20 conducted a study in ous dentin excavation. without any to occur frequently after placing composite intentional bevel (Figures 1 and 2). Minn. 1622 JADA. Dentsply Caulk. ongoing clinical dentistry twofold: an SE adhesive would result in less post- evaluation operative sensitivity than a TE adhesive.5 to 1. restorations in their patients. based dentin adhesive with a composition and dFewer than 20 teeth application mode different from that of currently dNonvital tooth used simplified one-bottle materials. either for replace- dTeeth or supporting structures with any painful ment of an existing restoration or for treatment of pathology dPeriodontal surgery within the previous three primary carious lesions.P. had radiographs taken within the previous year.org on March 30. etching gels.). while an those deep areas. an SE dSubject receiving desensitizing therapy. CLINICAL PROTOCOL including the long-term use of anti- inflammatory. Vol. All rights reserved. opposing and adjacent tooth contact. of the teeth to be restored.0. water- PATIENT EXCLUSION CRITERIA.22 dInability to return for recall appointments dFractured or cracked teeth The hypothesis tested in our clinical study was dSubject in another. 134.COSMETIC & RESTORATIVE CARE BOX seven weeks.14 While the pH for a 34 to 37 percent We obtained preoperative bitewing radiographs phosphoric acid gel is in the range of 0. .P. St.G. the researchers did not dAllergy to resin materials use a TE adhesive as a positive control.9 to 2. greater than or equal to one-third of the distance enced by clinicians for almost 20 years. The dental health status months of patients was normal in all other respects. Both the form and this research dAllergies and idiosyncratic responses to product ingredients protocol were reviewed and approved by the Insti- dOrthodontic appliance treatment within the tutional Review Board at the University of Min- previous three months nesota School of Dentistry. New York) is 1. the TE dentin adhesive used in their study was a multibottle. All preparations were of when a dentin liner is used. All 25 dTeeth restored in the preceding three months dAbutment teeth used for fixed or removable patients required Class I and Class II restora- prostheses tions in molars and premolars.16 Miller13 reported that The teeth to be restored had a normal occlusal SE adhesives do not etch enamel to the level relationship with natural dentition and an obtained with phosphoric acid. Although dHistory of tooth sensitivity dXerostomia or periodontal disease another study reported sensitivity to be virtually dBruxism zero for an SE adhesive.0. unless the patient had the pH of Clearfil SE Bond (Kuraray America. December 2003 Copyright ©2003 American Dental Association. 3M spontaneous postoperative sensitivity at five to ESPE. Paul. stated that if a pink color was observed on the tive sensitivity caused by dentin adhesives.19 actual restoration.

dentin was remoistened to an acceptable moisture or HO Bands no. Application of primer (Clearfil SE Bond Primer. E. and all operating sites were iso. H. D. Dentsply Caulk. 18. Application of primer and adhesive. After light-curing the first incre- ment. We assigned etching methods randomly to the preparation by applying an SE dentin/enamel teeth for each subject. Tooth at the six-month recall appointment. page 1625). or SE. I. The operators applied dentin was left visibly moist (glistening). B. The operators then applied the adhesives to Mo. Carious lesion on tooth no. the operator inserted the second increment of composite material and light-cured it. All rights reserved. Earth City. Clinical case in which self-etch. F. phoric acid was washed for 10 seconds and the lated with a rubber dam.) and Sycamore wood wedges (Premier Dental the walls of the preparations according to the Products.) to the cervical manufacturers’ instructions (Table 1. Matrix Restorative. All operative procedures were performed under Although the SE primer was not rinsed. Young Dental.ada. margins of Class II preparations. 1. Pa. or the an appropriate matrix (Palodent. G.org on March 30. 2011 B C D E F GA H B I C D E F GA HB I C D E F G H I E F GA HB I C D E F GA HB I C D E F G H I Figure 1. 134. Kuraray America). C. level. the phos- local anesthesia. A. for Prime & JADA. 18. Application of SE adhesive (Clearfil SE Bond). The operators inserted resin-based percent phosphoric acid (Caulk 34% Tooth composite restorative material (Esthet•X Micro Conditioner Gel. The with each etching method applied to one or two operators treated the enamel and dentin walls of teeth. Dentsply Caulk) for 15 seconds. Kuraray Placement of resin-based composite America) for 20 seconds or by etching with 34 restoration. December 2003 1623 Copyright ©2003 American Dental Association. Immediate postoperative view. Dentsply Caulk. Kuraray America) were used to restore tooth no. Removal of soft carious dentin with excavator. Removal of carious dentin with slow-speed carbide bur. New York) and resin- based composite material (Clearfil AP-X. . adhesive (Clearfil SE Bond. Insertion of first increment of resin-based composite material (Clearfil AP-X). COSMETIC & RESTORATIVE CARE A B C D E F GA HB I C D E F GA HB I C D E F G H I Downloaded from jada. Each subject received two or three restorations. Kuraray America. Plymouth Meeting. Vol. primer (Clearfil SE Bond Primer.

