Dental adhesives, as the name implies, are products that allow us to adhere various types of dental materials to enamel, dentin, and other dental materials. Conventional adhesives utilize etching with phosphoric acid as the fi rst step. However, virtually all adhesives recently introduced are considered “self-etching”, where a low pH solution that etches and primes at the same time replaces phosphoric acid. Regardless of whether the product is self-etching or not, these adhesives are typically hydrophilic to some extent to be compatible with dentin. Th is hydrophilic property distinguishes them from the old hydrophobic enamel bonding agents.
Types of AdhesivesTh ere are many ways to categorize adhesives. One popular method uses the “generations” nomenclature. But, unless you are a dental historian, there is really no value in using the “generations” system. Who really cares if an adhesive is a “fi ft h generation” or “sixth generation” or even the newly created “seventh generation”? Who is counting anyway?
Another way to separate these products is by the number of components. Th is system became popular (and was used by us in the past) during the years that the single-component products were being introduced. We still use this nomenclature to describe the products, but not for categorization.
We used to categorize these products as to whether they could be used for all procedures or just those for light-cured procedures. Th ese latter products were not eff ective when self-cure composites and/or indirect restorative procedures were used. However, even these products can usually be transformed into all-purpose by using various bond enhancers. Th erefore, we have dropped this separation.
More recently, the type of adhesive could be separated into the aforementioned self-etching versions compared to those still relying on phosphoric acid as a separate etch prior to their application. While these products have now been assimilated into mainstream bonding, we believe that there is a basis for knowing whether a product is self-etching or not. Th erefore, we continue to use this property for categorization purposes.
Total Etch Still the most versatile and reliable, these adhesives can be used for virtually any type of restoration and have the track record to prove it. Th e major reason many dentists stop using total etch adhesives is due to their patients suff ering from postoperative sensitivity. However, if you apply the adhesives carefully following our simplifi ed instructions, we are confi dent that you can greatly minimize or eliminate the sensitivity problem in the vast majority of patients.
Self-Etch Postoperative sensitivity is the primary reason for most clinicians who have made the switch. One of the reasons that self-etchers seem to cause less sensitivity is due to the fact that since etching and priming are being done concurrently, it is not possible to etch deeper than the primer can penetrate. However, it doesn’t mean a restoration was done properly just because a patient does not have any sensitivity. Self-etchers can work well in Class I, II, and V situations, but the application procedures of these materials can greatly infl uence their performance maybe even more so compared to total etch. And their abilities to bond to self-cure composites and unprepared enamel is typically below that of the total etchers. Indeed, some self-etchers recommend etching the enamel with phosphoric acid, especially if it’s unprepared. One evaluator
reported marginal staining as early as the 6-month recall, signifi cantly worse than reported for total etchers.
Components and CompositionMost adhesives still have multiple components, while a few have just one (other than the etchant) and the newest self-etchers incorporate every-thing into one bottle or unidose. Th ose with more than one component typically have the following:
Primer Applied fi rst, contains a solvent, and usually (but not always) does not have any light-curing capabilities. Th is component is typically premixed and packaged in one bottle or syringe, but some primers may be two components that require mixing. In self-etching systems, it is typically this component that etches and primes at the same time. Indeed, one product terms this component a “self-priming etchant”!
Bonding Resin Applied aft er the primer. Can enhance adhesion by its wetting agent function or it can also have hydrophilic qualities and thus can actually contribute to enhancing the hybrid layer. (Most current thought is that the bonding resin should be hydrophobic to prevent formation of water trees—see below.) If its companion primer is one component, the bonding resin may have two components that need to be mixed when it needs self-cure capability. Conversely, if the primer is in two components and needs to be mixed, the bonding resin may only need to be one component. And, in the products that were introduced as single-component adhesives, the primer and bonding resin are mixed together in one bottle.
Filled AdhesivesSome adhesives add diff erent types of fi llers to the normally unfi lled product for the following reasons:
1. Fluoride release if the fi ller glass has this capacity. While this is a noble goal, it is highly unlikely that there will be enough fl uoride released by the adhesive to be of clinical value.
2. Lower modulus of elasticity to impart added fl exibility to a restoration done with a stiff material such as a hybrid composite. Materials with more elasticity, such as microfi lls, may be better retained in Class V lesions due to their higher fl exibility, compared to hybrids. Th e fl exibility could also help to reduce the stress at the interface between the restoration and tooth caused by polymerization shrinkage. In other words, the elasticity of the adhesive could absorb within itself some of the curing stresses. By reducing this stress at the tooth-restoration interface, the restoration could be expected to have better retention. While this theory sounds feasible, it has yet to be proven.
3. Filler could actually reinforce and strengthen the hybrid layer. 4. Filler could help the adhesive cover the dentin surface in one
Enamel vs. DentinEnamelWhile dentin is the substrate that has garnered most of the interest, enamel is still the most reliable tooth tissue for adhesion. Although some initial dentin bond strengths may even exceed those of enamel, the long-term stability of this adhesion favors enamel. In addition, microleakage testing usually shows signifi cantly lower scores on enamel compared to those on dentin/cementum.
Th e main reason bonding to enamel is more reliable is that it is primarily inorganic. You etch it, you dry it, you bond to it. Th ere is nothing complicated or very technique-sensitive about this procedure. Etching creates micromechanical retention by selectively demineralizing the surface. Once dried, low viscosity resin penetrates into the microscopic spaces in its surface that were created by the etching process. Aft er curing the resin, it tenaciously adheres to the enamel.
However, when a hydrophilic adhesive is used, drying the enamel is not necessary and may not even be benefi cial. Our tests have shown moist or wet protocols, developed for dentin, are usually also eff ective on enamel. Nevertheless, if no dentin is exposed, a hydrophilic adhesive probably off ers no benefi ts over a simple, unfi lled resin applied to dry, etched enamel.
DentinUnlike enamel, dentin is primarily organic, mainly collagen and water, making it a much diff erent substrate for bonding. It is also directly above the pulp, which tells us that whatever we do to dentin must be done in a way that it doesn’t injure the pulp.
Most eff orts to bond to dentin have focused on both mechanical and theoretical chemical adhesion. Th e early adhesives tried to bond to the smear layer, which is basically the layer of preparation debris that is diffi cult to remove with conventional cleaning procedures, but, paradoxically, is not fi rmly attached to the dentin for bonding purposes. Th is means that trying to bond to the smear layer has been unreliable and not very successful.
As mentioned previously, conventional adhesives use an etchant to remove the smear layer and to demineralize the dentin surface. Th is leaves a lattice of unsupported collagen. Th e adhesive then infuses the collagen with resin, locking into it to form a micromechanical bond, similar to that of enamel. Th is complex of resin-reinforced dentin has been termed the hybrid layer.
Th e self-etching products, however, presumably dissolve and penetrate through the smear layer but do not remove it. With self-etching products, the smear layer becomes part of the hybrid layer.
Another issue of dentin bonding is the stability of the bond. Th is topic rarely arises with enamel, but the question is: Do dentin bonds get weaker or start to hydrolyze over time? To test this issue, we tested several adhesives aft er fi ve months storage in the temperature/humidity
chamber. Th e results clearly show bond strengths became higher, especially on dentin for the two 1-component products. However, these specimens did not obviously have pulpal fl uid with which to combat.
Th ere is also preliminary evidence from Editorial Team Member Dr. Franklin Tay that enzymes called matrix metalloproteinases (MMPs), which can break down the collagen scaff olding that is essential for stable bonds, can be inactivated by pretreatment of dentin with chlorhexidine that is not rinsed off . To inhibit MMP activity, the evidence suggests chlorhexidine in concentrations as low as 0.01% or even less are eff ective. Th erefore, it seems applying aqueous chlorhexidine aft er etching but before the primer/adhesive is a prudent procedure.
TestsBond StrengthTh ese are the most common tests done on adhesives. Th ey can be done relatively quickly and are especially valuable when trying to distinguish between technique variations. Many manufacturers tout the superiority of their adhesives based on these scores. Indeed, there have even been conferences devoted to “battle of the bonds”, which are sort of like bond strength Olympiads!
Th e most common yardstick to judge whether a specifi c adhesive has an adequate bond strength is to compare it to an enamel control. Since bonding to frosty, dry, etched enamel using a conventional unfi lled resin has been validated with over 30 years of clinical use, equivalent dentin values should be an indication that the product will perform satisfactorily.
In the RRL, we periodically test bond strength to dry, frosty enamel using an unfi lled, hydrophobic resin (Heliobond). While consistency is our goal, there have been variations in this bond strength test over the years based on the temperature and humidity in the lab, as well as diff erences in human extracted teeth. Th e range of these bond strengths have been from 20MPa to 27MPa. Th erefore, bond strengths for adhesives that produce similar values should be clinically acceptable.
However, the clinical signifi cance of bond strength tests (and just about all in vitro tests) continues to be debated. No one really knows how much bond strength is enough. It is also unknown whether adhesives with bond strengths, which exceed that of the enamel control, have any clinical advantages over those with equivalent values.
Th erefore, we continue to use bond strength tests as screening devices. For example, when we fi rst discovered clinically that self-cure core materials were debonding when a single-component adhesive was used, we tested this combination in the lab and confi rmed that fact that there is a basic incompatibility between most one-component adhesives and self-cure composites.
Spotting trends and discovering uses of these materials that just don’t work are really the main purposes of these tests. Consequently, while bond strengths falling below that of the enamel control may cause some justifi able concern, we do not use these values as the sole determinant in ranking the products, unless the scores are signifi cantly lower than the average in the group.
