Relationship between bond-strength tests and clinical outcomes

doi:10.1016/j.dental.2009.11.148

Dental Materials

Volume 26, Issue 2, February 2010, Pages e100-e121

https://doi.org/10.1016/j.dental.2009.11.148 Get rights and content

Abstract

One often alleges that laboratory bond-strength testing cannot predict clinical effectiveness of adhesives. Major argument to sustain this claim is the wide variation in bond-strength values recorded for one specific adhesive among different research institutes worldwide. The main reason for these inconsistent bond-strength measurements is supposedly the current lack of a standard bond-strength testing protocol. This paper (and presentation) aimed to report on an extensive literature review with regard to the different laboratory bond-strength test methods and their data provided, along with a second extensive literature review on clinical effectiveness data of adhesives in terms of retention rates of adhesive Class-V restorations. Combining both systematic reviews, we have subsequently searched for a potential relationship between bond-strength data and clinical outcomes.

Section snippets

Dental adhesive technology ANNO 2009

The fast progress in dental adhesive technology has extensively influenced modern restorative dentistry. Although decayed/fractured teeth can be reconstructed minimal-invasively and nearly invisibly using adhesive technology, the clinical longevity of composite restorations is today still too short [1], [2]. Despite the enormous advances made in adhesive technology during the last 50 years, the bonded interface itself remains the Achilles heel of an adhesive filling [3], [4]. Mainly water

Measuring bond strength

By definition, the ideal bond-strength test should be in the first place easy (meaning low technique-sensitivity) and relatively fast. In general, advantages of ‘laboratory testing’ are, among others, (1) the quickness to gather data on a specific parameter/property, (2) the relative ease of the test methodology commonly used, (3) the possibility (and necessity) to measure one specific parameter, while keeping all other variables constant, (4) to be able to directly compare the performance of a

Assessment of sealing ability

As the longevity of an adhesive composite restoration is mainly affected by leakage of oral fluids along the interface between restorative material and tooth substrate [104], [105], probably more clinically relevant than bond-strength studies is to evaluate the capacity of an adhesive to maintain the tooth-restoration transition sealed. It is especially thought to predict better the clinical performance of adhesives with regard to the occurrence of postoperative sensitivity and/or secondary

Clinical performance

Despite the importance of laboratory studies attempting to predict clinical performance of biomaterials, clinical trials remain the ultimate way to collect scientific evidence on the clinical effectiveness of a restorative treatment [2], [6], [141], [142]. The popularity of in vitro studies in the field of adhesive dentistry may in part be ascribed to the rapid evolution of dental adhesive technology and the resultant high turnover of adhesive systems, which often tempts manufacturers to

Relationship between laboratory and clinical bonding effectiveness

The ultimate question is if there is a relationship between the bonding effectiveness measured in the laboratory with the clinical effectiveness determined in patients. In other words, can we predict clinical effectiveness in the laboratory? Although it is hard to give a straightforward answer to this question, there are some trends that certainly point to certain associations between laboratory and clinical data on the bonding effectiveness of adhesives.

Conclusions and closing remarks

Adhesive technology has undergone great progress in the last decade. In light of the major drawbacks attributed to all-in-one adhesives, conventional 3-step etch&rinse adhesives and (mild) 2-step self-etch adhesives are still the benchmarks for dental adhesion in routine clinical practice. When bonding to enamel, an etch&rinse approach is definitely preferred, indicating that simple micro-mechanical interaction appears sufficient to achieve a durable bond to enamel. When bonding to dentin, a

Acknowledgments

The authors would like to thank Michael Burrow et al. (University of Melbourne), Ed Swift et al. (University of North-Carolina at Chapel Hill), and Jan Van Dijken et al. (Umeå University) for disclosing their most recent Class-V clinical data, and Siegward Heintze et al. (Ivoclar-Vivadent) for sharing their most recent laboratory and clinical correlation data.

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ReviewRelationship between bond-strength tests and clinical outcomes

Abstract

Section snippets

Dental adhesive technology ANNO 2009

Measuring bond strength

Assessment of sealing ability

Clinical performance

Relationship between laboratory and clinical bonding effectiveness

Conclusions and closing remarks

Acknowledgments

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