placed to ensure that it exceeded 400 Evaluation of hypersensitivity. followed by rinsing and application of TE adhesive (Prime & Bond NT) on moist dentin. All rights reserved. proximal finishing using a no.) and resin- based composite material (Esthet•X Micro Matrix Restorative. Kuraray and points (Enhance. sive strips (Brasseler USA). Prepara- tion after removal of infected dentin.org on March 30. COSMETIC & RESTORATIVE CARE A B C D E F GA HB I C D E F GA H B I C D E F G H I Downloaded from jada. Vol. Existing faulty restoration on tooth no. A. They performed three increments. the operator minum oxide disks (Sof-Lex XT. Del. and used a curing light to poly. the operators evaluated hypersensi- coarse finishing with appropriate finishing car. . Tooth at the six-month recall appointment. 134. C. Etching with 34 percent phosphoric acid (Caulk 34% Tooth Conditioner Gel) for 15 seconds. Bond NT adhesive or Clearfil AP-X. D. Ga. after treatment. E. tions for each patient were done in one or two They checked the intensity of the light with a appointments (if they had three restorations in radiometer after every 20 restorations were different quadrants). Dentsply Caulk) and pastes America. to the assessments made immediately before After polymerization. 12. tivity at two weeks. G. 2011 A B C D E F GA HB I C D E F GA HB I C D E F G H I D E F GA HB I C D E F GA HB I C D E F G H I Figure 2. Clinical case in which total-etch. At each evaluation. Use of an explorer to check for the hardness of remaining dentin. Removal of soft carious dentin with excavator. Dentsply Caulk. Removal of carious dentin with slow-speed carbide bur. 12 blade and abra- merize for 40 seconds per increment and 40 sec. the clinicians performed treatment. Dentsply Caulk) were used to restore tooth no. Savannah. alu. All restoration inser- onds for both facial and lingual gingival corners. for Clearfil SE Bond adhesive) in two or (Prisma Gloss. cups recorded the sensitivity of each tooth to applica- 1624 JADA. December 2003 Copyright ©2003 American Dental Association. 3M ESPE).ada. In addition milliwatts/square centimeter.). I. Dentsply Caulk). Milford. eight weeks and six months bide burs (Brasseler USA. After light- curing the first increment. H. 12. the operator inserted the second increment of composite material and light-cured it. F. or TE. Immediate postoperative view. B. adhesive (Prime & Bond NT.