EquipmentOur usual testing apparatus (developed by Ultradent) employs a mold that produces a small cylinder of composite about 2.2mm in diameter and 2.0mm in height. While this is adequate for testing adhesives in the light-cured mode using typical 2.0mm increments of composite, it does not permit adhesive performance testing when bulk fi lling a deep preparation for a core build-up. To solve this problem, we developed molds that are wider (3.8mm in diameter) to allow easier insertion of the restorative material and in various depths (2mm, 3mm, 4mm, and 5mm). Th ese deeper and wider molds are manufactured by 3M ESPE.
For example, using the 5mm deep molds, we can now test the bond strength of light-cured and dual-cure core materials, which would typically only be used in deep cavities. Th e other molds (2mm, 3mm, 4mm) are used to test the depth of cure of a product, in conjunction with hardness (see Hybrids and Packable Composites). And, using precured composite cylinders fabricated in the 5mm molds, we can test the best way to bond thick indirect restorations such as onlays.
Tooth SpecimensAll bond strength testing is done on extracted teeth that have been embedded in acrylic and then fl attened. While fl attened teeth really do not simulate cavity preparations, this protocol is essential to conduct these tests. Th e only exception to this “fl at tooth” rule is when unprepared enamel is tested. In this case, we select the extracted teeth that are as fl at as nature would allow, but this variable is unavoidable. Consequently, we do not perform bond strength tests on unprepared enamel as a rule. Although dentin is the substrate that we are most oft en testing, all adhesives are also tested on enamel.
Immediate vs. Delayed TestingImmediate Since we usually begin to stress a restoration with fi nishing procedures as soon as it is light cured, it is important to know this early bond strength. We literally test each adhesive as soon as light curing is completed. Th is is our most common test.
5 Minutes Typically used for all self-cure core materials and self-cure cements to simulate the usual waiting time for these materials to chemically polymerize in the mouth. Some testing of dual-cure materials is also done at this time, but not routinely since we have found only small diff erences in bond strength between immediate and fi ve minutes. Th e time starts aft er the mold is fi lled and the specimen is placed in an incubator set at 37°C/95% humidity in an eff ort to simulate the oral environment if a patient is allowed to close during the polymerization period. (While the intraoral temperature and humidity may not perfectly match these parameters in all cases, it should be reasonably close.) Teeth used for these tests are typically warmed to body temperature prior to testing.
24 Hours Most common test reported by manufacturers. It may produce higher values compared to those recorded immediately. In addition, many research facilities do not have their equipment conveniently ar-ranged for immediate testing, so the 24 hour test is done due to logistical considerations. We use this time delay typically only for dual-cure and self-cure core materials and cements, the latter of which is consistent with the usual advice given to patients to be careful with what they eat for the fi rst 24 hours aft er luting a restoration.
Specifi c TestsMoisture Status of Preparation Aft er rinsing the phosphoric acid etchant when using a total etch adhesive or prior to applying a self-etch primer, you need to know the optimal moisture status of the preparation. Our tests show that this can be one of the most critical steps during the adhesive process. However, the directions from many manufacturers either omit this description entirely or it is covered inadequately. Th erefore, we test all adhesives using three protocols:
• Dry Dry with forceful air for 2-3 seconds for a small preparation or longer until the cavity is completely void of visible moisture, but not totally desiccated.
• Moist Blot with a lint-free, dry 2x2 gauze, mini-sponge, or virtu-ally any absorbent product that will not leave a residue on the tooth surface. Th e result should be a tooth surface with no visible moisture, which appears to have either a matte or slightly shiny appearance (depending on the character of the dentin and type of instrument used to prepare it). Th is protocol will leave neces-sary moisture in the demineralized dentin (created by the etching process). Clinically, you would have to cut the 2x2 gauze (if used) into small sections or use other products such as an applicator tip or mini-sponge to siphon off the excess moisture in small areas. For large areas, such as a complete crown preparation, draping an intact 2x2 over the preparation may be more eff ective and expedi-tious.
• Wet Use the same type of blotting material described under Moist and dip it into distilled water. Th en blot this wet material with a dry 2x2 to create a “damp” blotting material. Use this “damp” material to blot the cavity preparation, leaving tooth surface with a defi nite sheen of water on it, but be sure all puddles of water are removed.
NOTE
To create the moist or wet status, many manufacturers will tell you to use your air syringe. Typical instructions will tell you to “dry lightly for 2-3 seconds” or some variation thereof. Our tests show that using air to create moist or wetoptions is not effective. From a clinical perspective, it is even more diffi cult. For example, if you are trying to “dry lightly” an MOD preparation, you may merely be blowing the excess water from one proximal box to another. Therefore, the blotting techniques we have developed have proven to be much more effective and easier to calibrate.
In addition, when using the moist or wet option, you should apply the adhesive or primer immediately after blotting the tooth. If you wait even 15 seconds (especially if you are using the rubber dam), some of the moisture could evaporate, which could affect the performance of the adhesive.
Method and Time for Applying the Primer/Adhesive Th e manner by which you apply a primer or adhesive can vary from the simple “let sit” of some manufacturers to literally scrubbing it into the surface of the preparation. “Let sit” may be eff ective in the laboratory on fl at test teeth, but it rarely works with the complex surfaces found in many preparations, especially vertical ones. Scrubbing is a relative term and the force by which it is accomplished is limited by the application instrument. “Gentle agitation”, which refers to applying the primer/adhesive and then basically moving it around on the preparation surface to be sure that there is even contact in all areas, is in-between scrubbing and let sit.
Application time can also vary the eff ectiveness. Our tests found the best method and optimal time to apply the adhesive. Be aware that the size of the preparation will determine the length of time you apply the adhesive. While the stated times are application for small Class V preparations, you should extend the times for large Class IIs. In addition, don’t start the timer until the preparation is thoroughly wet with primer or adhesive.
Method of Evaporating the Solvent Th e monomers in the primers or in adhesives themselves may be dissolved in solvents, which carry these monomers into the demineralized surface of the preparation. Etching with phosphoric acid or through the action of self-etching primers creates this demineralized surface. Th ese solvents, besides being the vehicle in which the monomers are dissolved, need to be hydrophilic since the demineralized dentin surface contains moisture to prevent the collagen network from collapsing. Th e solvents also tend to be “water-chasing.” Th is property refers to the solvent being attracted to the moisture content of the dentin. As the solvent “chases the water”, it literally brings the active monomers with it. Once this job is done, however, the solvent needs to be evaporated, since it can actually interfere with adhesion if it remains in the adhesive due to the dilution factor and the hydrophobic materials subsequently being placed. Th e solvents most commonly used in primers and single-component adhesives are ethanol and acetone, although several also contain water.
Aft er application of an adhesive or primer, the excess is usually fi rst removed by suctioning, being careful to allow a continuous coating to remain on the tooth. If you don’t suction the excess, there is a tendency to just blow the primer or adhesive from one part of the cavity to another section or onto the soft tissue, which can cause untoward reactions that are typically self-limiting but may provoke undesirable questions from the patient. Aft er suctioning the excess, the solvent needs to be evaporated using air.
Th e typical method is to place the tip of the air syringe about 1.0cm from the tooth and direct a gentle stream of air (like a breeze) at the preparation surface. Some adhesives, however, require a more forceful air fl ow, not only to evaporate the solvent, but also to keep the fi lm thickness as minimal as possible so the layer of adhesive does not interfere with the complete seating of an indirect restoration. When using forceful air, be careful not to blow the primer or adhesive completely off the tooth. Th is can usually be done by starting the evaporation procedure with gentle air and proceed to forceful. We have determined the optimal technique for each adhesive.
Th e result of this evaporation eff ort should be a layer of primer that appears dry (you can’t move it around with the air syringe) and the preparation surface appears shiny. Th is air-evaporation eff ort may take fi ve or more seconds, depending on the size of the cavity.
If the dentin surface is not shiny, it may not be sealed. Th erefore, it seems prudent to apply additional adhesive and repeat the evaporation process. Typically, the reapplication is merely applying the material and immediately beginning the evaporation process—you don’t need to wait as you may have when you applied it initially. If, aft er the second application, the dentin surface is still not shiny, we recommend applying the adhesive one fi nal time.
Light Curing the Primer/Adhesive If this is the fi nal component in the adhesive system, you would typically cure it at this time. Th e conventional
curing time has always been 20 seconds, using a halogen light. However, this may be overkill for some adhesives. We tested the optimal curing time for each adhesive. But be aware that even these times may need to be altered based on the distance from the tip of the light to the tooth surface. For some adhesives used in the dual-cure or self-cure mode, in which an activator is mixed with the main component of the kit, you may need to wait until the restorative material or indirect restoration is placed to cure the adhesive or allow it to cure concurrently along with the dual-cure or self-cure composite or cement.
Method of Applying the Bonding Resin As this component does not typically contain any solvents and, indeed, is usually primarily hydrophobic, you do not have to apply air other than to thin out the layer. While this will work, overaggressive use of the air can lead to overthinning, which, in turn, can aff ect the performance of the adhesive. You can alternately remove the excess by using the same applicator, but blotting it with a 2x2 each time you remove more excess. Th is is known as the brush on, brush off technique and works well.
