ReviewRelationship between bond-strength tests 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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