NT adhesive to thoroughly cetylamine hydrofluoride. 0101112 (AE). (Preliminary analyses showed that this considered any recall visit that occurred within analysis gave the same results as analyses in plus or minus 10 percent of the scheduled time for which the dependent variable was the change recall as occurring at that time. The clinicians timed the applica. Esthet•X Micro Matrix Restorative (Dentsply Caulk): 0012113 (A40). 00350B (B2). ately brush on generous butylated hydroxitoluene.. we months). For the purpose of data collection. 010411 (B20). 00319A (C2). COSMETIC & RESTORATIVE CARE TABLE 1 ADHESIVE SYSTEM. N. and air sensitivity and response The clinicians examined patients at recall time.G. from baseline to each follow-up time. evaluated marginal discoloration at six months way dental unit syringe at a distance of approxi. two weeks.) were present at each evaluation to dependent variables: cold sensitivity and help ensure standardization. 10-methacryloy. 134. or undisturbed for 20 seconds. Dispense and apply Clearfil (Primer: 00199A loxy decyl dihydrogenphosphate. acetone. silica nanofiller Surface should remain wet for 20 seconds. amounts of Prime & Bond ethyl dimethyl aminobenzoate.org on March 30. dentin Dentsply Caulk. The two operators an ice stick and compressed air from the three. 2011 Gel: 0102161. so we Evaluation of marginal discoloration. according to this scale: Alfa = no marginal discol- mately 2 cm. hydrophilic dimethacrylate silanated colloidal silica. All rights reserved. Rinse thoroughly for Adhesive: 010519) dimethacrylate and T-resin 10 seconds. * Batch numbers of resin-based composites used in the study are as follows (composite shade in parentheses): Clearfil AP-X (Kuraray America): 00643A (A2).5). tions of compressed air.N-diethanol-p-toluidine. Each analysis was a repeated-measures appointments that were scheduled as close as analysis of variance in which each subject pro- possible to the actual day prescribed by the study vided measures for both treatments at three design (that is. Adhesive: PENTA†. which may necessitate additional application of adhesive. Immedi- Milford.0 or ×1. ADHESIVE SYSTEM CLASSIFICATION COMPOSITION OF ADHESIVE INSTRUCTIONS FOR USE (BATCH NUMBER)* SYSTEM Clearfil SE Bond Self-etch adhesive Primer: water. New HEMA. response time. Two of Statistical methods. Clearfil SE Bond. eight weeks. with a maximum trates the interface and cannot be polished. (cross-linking agent) and D-resin should be moist. intraoral color photographs at baseline and at ticatory forces as the patient’s spoken response to each recall appointment. Kuraray America. 0105092 (A3. gentle airflow. They applied cold in the form of magnification of ×1. We analyzed four us (J.P. † PENTA: Dipentaerythritol penta acrylate monophosphate. 4. Del. light-cure for bisphenol A diglycidylmethacry. Vol. 00338A (B3). N. .N-diethanol- p-toluidine. six follow-up times (two weeks. December 2003 1625 Copyright ©2003 American Dental Association. 00396A (A4). 010504 (GE). a cold stimulus and mas. Clinical photographs a visual analogue scale from 0 to 10 (continuous consisted of digital images taken at an original measurements). COMPOSITION AND INSTRUCTIONS FOR USE. Charlie = discoloration that pene- by raising his or her left hand. 10 seconds late. 0105213 (C40). Bravo = slight staining that disappears tions of each stimulus until the subject responded on polishing. Immediate Delta = evidence of caries. we collected For subjects with more than one tooth JADA. 010511 (A20).5. Tooth Conditioner Gel for 15 Downloaded from jada.ada. 010514 (U). (small hydrophilic molecule). eight weeks. apply Bond: methylene diphosphonate. oration. 010525 (A2). dry with mild airflow. 0105183 (D30). wet the cavity surface. camphoroquinone Prime & Bond NT Total-etch Etchant (gel): 34% phosphoric Etch enamel with Caulk 34% (34% Phosphoric Acid adhesive acid with silica. urethane seconds. SE Bond Primer. six months). S.) evaluate marginal discoloration. HEMA. responses were recorded as zero seconds. hydrophilic dimethacry. apply York late. 0105011 (YE). 0105182 (C10). leave Bond: 00198B) 2-hydroxyethyl methacrylate. To omitted the latter analyses. application lasting 15 seconds. 00787A (A3). Blot dry.