Component(s) to use when bonding a dual-cure core or an indirect restoration such as an onlay It has been thought that, if you are using a dual-cure core material to build up a tooth or dual-cure cement to lute a thick, indirect restoration, you also need to use a dual-cure adhesive (two components) for compatibility and just in case the light doesn’t penetrate to the tooth surface. However, if you can light cure all the way through the core or to the bottom of the indirect restoration (especially if you position the tip of the curing light on the facial, lingual, and occlusal surfaces and use a high-powered light), then a single-component, light-cured adhesive or the light-cured version of a multi-component product may be quite satisfactory. In addition, a light-cured cement may also work instead of a dual-cure version for the indirect restoration.
Th e fi rst test simulates a direct, dual-cure core build-up (5mm deep) immediately aft er light curing. If bond strengths are not substantial at this stage, you may be able to dislodge the core when you remove the core form or matrix band. Th e second test simulates bonding a 5mm thick onlay with both light-cured and dual-cure adhesives and/or cement.
Component(s) to use when bonding a self-cure core or an in-direct, metal-based restoration such as a ceramometal crownSimilar to the dual-cure core test, this test is done by using the self-cure version of the adhesive (if it has one). Th e test simulates a direct, self-cure core build-up or indirect restoration cemented with a self-cure resin cement if you waited fi ve minutes aft er placement to allow the material to chemically-cure.
MicroleakageWhile bond strength tests are done on fl at tooth specimens, which really do not simulate a clinical procedure, microleakage is performed by restoring cavity preparations. In this respect, it has more clinical relevance than bond strength. However, it should still just be considered another screening tool, since the teeth are obviously pulpless and we do not subject them to occlusal forces.
Standardized Class V preparations with margins coronal and apical to the CEJ are restored using a standard composite (TPH Spectrum
or TPH3) in combination with all the adhesives. Aft er fi nishing and polishing, the teeth are stored at least 24 hours in the temperature/humidity chamber and then thermocycled 500 times between 5˚C and 55˚C. Th e teeth are then stained, sectioned, and scored for microleakage using digital imaging soft ware, which measures the % penetration of the dye to the midway point of preparation from both the coronal (enamel) and cervical (dentin) margins. Th e lower the percentage, the less leakage is being allowed.
pHA low pH is presumably one of the main reasons single-component adhesives do not bond well to self-cure materials. We measured the pH of all these products using a special probe and digital pH meter.
Miscellaneous Adhesive Issues Effect of Moisture on Restorative MaterialsIf a restoration fractures, not only do we have to bond to the remaining section of the restoration, but also to any exposed tooth surface. If dentin is exposed, you would typically want to use an adhesive that will bond securely to it to ensure optimal adhesion and so the tooth will not be sensitive. If your typical adhesive requires you to leave the tooth moist for optimal bond strength, then it may be diffi cult to leave the tooth moist but dry the fractured area of the restoration.
We tested the eff ect of moisture on bond strength to several restorative materials. Using Prime & Bond NT, the level of moisture on NT, the level of moisture on NTthe restorative materials was the same as if we were bonding to a tooth. Th is bond strength was then compared to the more typical dry bonding you would do when luting an indirect restoration.
Our test results confi rm that most indirect resins and ceramic materials should be repaired dry. Th erefore, the use of an adhesive that bonds to dry enamel and dentin reasonably well would be the product of choice. Th e products that can be used in this manner are OptiBond FL, Gluma Comfort Bond + Desensitizer, and Adper Scotchbond Multi-Purpose Plus. Even though all three products have their performances maximized by the moist protocol, they can also be used dry without suff ering a major decline in effi cacy.
Effect of Silane on Tooth StructureWhen a repair is done, silane is typically applied to the restorative material prior to applying the adhesive to the tooth and restorative material. We wanted to know what eff ect silane could have on the bond of the repair material to dentin. Our test results show that silane can interfere with the bond of the composite to dentin. When doing a repair, make every attempt to confi ne the application of silane just to the fractured restorative material. Since silane is a liquid, this confi nement will not be possible if you merely douse the tooth with it. But if you apply the silane with a fi ne brush, keeping it off the tooth is certainly a possibility.
Water AdditivesWith the increased concern about contaminated water lines, some dentists are adding chemicals to their dedicated water supplies. However, most of these products have not been tested properly as to their eff ects on adhesion. Our own testing of one product showed bond strengths decreased 22% compared to the untreated control. Th erefore, we strongly suggest not adding a disinfectant to your water supply without having data on its eff ect on issues such as adhesion.
Water TreesEven when the dentin is shiny and appears to be totally sealed, the adhesives that do not employ a fi nal layer of a hydrophobic bonding resin may be subjected to a phenomenon called the semi-permeable membrane eff ect. Discovered by Editorial Team Member Dr. Franklin Tay, this eff ect is characterized by a porous hybrid layer, which allows pulpal fl uid to diff use onto the dentin surface and potentially interfere with the bond between the restorative material and adhesive. Th is diff usion eff ect simulates branches on a tree, thus the term “water trees” was created to describe it. However, while this eff ect has been shown to exist clinically, it remains to be seen what its long-term sequelae may be. Nevertheless, using a multi-component adhesive that includes a fi nal layer of a hydrophobic bonding resin will presumably prevent this problem from occurring and is one reason that the multi-component adhesives are making somewhat of a comeback.
Hybridizing the Dentin at the Preparation AppointmentTh ere is a trend to create a hybrid layer at the preparation appointment for an indirect restoration. Th e purposes of the hybrid layer in this instance are to protect the pulp by sealing the dentin surface, minimize or eliminate sensitivity between the preparation and seating appointments, and allow seating of the defi nitive restoration without having to anesthetize the tooth. While these are noble goals, there are also some downsides to this procedure. In the fi rst place, the hybridizing procedure is done before taking the impression. Depending on the type of adhesive used to create the hybrid layer, the sharp margins of the preparation could be less distinct and more diffi cult for the lab to see. Second, applying an adhesive aft er preparing a tooth especially for full coverage may be diffi cult due to the challenges of adequately isolating the preparation. Th ird, the adhesive could bond with the provisional cement if a resin version is used. Fourth, bonding to this precured adhesive layer may not be as adhesive as starting with fresh tooth structure. And, fi nally, unless you are using a hydrophobic layer over your hydrophilic adhesive, this presumably sealed dentin surface may be susceptible to the formation of water trees. Th erefore, this procedure may not produce all of its presumed benefi ts and may not be worth the eff ort it takes.
Shaking the bottle/Stirring the UnidoseMany adhesives suff er from phase separations of their components in bottles and unidose vessels. Th is means that most bottles should be shaken before dispensing and the contents of unidose vessels should be stirred before applying to the preparation. Some bottles even have a small ball inside to act as a shaker to help mix the components. When in doubt, shake or stir.
Simplifi ed Application TechniquesIn each product commentary, we have listed the application techniques that we have found to be most eff ective and practical for clinical use. In some instances, these procedures may vary from the manufacturer’s directions. However, we feel strongly that our techniques will give you the best chance for success and will minimize failures.
1 year for light-cured components2 years for dual-cure components
USES
Direct restorations (all types) and indirect, metal-free restorations using light-cured and dual-cure cement. Do not use with metal-based, indirect restorations.
COMPOSITION
OptiBond/OptiBond FL FL Prime (1) HEMA, GPDM, mono (2-methacryloxy ethyl) phthalate (PAMM), ethyl alcohol, camphorquinone, and water.
OptiBond Dual Cure Activator (3A) BIS-GMA, HEMA, glycerol dimethacrylate, and catalysts (benzoyl peroxide and camphorquinone).
Dual Cure Paste (3B) Barium aluminum borosilicate glass, fumed silica, disodium hexafl uorosilicate, HEMA, glycerol dimethacrylate, and tertiary amine. When mixed, this component is 48% fi lled by weight.
pH
FL Prime 1.9
FL Adhesive 6.9
Dual Cure Activator/Paste 6.3
RAVES & RANTS
+ Dry, moist, wet — all will work+ Longest track record next to All-Bond 2
– 3A/3B probably not necessary after all– Cannot use with metal-based indirects
Bond Strength (MPa)Enamel 23.0 Dentin 32.4
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were close to that of the halogen control.
Simplifi ed Application Techniques Direct restorations (all types)
1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply FL Prime (1) for 15s with GENTLE AGITATION.4. Apply GENTLE AIR to evaporate the solvent.5. Apply FL Adhesive (2) using brush-on/brush/off .6. Light-cure FL Adhesive (2) for 20s.
Indirect, metal-free restorations 1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply FL Prime (1) for 15s with GENTLE AGITATION.4. Apply GENTLE AIR to evaporate the solvent.5. Apply FL Adhesive (2) using brush-on/brush/off .6. Seat restoration with light-cured or dual-cure cement and light-cure adhesive
simultaneously with cement.
Component Applied to Inside Surface of Indirect Restoration FL Adhesive or unfi lled resin (apply and gently air-thin, do not cure).
Light-cured and dual-cure direct and indirect, metal-free restorations.
COMPOSITION
BIS-GMA, HEMA, GDM, GPDM (glycero-phosphate dimethacrylate), ethanol, fumed silica, barium glass, sodium hexafl uorosilicate, CQ (camphorquinone). Approximately 15% fi lled by weight with 0.4µ glass.
pH
2.2
RAVES & RANTS
+ Good bond strengths with indirects+ Consistent, reliable performance
– Dual-cure version a fl op– Need to thin out very carefully with indirects
Bond Strength (MPa)Enamel 20.4 Dentin 26.1
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED exceeded those using a halogen light.
Simplifi ed Application Technique 1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration Unfi lled resin or OptiBond Solo plus (apply and gently air-thin, do not cure).
2b Prime & Bond NT/ Prime & Bond NT Dual CureDentsply/Caulkwww.caulk.com
PRICES
KITS
Introductory Bottle$115.75/4.5ml ($25.72/ml)
Unit Dose Package$192.35/10ml ($19.24/ml or $2.40/dose)
Dual Cure Introductory$227.85/9ml ($25.32/ml)
Amalgam Bonding Accessory $115.10/6ml ($19.18/ml)
REFILLS
Self Cure Activator$115.10/4.5ml ($25.58/ml)
SHELF LIFE
2 years
USES
All types of restorations.
COMPOSITION
NT AdhesiveNT AdhesiveNT PENTA (dipentaerythritol penta acrylate monophosphate), UDMA, R5-62-1, camphorquinone, cetylamine hydrofl uoride, nanofi llers (amorphous silicon dioxide) and two proprietary elastomeric resins (T-resin and D-Resin) in acetone. Self-Cure Activator Aromatic sodium sulfi nate in acetone and ethanol. Amalgam Bonding Base BIS-GMA, TEGDMA. Amalgam Bonding Catalyst Benzoyl peroxide, dimethacrylate resins.
pH
NT AdhesiveT AdhesiveT 1.9
NT Adhesive/Self-CurT Adhesive/Self-CurT e Activator 4.8
Amalgam Bonding Base/Catalyst 6.1
RAVES & RANTS
+ Long track record+ Unit dose or bottle
– Activator is probably not necessary with dual-cure– Failed semi-permeable membrane test
Bond Strength (MPa)Enamel 28.2 Dentin 21.7
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly lower than those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured or dual-cure materials)Metal-free indirect restorations (using light-cured or dual-cure cement)
1. Etch for 15s.2. Rinse and leave preparation WET.3. Apply NT Adhesive for NT Adhesive for NT 20s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure NT Adhesive for 10s.NT Adhesive for 10s.NT
Direct restorations (using self-cure materials)1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix NT Adhesive and Self-Cure Activator in 1:1 ratio and apply for NT Adhesive and Self-Cure Activator in 1:1 ratio and apply for NT 20s with GENTLE
AGITATION adding more of the adhesive mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure NT Adhesive/Self-Cure Activator for 10s.
Metal-based indirect restorations (using self-cure cement)1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix NT Adhesive and Self-Cure Activator in 1:1 ratio and apply for NT Adhesive and Self-Cure Activator in 1:1 ratio and apply for NT 20s with GENTLE
AGITATION adding more of the adhesive mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure NT Adhesive/Self-Cure Activator for 10s.NT Adhesive/Self-Cure Activator for 10s.NT5. Mix Amalgam Bonding base and catalyst in 1:1 ratio and apply using brush-on/brush/off . 6. Quickly seat restoration with self-cure cement. Amalgam Bonding base and catalyst
will self-cure along with cement.
Components Applied to Inside Surface of Indirect Restoration Light-cured/dual-cureUnfi lled resin (apply and gently air-thin, do not cure).
Self-cure
Amalgam Bonding base and catalyst (mix) (apply and gently air-thin, do not cure).
+ Best bond to self-cure materials for single components+ Filler makes it less technique-sensitive
– Dry prep causes much lower bond strength– Must be shaken before using—don’t forget!
Bond Strength (MPa)Enamel 23.4 Dentin 22.7
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application Technique1. Etch for 15s.2. Rinse and leave preparation WET.3. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration One-Step Plus (apply and gently air-dry for fi ve seconds to evaporate the acetone, do not cure). For self-cure indirects, use Primer B from the All-Bond 2 kit.
Unit Dose 50 pack$99.99/10ml ($10.00/ml or $2.00/unit dose)
SHELF LIFE
1.5 years refrigerated
USES
Light-cured and dual-cure direct and indirect restorations.
COMPOSITION
HEMA, proprietary monomers, camphorquinone, 40% fi lled with barium borosilicates (0.7µ), proprietary natural resins, and fl uoride in 8% ethanol.
pH
1.7
RAVES & RANTS
+ Convenient syringe delivery+ High fi ller leads to consistent bonding
– Milky look only for mustaches– Mediocre results with indirects
Bond Strength (MPa)Enamel 24.5 Dentin 20.1
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly less than those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured or dual-cure materials)
1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Adhesive for 15s with RUBBING MOTION adding more primer about every
fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent and to eliminate the milky appearance.
You are fi nished when the coat of PQ1 is translucent.5. Light-cure Adhesive for 20s.
Metal-free indirect restorations (using light-cured or dual-cure cement)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Adhesive for 15s with RUBBING MOTION adding more primer about every
fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent and to eliminate the milky appearance.
You are fi nished when the coat of PQ1 is translucent.5. Seat restoration with light-cured or dual-cure cement and light-cure PQ1
simultaneously with cement.
Component Applied to Inside Surface of Indirect Restoration PQ1 (apply and gently air-thin and evaporate the ethanol, do not cure).
1 btl (8ml) of primer or adhesive $152.60 ($19.08/ml)
1 btl (4ml) of activator or catalyst$103.40 ($25.85/ml)
SHELF LIFE
3 years refrigerated
USES
All types of restorations.
COMPOSITION
Activator, component 1.5 Ethanol-based solution of benzenesulfi nic acid salt plus photoinitiator. Primer, component 2 Water, HEMA, and polycarboxylic acid copolymer. Adhesive, component 3 BIS-GMA and HEMA plus photoinitiator. Catalyst, component 3.5 BIS-GMA, HEMA, and benzoyl peroxide.
pH
Activator, component 1.5 8.1
Primer, component 2 4.0
Activator/Primer (mixed) 4.7
Adhesive, component 3 8.2
Catalyst, component 3.5 5.7
Adhesive/Catalyst (mixed) 6.9
RAVES & RANTS
+ Will bond to good old dry tooth structure+ Light-cured, dual-cure, self-cure
– Keeping track of which components to use is confusing– Low enamel bond strength
Bond Strength (MPa)Enamel 17.7 Dentin 28.2
Can You Cure It With an LED?Probably, although dentin bond strengths using an LED were somewhat lower than those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured or dual-cure materials)
1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Primer (2) for 10s with GENTLE AGITATION.4. Apply GENTLE AIR to evaporate the solvent.5. Apply Adhesive (3) using brush-on/brush/off .6. Light-cure Adhesive (3) for 10s.
Direct restorations (using self-cure materials)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Activator (1.5) and merely air-dry gently for fi ve seconds.4. Apply Primer (2) for 10s with GENTLE AGITATION.5. Apply GENTLE AIR to evaporate the solvent.6. Apply Adhesive (3) using brush-on/brush/off .7. Light-cure Adhesive (3) for 10s.
Metal-free indirect restorations (using light-cured cement)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Primer (2) for 10s with GENTLE AGITATION.4. Apply GENTLE AIR to evaporate the solvent.5. Apply Adhesive (3) using brush-on/brush/off .6. Seat restoration with light-cured cement and light-cure adhesive simultaneously
with cement.
Metal-free indirect restorations (using dual-cure cement)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Activator (1.5) and merely air-dry gently for fi ve seconds.4. Apply Primer (2) for 10s with GENTLE AGITATION.5. Apply GENTLE AIR to evaporate the solvent.6. Mix Adhesive (3) and Catalyst (3.5) in 1:1 ratio using brush-on/brush/off .7. Seat restoration with dual-cure cement and light-cure adhesive simultaneously
with cement.
Metal-based indirect restorations (using self-cure cement)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Activator (1.5) and merely air-dry gently for fi ve seconds.4. Apply Primer (2) for 10s with GENTLE AGITATION.5. Apply GENTLE AIR to evaporate the solvent.6. Apply Catalyst (3.5) using brush-on/brush/off .7. Seat restoration with self-cure cement. Adhesive will self-cure along with cement.
Components Applied to Inside Surface of Indirect Restoration Light-curedAdhesive or unfi lled resin (apply and gently air-thin, do not cure).
Dual-cure Catalyst (apply and gently air-thin, do not cure).
Self-cure
Catalyst/Adhesive (apply and gently air-thin, do not cure).
1 btl of Dentin/Enamel Bonding Resin (6ml) $26.00 ($4.33/ml)
1 btl of Pre-Bond (3ml) $14.00 ($4.67/ml)
SHELF LIFE
2 years
USES
All types of restorations.
COMPOSITION
Primer A NTG-GMA, acetone, and ethanol. Primer B BPDM (biphenyl dimethacrylate), acetone, and ethanol. Dentin/Enamel Bonding Resin BIS-GMA, UDMA, and HEMA. Pre-Bond BIS-GMA, triethyleneglycol dimethacrylate, HEMA, and benzoyl peroxide. This acts as a wetting agent and slows down the reaction between Primers A & B and a dual-cure or self-cure resin cement used for indirect restorations. Slowing down the setting time between the adhesive and resin cement helps tremendously when cleaning the excess cement off the restoration. The benzoyl peroxide will chemically polymerize when it is “sandwiched” between the tertiary amine in Primer A and the dual-cure or self-cure resin cement. For a true dual-cure/self-cure bonding resin, mix Pre-Bond with the Dentin/Enamel Bonding Resin.
pH
Primers A/B 5.7
Dentin/Enamel Bonding Resin 7.5
Pre-Bond 4.4
Pre-Bond/Dentin/Enamel Bonding Resin 4.6
RAVES & RANTS
+ Has longest track record+ Can do everything with it
– Too many bottles– Very susceptible to overdrying
Bond Strength (MPa)Enamel 21.3 Dentin 25.3
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were roughly equal to those using a halogen light.