the SEs are derived from two analyses of variance.63 1.03 (SE) Severity (1 to 10 Scale) * Clearfil SE Bond adhesive is manufactured by Kuraray America. for a given dependent variable. receiving a given treatment. § For each dependent variable.94 7.50) Response Downloaded from jada.06 (SE‡§) (0.42) (0. 21 main effect (treatment or time) was significant.34 7. to 54 years). COLD AND MASTICATORY FORCES.18) (0.42 8.62) (0.25) (0.71 2. one for baseline and one for the posttreatment times. we averaged the percent) were molars.79) (0.74 2. December 2003 Copyright ©2003 American Dental Association. the SEs are the same for both treatments at baseline and the same for all six treatment/time combinations after baseline.COSMETIC & RESTORATIVE CARE TABLE 2 SEVERITY AND TIME OF RESPONSE TO COMPRESSED AIR. cold response time).25) (0. or ANOVAs.72 2.50) (0.18) (0. “severity of response” and “time to response” for both air and cold stimuli.36 (SE) (0.94 (SE) (0. Deriving the SEs from the ANOVA instead of from each group individually provides more statistical power.86) (0.org on March 30.25) (0.44 (SE) (0. air response We restored 66 teeth (42 molars. Of the time. 24 premolars) in time. New York.83 1. † Prime & Bond NT adhesive is manufactured by Dentsply Caulk.30 9. AFTER AFTER AFTER TREAT.62) Response Time (0 to 15 Seconds) Masti- catory force Mean 0 0 0 0 0 0 0 0.ada.18) (0.86) (0. ‡ SE: Standard error.62) (0.42) (0.71 10. neither 25 subjects (seven men. the analy. 2011 Time (0 to 15 Seconds) Cold Mean 2.25) (0.79 2. AFTER AFTER AFTER MENT TREATMENT TREATMENT TREATMENT MENT TREATMENT TREATMENT TREATMENT Clearfil SE Bond* Prime & Bond NT † Air Mean 1. 22 (61 percent) were that received a given treatment.50) (0.79) (0.06 2.80 2.08 9. (The treatment main effect answers the 30 teeth restored with Clearfil SE Bond. cold sensitivity.29) (0.81 10.50) (0.00 2.44 7.50) (0. “Averaging over visits.18) (0.27 1. sis used one measure per subject per treatment at Table 2 shows means and standard errors for each visit. molars (the difference was not significant).25) Severity (1 to 10 Scale) Mean 8. All rights reserved. Milford.08 8. age range.84 9. STIMULUS BEFORE TWO WEEKS EIGHT WEEKS SIX MONTHS BEFORE TWO WEEKS EIGHT WEEKS SIX MONTHS TREAT.25) (0.68 11.32 9. Vol. Del. 20 (67 question.18) Severity (1 to 10 Scale) Mean 9.50) (0.70 11. . 134.18) (0.76 1.29) (0.62) (0. do the two 1626 JADA. Thus.62) (0. Nine subjects had two teeth restored nor was the interaction between treatment and and 16 subjects had three teeth restored.49 2. 18 women. Of the 36 teeth restored dependent variables at each visit across the teeth with Prime & Bond NT.62) (0. air sensitivity.12 1. Thus.17 1. For all four dependent RESULTS variables (that is.29 8.

134. the visit main effect answers one produced by phosphoric acid etching. This baseline to 30. tions. they rely on their ability to partially dis. The operators solve hydroxyapatite to yield a resin-infiltrated placed at least two coats of adhesive in all zone with minerals incorporated. deformation not remove the smear layer from of the cusps by shrinkage stress16 Self-etch adhesives dentin completely. but are less effective on intact thereby preventing postoperative sensitivity prob- enamel. This decrease in bond tooth. SE adhesives are less technique-sensitive than Downloaded from jada.13 Several studies have not covered with the adhesive material.23 are TE adhesives. All rights reserved. Accordingly.000 cycles. we found no clinical DISCUSSION signs of marginal degradation at six months for Postoperative sensitivity has been attributed to restorations bonded with the SE adhesive. “Is the difference between which they found a significant decrease in enamel treatments the same for all three visits?”) bond strengths for the three SE adhesives tested No tooth exhibited sensitivity to masticatory when specimens were thermocycled up to 30. enamel. The interaction Miyazaki and colleagues30 conducted a study in answers the question. including dentin etching and bac. several factors. Another advantage of SE adhe- the results have been mixed.20. If they evaluated SE adhesives for their enamel-etching found a dry spot. TE infiltration.000 forces.29 Other studies demonstrated that dentin tubules from being in direct contact with SE adhesives are effective only on ground the resin-based composite in the dry spot areas. December 2003 1627 Copyright ©2003 American Dental Association. SE adhesives do occlusal