Simplifi ed Application Techniques Direct restorations
1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix Primers A & B and apply for 20s with GENTLE AGITATION adding more of
the primer mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Apply D/E Resin using brush-on/brush/off .6. Light-cure D/E Resin for 20s.
Metal-free indirect restorations (using light-cured or dual-cure cement)1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix Primers A & B and apply for 20s with GENTLE AGITATION adding more of
the primer mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Apply D/E Resin using brush-on/brush/off .6. Seat restoration with light-cured or dual-cure cement and light-cure D/E Resin
simultaneously with cement.
Metal-based indirect restorations (using self-cure cement)1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix Primers A & B and apply for 20s with GENTLE AGITATION adding more of
the primer mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Mix D/E Resin and Pre-Bond in 1:1 ratio using brush-on/brush/off .6. Quickly seat restoration with self-cure cement. Adhesive will self-cure along with
cement.
Components Applied to Inside Surface of Indirect Restoration Light-cured/dual-cure D/E Resin (apply and gently air-thin, do not cure)
Self-cure
Primer B (apply and gently air-thin and evaporate the acetone, do not cure).
4c Gluma Comfort Bond + DesensitizerHeraeus Kulzer
PRICES
KITS
NoneREFILLS
Bottle $93.94/4ml ($23.49/ml)
Single Dose $80.34/4ml ($20.09/ml or $2.01/single dose)
SHELF LIFE
3 years
USES
Light-cured and dual-cure direct and indirect restorations plus self-cure direct restorations.
COMPOSITION
4-META, UNMA, HEMA, glutaraldehyde, maleic acid, methacrylic polycarboxylic acid, and photoinitiator in ethanol and water.
pH
2.4
RAVES & RANTS
+ Tooth wetness status not critical+ Bond and desensitize in one step
– Inconsistent bond strengths with LED– Unidose applicator too large for small preps
Bond Strength (MPa)Enamel 22.3 Dentin 22.0
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly lower than those using a halogen light. However, the bond strengths with the LED were not as consistent as they were with the halogen.
Simplifi ed Application Technique 1. Etch for 15s.2. Rinse and leave preparation WET.3. Apply Adhesive for 20s with SCRUBBING MOTION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 20s.
Component Applied to Inside Surface of Indirect Restoration GCB+D (apply and gently air-dry for fi ve seconds to evaporate the ethanol and water, do not cure).
Adhesive PMGDM, monomer resin and activators in acetone. Catalyst NTG-GMA and acetone.
pH
Adhesive 1.3
Adhesive/Catalyst (mixed) 2.1
RAVES & RANTS
+ Top bond strength in self-cure cement mode+ 1:1 ratio makes more sense
– Expiration date on adhesive bottle is erased instantly during disinfection
– No instructions for using with self-cure cores
WHAT’S NEW?
UnidoseNew packaging
Bond Strength (MPa)Enamel 25.4 Dentin 22.4
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED are roughly equal to those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured or dual-cure materials)Metal-free indirect restorations (using light-cured or dual-cure cement)
1. Etch for 15s. 2. Rinse and leave preparation MOIST.3. Apply Adhesive for 20s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 10s.
Direct restorations (using self-cure materials)Metal-based indirect restorations (using self-cure cement)
1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Mix Adhesive and CQ Catalyst in 1:1 ratio and apply for 20s with GENTLE
AGITATION adding more of the adhesive mix about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent. DO NOT LIGHT-CURE.5. Place self-cure restorative material or seat restoration with self-cure cement. Adhesive
will self-cure along with restorative material or cement.
Components Applied to Inside Surface of Indirect Restoration Light-cured/dual-cure (metal-free)Unfi lled resin (apply and gently air-thin, do not cure).
Self-cure (metal-based) Adhesive and Catalyst (mix) (apply and gently air dry for fi ve seconds to evaporate the acetone, do not cure).
UNO PMGDM, HEMA, water, photoinitiator, and acetone.DUO MgNTG-GMA, ethanol, and acetone.
pH
UNO 2.8
UNO•DUO (mixed) 3.5
RAVES & RANTS
+ Not necessary to light cure with UNO•DUO+ Moist and wet will both work
– 2:1 ratio with UNO•DUO not intuitive– No unidose
Bond Strength (MPa)Enamel 25.2 Dentin 29.4
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly lower than those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured materials)Metal-free indirect restorations (using light-cured or dual-cure cement)
1. Etch for 15s. 2. Rinse and leave preparation MOIST.3. Apply UNO for 15s with GENTLE AGITATION adding more UNO about every fi ve
seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure UNO for 10s.
Direct restorations (using dual-cure or self-cure materials)Metal-based indirect restorations (using self-cure cement)
1. Etch for 15s.2. Rinse and leave preparation WET.3. Mix UNO and DUO in 2:1 ratio and apply for 15s with GENTLE AGITATION adding
more UNO/DUO about every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent. DO NOT LIGHT-CURE.5. Place dual-cure or self-cure restorative material or seat restoration with self-cure
cement. Adhesive will self-cure along with restorative material or cement.
Components Applied to Inside Surface of Indirect Restoration Light-curedUNO (apply and gently air dry for fi ve seconds to evaporate the acetone, do not cure).
Dual-cure/Self-cureUNO•DUO mixture (apply and gently air dry for fi ve seconds to evaporate the acetone and ethanol, do not cure).
Unit Dose $79.10/4.4ml ($17.98/ml or $1.98/unit dose)
REFILLS
1 btl $150.10/5.6ml ($26.80/ml)
SHELF LIFE
3 years
USES
Light-cured and dual-cure direct and indirect restorations plus self-cure direct restorations.
COMPOSITION
BIS-GMA, HEMA, ethanol, water, dimethacrylates, photoinitiator, and methacrylate functional copolymer of polyacrylic and polyitaconic acids (polyalkenoic acid). Filled 10% by weight with 5.0nm (0.005µ) silica.
pH
4.6
RAVES & RANTS
+ Very easy to achieve shiny dentin surface+ Can be used in virtually all applications
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly lower than those using a halogen light.
Simplifi ed Application Technique 1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so..4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration ASB Plus (apply and gently air-dry for fi ve seconds to evaporate the ethanol and water, do not cure).
BPDM (biphenyl dimethacrylate), BIS-GMA, and HEMA in acetone.
pH
5.0
RAVES & RANTS
+ The original single-component that bonds to self-cure materials
+ Highest pH of single-components
– Be sure it’s wet– Has to play second fi ddle to Plus
Bond Strength (MPa)Enamel 22.7 Dentin 21.0
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application Technique 1. Etch for 15s.2. Rinse and leave preparation WET.3. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about
every fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration One-Step (apply and gently air-dry for fi ve seconds to evaporate the acetone, do not cure). For self-cure, use Primer B from the All-Bond 2 kit.
Light-cured and dual-cure direct and indirect restorations.
COMPOSITION
Primer Canadian balsam, HEMA, methacrylic acid, camphorquinone, and a phosphate monomer in ethanol. The key ingredient is the Canadian Balsam (better known as tree sap). Bonding Resin BIS-GMA, TEGDMA, HEMA, diluent monomer, tertiary amine, camphorquinone, and proprietary glass silicate fi llers which release fl uoride. Filled 45% by weight. Filler particle size <0.7µ.
pH
Primer 1.8
Bonding Resin 2.6
RAVES & RANTS
+ Syringe packaging very convenient+ Incredible shelf life
– Isn’t balsam a hair conditioner?– We miss the white knuckles
Bond Strength (MPa)Enamel 26.4 Dentin 23.9
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED equaled those using a halogen light.
Simplifi ed Application Techniques Direct restorations (using light-cured or dual-cure materials)
1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Primer for 15s with RUBBING MOTION adding more primer about every
fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Primer for 20s.6. Apply Bonding Resin for 15s with RUBBING MOTION.7. Light-cure Bonding Resin for 20s.
Indirect restorations (using light-cured or dual-cure cement)1. Etch for 15s.2. Rinse and leave preparation MOIST.3. Apply Primer for 15s with RUBBING MOTION adding more primer about every
fi ve seconds or so.4. Apply GENTLE AIR to evaporate the solvent.5. Light-cure Primer for 20s.6. Apply Bonding Resin for 15s with RUBBING MOTION.7. Seat restoration with light-cured or dual-cure cement and light-cure Bonding Resin
simultaneously with cement.
Component Applied to Inside Surface of Indirect Restoration Light-cured/dual-cure Bonding Resin (apply and gently air-thin, do not cure).
+ Gold standard for self-etchers+ Clinical performance exemplary
– Two bottles are very nearly the same color– Weak effectiveness with indirects
Bond Strength (MPa)Enamel
Self-etch 24.9 Etch w/PA 32.3
Dentin Self-etch 29.3 Etch w/PA 30.8
Can You Cure It With an LED?Probably, although dentin bond strengths using an LED were lower than those using a halogen light.
Simplifi ed Application Technique 1. Leave preparation DRY, but don’t desiccate the tooth.2. Apply Primer for 20s with GENTLE AGITATION adding additional Primer during
the 20-second application period.4. Apply GENTLE AIR to evaporate the solvent.5. Apply Bond resin using brush on/brush off method, then use GENTLE AIR to thin
this layer to create an even, medium-thin, shiny coating. 6. Light-cure Bond resin for 10s.
+ Great bonding and kill bugs at the same time+ Follows success of SE Bond
– More expensive than stablemate– Diffi cult to disinfect dispenser
Bond Strength (MPa)Enamel
Self-etch 29.8 Etch w/PA 27.3
Dentin Self-etch 24.7 Etch w/PA 19.5
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application Technique 1. Leave preparation DRY, but don’t desiccate the tooth.2. Apply Primer for 20s with GENTLE AGITATION adding additional Primer during
the 20-second application period.3. Apply GENTLE AIR to evaporate the solvent.4. Apply Bond resin using brush on/brush off method, then use GENTLE AIR to thin
this layer to create an even, medium-thin, shiny coating. 5. Light-cure Bond resin for 10s.
1 btl (5ml) of Primer, Adhesive, or Link $49.95 ($9.99/ml)
SHELF LIFE
2 years
USES
Primer + Adhesive Light-cured and dual-cure direct restorations.Primer + Adhesive + Link Self-cure direct restorations.
COMPOSITION
Primer HEMA and GPDM in ethanol and water. Adhesive BIS-GMA, HEMA, GPDM, barium aluminoborosilicate glass, fumed silica, and sodium hexafl orosilicate in ethanol. Filled 25% by weight; average particle size is 0.4µ.Link BIS-GMA, TEGDMA, and accelerators in ethanol.
pH
Primer 2.1
Adhesive 2.8
Link 9.3
RAVES & RANTS
+ No mixing for self-cure mode+ Highest bond strength of self-etchers to self-cure cores
– 2-compartment well is not consistent with 3 components
– Enamel bond strength was on the low end
Bond Strength (MPa)Enamel
Self-etch 19.2 Etch w/PA 21.2
Dentin Self-etch 29.3 Etch w/PA 23.7
Can You Cure It With an LED?Probably, since enamel bond strengths using an LED were equal to those using a halogen light. However, dentin bond strengths were much lower using the LED.
Simplifi ed Application Technique Direct restorations (using light-cured and dual-cure materials)
1. Leave preparation MOIST. Dry was slightly less eff ective on dentin and slightly more eff ective on enamel.
2. Apply Primer for 10–15s with SCRUBBING.3. Apply GENTLE AIR to evaporate the solvent.4. Apply Adhesive IMMEDIATELY using SCRUBBING for 10–15s, then use GENTLE
TO MEDIUM AIR to evaporate the solvent and thin this layer.5. Light-cure Adhesive for 10s.
Direct restorations (using self-cure materials)1. Leave preparation MOIST. Dry was slightly less eff ective on dentin and slightly more
eff ective on enamel.2. Apply Primer for 10–15s with SCRUBBING.3. Apply GENTLE AIR to evaporate the solvent.4. Apply Adhesive IMMEDIATELY using SCRUBBING for 10–15s, then use GENTLE
TO MEDIUM AIR to evaporate the solvent and thin this layer.5. Light-cure Adhesive for 10s.6. Apply Link using brush on/brush off method, then use GENTLE AIR to evaporate
solvent, which produces a dull surface. Allow to cure with self-cure composite.
4a Clearfi l Liner Bond 2VKuraraywww.kuraraydental.com
PRICES
KIT
$176.00/20ml ($8.80/ml)
REFILLS
1 btl (6ml) of Primer A or B (6ml) $39.00 ($6.50/ml)
1 btl of Bond A (5ml) $99.00 ($19.80/ml)
1 btl of Bond B (3ml) $54.00 ($18.00/ml)
SHELF LIFE
2 years refrigerated
USES
Primers + Bond A Light-cured direct restorations.Primers + Bond A/Bond B Self-cure direct and indirect restorations.
COMPOSITION
Primer A 2-hydroxyethyl methacrylate, hydrophilic dimethacrylate, 10-methacryloyloxydecyl, dihydrogen phosphate, N, N-diethanol-p-toluidine, d, 1-camphorquinone, water. Primer B 2-hydroxyethyl methacrylate, hydrophilic dimethacrylate, water.Bond A Silanated colloidal silica, bisphenol A diglycidylmethacrylate, 2-hydroxyethyl methacrylate, hydrophobic dimethacrylate, 10-methacryloyloxydecyl, dihydrogen phosphate, N, N-diethanol-p-toluidine,d, l-camphorquinone.Bond B Silanated colloidal silica, bisphenol A diglycidylmethacrylate, 2-hydroxyethyl methacrylate, hydrophobic dimethacrylate, benzoyl peroxide.
pH
Primers A/B (mixed) 2.8
Bond A 1.7
Bond A/B (mixed) 1.8
RAVES & RANTS
+ Surprisingly good bond to prepared enamel+ Highest bond strength to dentin
– Not very effective with indirects– Tepid results with self-cure materials
Bond Strength (MPa)Enamel
Self-etch 32.8 Etch w/PA 28.6
DentinSelf-etch 38.8 Etch w/PA 33.2
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application Techniques Direct restorations
1. Leave preparation DRY, but don’t desiccate the tooth.2. Mix Primers A & B and apply for 30s with GENTLE AGITATION adding additional
Primer during the 30-second application period.3. Apply GENTLE AIR to evaporate the solvent. Surface of preparation will look non-
shiny.4. For light-cured and dual-cure materials, apply Bond resin A using brush on/brush
off method, then use GENTLE AIR to thin this layer to create an even, medium-thin, shiny coating. For self-cure materials, mix and apply Bond resins A & B instead of just using Bond resin A by itself.
5. Light-cure Bond resin A or the mixture of Bond resin A & B for 10s.
Metal-free indirect restorations1. Leave preparation DRY, but don’t desiccate the tooth.2. Mix Primers A & B and apply for 30s with GENTLE AGITATION adding additional
Primer during the 30-second application period.3. Apply GENTLE AIR to evaporate the solvent. Surface of preparation will look non-
shiny.4. When using light-cured cement, apply Bond resin A using brush on/brush off
method, then use GENTLE AIR to thin this layer to create an even, medium-thin, shiny coating. When using dual-cure cement, mix Bond resins A & B and apply instead of just Bond resin A.
5. Seat restoration with light-cured or dual-cure cement and light-cure Bond resin A or the mixture of Bond resins A & B simultaneously with cement.
Metal-based indirect restorations (using self-cure cement)1. Leave preparation DRY, but don’t desiccate the tooth.2. Mix Primers A & B and apply for 30s with GENTLE AGITATION adding additional
Primer during the 30-second application period.3. Apply GENTLE AIR to evaporate the solvent. Surface of preparation will look non-
shiny.4. Mix Bond resins A & B and apply using brush on/brush off method, then use GENTLE
AIR to thin this layer to create an even, medium-thin, shiny coating. 5. Seat restoration with self-cure cement and allow Bond resin mix to polymerize si-
multaneously with cement.
Components Applied to Inside Surface of Indirect Restoration Light-cured indirect restorations Bond Liquid A, but do not cure.
4-META, phosphoric ester monomer. UDMA, silica, and CQ in acetone and water. Filled 5% by weight.
pH
2.8
RAVES & RANTS
+ Unidose can be recapped+ Can be used moist or dry
– Let sit directions not as effective – Bond strengths w/o PA on the low end
Bond Strength (MPa)Enamel
Self-etch 20.3 Etch w/PA 30.9
DentinSelf-etch 21.4 Etch w/PA 24.5
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were only slightly lower than those using a halogen light.
Simplifi ed Application Technique 1. Leave preparation DRY, but don’t desiccate the tooth. Moist was also eff ective, but
results were not as consistent as when dry was used.2. Apply Adhesive initially with GENTLE AGITATION followed by allowing it to
sit for 20s. Th e manufacturer’s direction of letting it sit for 10s was not as eff ective except when phosphoric acid was used to pre-etch tooth.
3. Apply MEDIUM AIR to evaporate the solvent. Th e manufacturer’s direction of forceful air was also eff ective, but the results were not as consistent. However, when phosphoric acid was used to pre-etch tooth, forceful air was very eff ective.
Unidose (adhesive)$202.50/10ml ($20.25/ml or $2.03/unidose)
Bottle (self-etch primer)$45.50/5ml ($9.10/ml)
SHELF LIFE
2 years
USES
Light-cured and dual-cure direct and indirect, metal-free restorations.
COMPOSITION
Self-Etch Primer HFGA-GDM (hexafl uoroglutaric anhydride —glycerodimethacrylate adduct), GPDM, MEHQ (4-methoxyphenol), ODMAB (2-[ethylhexyl]-4-[dimethylamino] benzoate), CQ in ethanol.Adhesive BIS-GMA, HEMA, GDM, GPDM (glycero-phosphate dimethacrylate), ethanol, fumed silica, barium glass, sodium hexafl uorosilicate, CQ (camphorquinone). Approximately 15% fi lled by weight with 0.4µ glass.
pH
Self-Etch Primer 1.9
Adhesive 2.2
RAVES & RANTS
+ Good bond strengths with light-cured indirects+ Borrows from a great heritage
– Dual-cure version doesn’t work– Must blot primer applicator before adhesive
Bond Strength (MPa)Enamel 24.6 Dentin 26.1
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED exceeded those using a halogen light.