discrepancies. SE adhesives condition and adhesive if the tooth surface does not remain prime enamel and dentin simultaneously without totally wetted by the material after the first rinsing. They used magnification loupes for moderate and aggressive. resulted that enamel marginal adaptation under clinical in a sensitivity score of 1 (0 to 10 scale) in conditions might not be optimized. .14 because both processes occur adhesives or both in posterior restorations.26-30 Some of these studies indicated that Prime & Bond NT. the these were multistep materials that are no longer operators followed the manufacturer’s instruc- popular among clinicians. are not likely to result in a discrep- sitivity is still prevalent. cycles. the operators inspected the pulpal floor of they do not etch enamel to the level achieved each preparation to check for any area that was with phosphoric acid.28 the analogous question for visits. application of the TE adhesive. Vol. they found no significant differences from hydroxide and resin-modified glass ionomer. sives. the first coat. as many den. which call for application of additional SE adhesives. which happened only with ability. with Clearfil SE Bond every procedure in this clinical study.24 The problem tive sensitivity than do TE adhe- sensitive than are recently resurfaced. total-etch adhesives. For Prime & Bond NT.28 because SE materials do not result in ably due to hydraulic pressure from occlusal an enamel-etching pattern as well-defined as the forces.ada. believe they cause less postopera- occlusal forces.19 Only a ancy between the depth of deminer- few clinical studies have measured alization and the depth of resin postoperative sensitivity of SE adhesives. the operators applied an extra enamel bonding with SE adhesives is as effective coat of adhesive according to the manufacturer’s as enamel bonding after conventional phosphoric instructions. while for three of the four TE adhesives scopic pulp exposure that we capped with calcium tested.25 However. 2011 terial penetration of the pulp. COSMETIC & RESTORATIVE CARE treatments differ?”. SE adhesives tists report that postoperative sen. and simultaneously. Platt and colleagues32 have shown JADA. However. being a mild SE adhesive. This might have prevented the acid etching. not restorations that were bonded with Prime & Bond all SE materials are similar in their ability to NT.13.31 In fact. because the pulpal floor never looked consis- interact with the smear layer.org on March 30. microleakage might occur around enamel mar- gins. Furthermore. sives is that moist bonding is not required. except for one tooth that had a macro. they tently covered by the adhesive after application of have been classified in three categories: mild. and response to occlusal forces at six months. but TE adhesives. so clinicians13 and deformation of composite by are less technique. pared an SE adhesive with a TE adhesive. in our study.16 After applying the last coat of the dentin adhe- One of the shortfalls of SE adhesives is that sive.16. which was restored with Prime & Bond NT strength with thermal fatigue might be a sign and Esthet·X Micro Matrix Restorative.22 One study20 com.

J Dent Res 1994.. 11. stress generated by light-curing resin-based com. Perdigão J. The promotion of adhe- posites in the preparation is deemed to be an sion by the infiltration of monomers into tooth substrates. Swift EJ. et al.40 have shown that increments of Restorative Sciences. stress is a function of the ratio of the bonded sur. Minneapolis. Operative Dentistry. Pashley DH. Core. and each appointment was scheduled for posites as the cervical increment in Class II com- two hours per patient during the insertion phase (a posite restorations. J Dent Res 1955. Researchers39.58: tions for inserting posterior resin-based compos. 4. patient needed to return for a second appointment only if he or she required more than two restora.37 The polymerization shrinking stresses are crit- ical for the microscopic integrity of the adhesive bond to dentin. clinical problems caused by polymerization 8. Vanherle the restoration. or should it be carried out in a clinical practice setting in which the material is 1. Bayne SC. Effect of resin primer solvents and surface wetness on enamel and opening of restoration margins may resin composite bond strength to dentin. Department professor. Kojima K. St. Am J Dent 1992. All rights reserved. Inokoshi S.34.34:849-53. 