Simplifi ed Application Technique 1. Rinse and leave preparation MOIST.2. Apply self-etch primer for 15s with GENTLE AGITATION. 3. Create a non-shiny, matte surface by using GENTLE AIR FOR THREE SECONDS.
Blotting doesn’t work since you need to evaporate the ethanol solvent. With the unidose version, this was not a problem. With the bottle version, the surface was substantially shinier, even aft er as long as 50 seconds of drying, which, of course, would never be done clinically. Th is shinier surface, unfortunately, resulted in lower bond strengths.
4. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about every fi ve seconds or so. Note: If you are using the self-etch unidose and the applicator that comes with it, blot the applicator aft er applying the self-etch primer before entering into the adhesive chamber. Blotting the applicator to remove the excess self-etch primer signifi cantly increased bond strengths in our tests. However, once you have activated the adhesive, you can’t go back to the primer with the same applicator.
5. Apply GENTLE AIR to evaporate the solvent.6. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration Unfi lled resin or OptiBond Solo plus (apply and gently air-dry for fi ve seconds to evaporate the ethanol in the OS+, do not cure).
Unidose (100)$220.00/12.5ml ($17.60/ml or $2.20/dose)
SHELF LIFE
Unidose: 2 years refrigeratedBottle: 3 years refrigerated
USE
Light-cured direct restorations.
COMPOSITION
PENTA (dipentaerythritol penta acrylate monophosphate), UDMA, cetylamine hydrofl uoride, camphorquinone, and two proprietary elastomeric resins (T-resin and D-Resin) in acetone and water.
pH
2.7
RAVES & RANTS
+ Highest bond strengths among one-components+ Unit dose has mini stand
– Requires double application for dentin– Only one-component advising against PA on
unprepared enamel
Bond Strength (MPa)Enamel
Self-etch 31.9 Etch w/PA 28.2
Dentin Self-etch 34.9 Etch w/PA 26.2
Can You Cure It With an LED?Maybe not, since dentin bond strengths using an LED were lower than those using a halogen light.
Simplifi ed Application Technique 1. Leave preparation DRY, but don’t desiccate the tooth.2. Apply Adhesive for 15s with SCRUBBING, then APPLY AGAIN and SCRUB FOR
ANOTHER 15s. Applying once was adequate for enamel, but not for dentin.3. Apply GENTLE AIR to evaporate the solvent.4. Light-cure Adhesive for 10s.
1 btl (5ml) of Primer, Bond, or Activator $70.95 ($14.19/ml)
SHELF LIFE
2 years
USES
Primer + Bond Light-cured and dual-cure direct restorations.Primer + Bond/Activator Self-cure direct restorations.
COMPOSITION
Primer Water, maleic acid, and sodium fl uoride.Bond Hydrophilic and Bis-GMA-based resin matrix and catalyst. Activator Aliphatic dimethacrylate, aromatic dimethacrylate, carboxylic methacrylate and benzoyl peroxide.
pH
Primer 2.4
Bond 3.9
Activator 3.0
Bond/Activator (mixed) 3.4
RAVES & RANTS
+ More versatile than most self-etchers+ Relatively inexpensive
– Just mediocre bond strength with self-cure cores– Box diffi cult to store on shelf
Bond Strength (MPa)Enamel
Self-etch 22.5 Etch w/PA 21.4
Dentin Self-etch 26.0 Etch w/PA 23.4
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application TechniqueDirect restorations (using light-cured and dual-cure materials)
1. Leave preparation DRY, but don’t desiccate the tooth. Moist is adequate on enamel, but is less eff ective on dentin.
2. Apply Primer for 20s with RUBBING.3. Do NOT air dry. Surface of preparation will look shiny.4. Apply Bond for 20s with RUBBING, then suction excess and use GENTLE AIR to
thin this layer to create an even, medium-thin, shiny coating. 5. Light-cure Bond for 20s.
Direct restorations (using self-cure materials)1. Leave preparation DRY, but don’t desiccate the tooth.2. Apply Primer for 20s with RUBBING.3. Do NOT air dry. Surface of preparation will look shiny.4. Mix Bond and Activator and apply for 20s with RUBBING, then suction excess and
use GENTLE AIR to thin this layer to create an even, medium-thin, shiny coating. 5. Light-cure Bond/Activator mix for 20s.
Tyrian SPE Primer A Thymol blue, ethanol, water.Primer B AMPS (3-Acrylamido — 2-methyl propanesulfonic acid), BisMEP (Bis[2-{methacryloyloxy}ethyl] phosphate), TPO, ethanol.
pH
TyrianTyrianT SPE Primer A/B (bottles) 0.5
TyrianTyrianT SPE Primer A/B (unidose) 0.6
One-Step Plus 4.4
RAVES & RANTS
+ Purple color reduces the guesswork+ Will bond to self-cure composite
– Don’t overdry Tyrian or else!– Be sure to get rid of the purple
Bond Strength (MPa)Enamel 24.2 Dentin 23.2
Can You Cure It With an LED?Probably, since dentin bond strengths using an LED were equal to those using a halogen light.
Simplifi ed Application Technique 1. Rinse and leave preparation MOIST.2. Apply two coats of Tyrian SPE for 10s (20s on uncut enamel) with GENTLE
AGITATION using the supplied (in bottle kit) foam pellets. In unidose kit, you are supplied with a disposable brush.
3. Blot excess (with foam pellet) Tyrian SPE to eliminate the purple color, but leave preparation surface WET.
4. Apply Adhesive for 15s with GENTLE AGITATION adding more adhesive about every fi ve seconds or so.
5. Apply GENTLE AIR to evaporate the solvent.6. Light-cure Adhesive for 10s.
Component Applied to Inside Surface of Indirect Restoration One-Step Plus (apply and gently air-dry for fi ve seconds to evaporate the acetone, do not cure). For self-cure indirects, use Primer B from the All-Bond 2 kit.
STRENGTHS It continues to be, perhaps, the adhesive with which you really have to try hard to get poor results. Besides its lofty results in many independent studies and anecdotal observations, our tests confi rmed it is probably the least technique-sensitive of any adhesive. Regardless of whether your preparation is dry, moist, or wet, it will still work. Even if you have a heavy hand on the air syringe when you are evaporating the alcohol solvent, it will work. If you want to use an adhesive that doesn’t force you to think about things such as how wet the tooth needs to be prior to its application, this is it.
WEAKNESSES The venerable original version with the dual-cure components is probably not necessary — the FL version seems to be able to do everything better than its older sibling. We also confi rmed that even the dual-cure version is not effective when luting a metal-based indirect restoration with self-cure cement. No unidose option.
BOTTOM LINE With a clinical heritage second to none, OptiBond FL is the safe choice for all but self-cure indirects.
OptiBond Solo plus
STRENGTHS It has been a stellar performer (along with the original version) for over eight years, being the gold standard for most of our direct, light-cured bond strength tests. It was also the fi rst with unidose packaging. From a clinical perspective, there has been very little post-operative sensitivity reported by the evaluators. Its increased viscosity makes applying it very easy, with only two evaluators reporting any problems seating an indirect restoration after light curing it.
WEAKNESSES Dual-cure/self-cure version is just not up to the same high standards. Our tests showed adding the activator to the adhesive decreased its performance virtually across the board. We do not recommend its use. This means that self-cure procedures cannot be done without an adhesion promoter from another vendor.
BOTTOM LINE Light-cured version still performs with consistency and reliability.
Prime & Bond NT/NT/NT Prime & Bond NT Dual Cure
STRENGTHS No surprises. It has proven chemistry and can work across-the-board. Our tests suggest that the original adhesive will perform better than the dual-cure version for virtually anything that you can light cure, which means any metal-free restoration less than 5mm in thickness. For self-cure purposes, however, the activator is still necessary. Regardless of whether you are using the adhesive alone or mixed with the self-cure activator, be sure to precure it before placing the restoration. It also has the advantage of having a unit dose version.
WEAKNESSES Sometimes requires additional coats when mixed with the self-cure activator to achieve shiny surface.
BOTTOM LINE Began the single-component adhesive trend and still continues to perform admirably in most clinical situations.
One-Step Plus STRENGTHS Second generation, fi lled version of the original single-component product in this category that bonds to self-cure materials. This property is probably due to the fact that its pH is relatively high compared to most other single component adhesives. Least expensive unidose.
WEAKNESSES Even though the addition of the fi ller makes it easier to coat the dentin, you defi nitely need to use it on a tooth that is wet, making its application protocol critical.
BOTTOM LINE Only having to deal with one bottle defi nitely simplifi es all the uses.
PQ1 STRENGTHS Stable chemistry and application technique that no longer requires white-knuckled scrubbing it into the surface of the preparation.
WEAKNESSES No option for self-cure and syringe application may limit access in some areas.
BOTTOM LINE Satisfactory performance with the convenience of syringe delivery and the totally unique single-dose syringes.
STRENGTHS Seems to work almost as well when the tooth is dry, compared to moist. This is a great convenience over having to worry whether you overdried or left it too wet and makes it a good choice for repairs, when the restorative material that is fractured needs to be dry. And, you don’t even have to mix anything, even with self-cure procedures, where its bond strength with directs was the highest. Due to its hydrophobic bonding resin, it should overcome any water tree issues.
WEAKNESSES Decimal point components can get confusing and enamel bond strength results were disappointing. No unidose option.
BOTTOM LINE Versatile adhesive with a proven track record.