2.16:265-73. December 2003 Copyright ©2003 American Dental Association. research associate.edu”. Perdigão is an At the time this study Dr.71:1530-40.36. tive Sciences. Univer. Future layer. Nakabayashi N. important factor in determining the longevity of 10.org on March 30.. Robinson SJ. Dr. Dentistry. SE or TE) did not result in any “perdi001@umn. studies should focus on the long-term perfor- Clinical conditions. Paul. 2011 that when Prime & Bond NT is applied in one sitivity than is the type of adhesive itself. Current con- face area to the unbonded surface area of the cepts on adhesion to dentin. 515 S. ites always has been rubber dam isolation). Fusayama T. JADA 2001. Should the study be conducted Bond NT. Clinical evaluation of two one-bottle dentin adhesives at three years. and recurrent caries. and are the most common 7. behavior of materials used under ideal conditions. School of uniform and maximum polymerization. may be available for use. was conducted. fracture of the 5. Heymann HO. Shear bond strength of a new one-bottle dentin adhesive. Both of the adhesives resulted in excel- in an academic environment (in which students lent enamel marginal integrity at six months. Van Meerbeek B. Crit Rev Oral Biol Med 1997. The clinical technique. Dentistry. Non-pressure adhesion of a new adhesive restorative resin. 134. Kanca J. 1628 JADA. academic setting (for example. staining of marginal gaps enamel/dentin bonding agents. Biostatistical should be no larger than 2 millimeters to provide 8-450 Moos Tower. . Laboratory evaluation of one-component result in microleakage. J Dent Res 1979. in less postoperative sensitivity at any recall Academic environment versus clinical period than that of the TE adhesive Prime & practice setting. Minn. J Biomed Mater Res 1982. 3. Heymann HO.. Masuhara E.ada. Clinical status of ten adhesive systems.COSMETIC & RESTORATIVE CARE restoration. University of Address reprint requests Santo Amaro. to Dr. and include out in ideal clinical conditions. New York. sity of Minnesota. A simple method of increasing the adhesion of used most often? We definitely need to know the acrylic filling materials to enamel surfaces. professor. Division of Operative Geraldeli was a visiting Division of Biostatistics.5:213-5. CONCLUSION tions). Fritz U. Finger WJ.10:184-8. one of the condi.35 as well as of the properties of the composite. Bonding to enamel and dentin: a brief history and state of the art. Buonocore MG. we used associate professor. Vol. Hodges is a senior integrity of the composite restorations. 1995. a wider selection of dental materials This project received the financial support of Kuraray America. Braem M. SP. Division of University of Minnesota. Minneapolis. regarding the correct use of materials are more Milford.33 The amount of curing contraction Bayne SC. significant difference in postoperative sensitivity. ■ and faculty typically have more time to perform procedures. This study was carried mance of TE versus SE adhesives. Iwaku M. readily available).38 To minimize the deleterious effects of shrinkage stresses on the marginal Dr. Quintessence Int so all materials should be tested first in the ideal 1995. Postoperative sensitivity. Peumans M. and Premier Dental Prod- ucts.132:1117-23. Minn.73:1690-702. He Minnesota. shrinkage. Department of Restora. Perdigão. J Dent Res 1992. 1364-70. 3M ESPE. The environment in which the clinical study The SE adhesive Clearfil SE Bond did not result is carried out raises a somewhat debatable issue. 6. Brazil. and research data Materials were donated by Kuraray America. Verschueren M.26:95-110. Delaware St. The magnitude of the curing G. bond strengths are substantially reduced. Plymouth Meeting.. 9. under rubber dam other variables such as the use of flowable com- isolation. Perdigão J. Sturdevant JR. University of Minneapolis.9:206-10. Nakamura M. Swift EJ.E.8:306-35. Am J Dent 1996. Van Meerbeek B. Morphological aspects of the resin-dentin interdiffusion zone with different dentin adhesive systems. and University of Minnesota. e-mail currently is a research adhesive (that is. Lambrechts P. Am J Dent 1997. Swift EJ. therefore. Wilder AD. Pa. an incremental filling technique in this study. may be more relevant for the development of postoperative sen- Downloaded from jada. Kurosaki N. director. Gwinnett AJ. Our study showed that the choice of dentin 55455. Eick JD. Del. Dentsply Caulk.

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