All-Bond 2 STRENGTHS Proven two-primer system and hydrophobic bonding resin that should overcome the water tree problem. Our tests show that taking advantage of all the components will give you results that exceeded or came very close to all of our controls. This certainly provides peace of mind that any procedure you need to accomplish can be handled using it.
WEAKNESSES Defi nitely requires a moist or even wet dentinal surface. Reports of postoperative sensitivity are probably related to the application technique. One study club had numerous failures when the directions were not followed precisely. All the various components can also be confusing and the instructions are not always as clear as they could be. No unidose option.
BOTTOM LINE Still the most universal and complete system available today and has stood the test of time.
Gluma Comfort Bond + Desensitizer
STRENGTHS Adhesive and desensitizer in one simple bottle. By using the proven chemistry of Gluma Desensitizer (glutaraldehyde and HEMA) and 4-META in an ethanol/water solvent, this is a product that not only performs well, but is also less technique-sensitive than some of its competitors due to its ability to bond under dry, moist, or wet conditions. Even the application method and curing time do not seem to affect its performance very much. The single-dose packaging was also well-received by our evaluators, with the only concerns being that rather large head of the applicator, which may not fi t into a small preparation very well. In addition, it registered a surprisingly high bond strength with the self-cure composite.
WEAKNESSES Basic bond strengths were on the low end of the continuum and its cost is on the high end. Name is descriptive but cumbersome.
BOTTOM LINE If you are still plagued with patients complaining of sensitivity and still prefer to use a total etch adhesive, this product could solve your problems.
Cabrio CQ STRENGTHS Second version of this product that we use for all of our dual-cure and self-cure testing due to its consistent results and ease of use. It is particularly effective with self-cure materials, registering the highest bond strength in the self-cure cement test in this entire group. And, when it is used with a self-cure product, its performance is enhanced by allowing it to cure with the cement, a characteristic that also simplifi es its use. Now has unidose option.
WEAKNESSES Directions could be improved.
BOTTOM LINE With very good performance in most of our other tests and a reasonable price, it could be considered one of the best buys in this category.
STRENGTHS Applies evenly, creates a glossy dentin surface without additional coats, seems to dry without wrinkles, and has one of the highest bond strengths to dentin. Our clinical experience with UNO has been successful, with only a few reports of sensitivity. When using it in the self-cure mode (UNO•DUO), you should not light cure the mixture, but allow it to chemically set on the tooth along with the self-cure material or cement. This is a well-researched product from an established, reliable manufacturer that is effective in all applications.
WEAKNESSES 2:1 ratio for mixing UNO and DUO is not intuitive and could be confusing to staff members used to the much more common 1:1 mixing of most products. No unidose option.
BOTTOM LINE Unsung product that deserves more attention than it gets.
Adper Single Bond Plus
STRENGTHS Nanofi lled version of the original product. High bond strengths on dentin and, with its relatively high pH (for single-component adhesives), it is also able to bond to self-cure materials. From a clinical perspective, it applies easily and virtually always gives you that sought-after shiny surface after evaporating the solvent. In addition, we had only two reported cases of sensitivity when it was applied to a moist tooth, while another evaluator tried applying it to a dry tooth and had sensitivity.
WEAKNESSES You must be certain to use a rolling motion with the unit dose blisters or you’ll waste a lot of material and/or not get enough of it on the applicator, the head of which is quite large and will probably not fi t into small preparations. What’s more, the fl ip-back cap on the bottle was not universally appreciated.
BOTTOM LINE Proven chemistry and solid performance make it a strong and versatile product.
One-Step STRENGTHS Precursor to the fi lled version and its overall clinical success has been good. Will bond to all types of composite.
WEAKNESSES Defi nitely need to use it on a tooth that is wet, making its application protocol critical. Its fi lled sibling outshined it in our tests. No unidose option.
BOTTOM LINE Has a longer track record than all but the original Prime & Bond among the single-components, but its application is technique-sensitive.
PermaQuick STRENGTHS Syringe delivery system eliminates the need for dispensing wells, separate brushes or applicator tips, etc. Its unique chemistry also gives PermaQuick remarkable stability.
WEAKNESSES Only phosphoric acid-based, multi-component adhesive on our list that will not bond to self-cure composite. No unidose option.
BOTTOM LINE Perhaps the easiest of the multi-components to use with its signature syringe system.
SELF-ETCH
Clearfi l SE Bond
STRENGTHS Most dependable self-etching product in this category. While its older sibling, Liner Bond 2V, has more impressive bond strength test results, SE Bond is simpler and easier to use. Its excellent clinical performance to date combined with its exceptional lab results makes it the gold standard for self-etchers. The unique dispenser allows you to handle both bottles with one hand.
WEAKNESSES Squeezing the dispenser requires more pressure than is normally needed to express primers from the bottles. It can also be somewhat messy and asepsis is compromised. Its effectiveness with indirect restorations is mediocre and it does not bond to self-cure materials (without the help of an adhesion promoter). No unidose option.
BOTTOM LINE For conventional light-cured restorations, it’s the one to choose if you want to use a self-etcher.
STRENGTHS SE Bond with an antibacterial agent and sodium fl uoride. These additional ingredients presumably add an extra level of protection against the inevitable microbial invasion via microleakage and may eliminate even trying to disinfect the preparation prior to placing restorations. While this approach is sound and there is at least one study giving credence to its effi cacy, it would be better if it performed up to the level of SE Bond AND had the aforementioned benefi ts. Fortunately, our tests show that its performance is quite good and even exceeds the lofty status of its brethren on enamel.
WEAKNESSES Don’t follow the manufacturer’s advice of just letting it sit undisturbed—you should agitate the primer on the tooth surface. Same problems as SE Bond when it comes to indirect and/or self-cure usage. And it is much more expensive than its sibling. No unidose option.
BOTTOM LINE Almost as good as SE Bond, but with the added antimicrobial action.
Clearfi l S3
Bond STRENGTHS Unique characteristics include a new method to prevent phase separation of the hydrophilic and hydrophobic ingredients, which means you don’t need to shake the bottle or stir the unidose. While this is not a major issue if you are conscientious in always performing this function (shaking or stirring), it’s just one less item about which you need to be concerned. Its bond strengths were adequate, no sensitivity was reported regardless of the application method, and etching enamel with phosphoric acid before applying it had virtually no effect on bond strength.
WEAKNESSES Recommended application protocols produced inconsistent results. Our clinical evaluation found two lost restorations and staining at the margins when the application technique that we suggest was not followed.
BOTTOM LINE Latest in the line of self-etchers from the company that essentially initiated and continues to lead the category.
Prelude STRENGTHS Has both total etch and self-etch versions, but the latter variant is the prime mover and shaker. It utilizes a different approach than most multi-component adhesives in that both its primer and adhesive contain a solvent. Therefore, you must apply air to the adhesive not just to thin it out, but to evaporate the solvent. In addition, its self-cure mode is mediated by the application of a third component (Link) that is placed sequentially instead of mixed. While several total etch products use this approach, this product is the only self-etcher with this protocol. Self-cure bond strengths using the Link component were adequate at 5 minutes and increased substantially after 24 hours to offer the best retention for self-etchers. Its dentin bond strength exceeded that of the control. Etching enamel with phosphoric acid before applying it had virtually no effect on bond strength. Our clinical evaluation found no lost restorations and no sensitivity. Least expensive of the self-etchers.
WEAKNESSES Enamel bond strength was lower than the control. No unidose option.
BOTTOM LINE Versatile product that is challenging the Clearfi l dominance in this subcategory.
Clearfi l Liner Bond 2V
STRENGTHS Highest dentin bond strength with light-cured composite of any product in this category, conventional or self-etch.
WEAKNESSES Only reasonably adequate with dual-cure and self-cure directs and rather poor test results with indirects. No unidose option.
BOTTOM LINE Longest track record and second generation of the original self-etch adhesive.
G-Bond STRENGTHS Only product in this category that incorporates the well-known adhesive properties of 4-META, which has been used successfully in numerous products in the past. No sensitivity was reported regardless of the application method. Its unidose is also the only one that can be recapped, which could be important if you wanted to use it for multiple restorations done in a sequential rather than concurrent manner.
WEAKNESSES Bond strengths, while seemingly adequate for clinical use, are lower than the control. Our clinical evaluation found two lost restorations when the application technique that we suggest was not followed, suggesting technique sensitivity. We also found its recommended application protocols produced inconsistent results. Etching enamel with phosphoric acid, however, before applying it boosted bond strength substantially. Most expensive unidose of the self-etchers.
BOTTOM LINE Proven chemistry in one bottle, but technique appears to be critical to its success.
OptiBond Solo plus Self-Etchplus Self-Etchplus
STRENGTHS More than satisfactory performance for light-cured and dual-cure direct restorations, plus light-cured indirect restorations.
WEAKNESSES Falls short of the performance of its total etch sibling with dual-cure indirect procedures. Interestingly, the product in the unidose packaging performed better than that in bottles.
BOTTOM LINE OptiBond Solo plus for those who don’t want to use phosphoric acid.plus for those who don’t want to use phosphoric acid.plus
Xeno IV STRENGTHS Adapts the one-component format pioneered by its total etch brethren, Prime & Bond, and borrows its main ingredient, PENTA. The result is the top bond strengths for a one-component self-etcher. Curiously, this is the only self-etcher that specifi cally advises against etching unprepared enamel with phosphoric acid and our tests confi rm that bond strengths are actually lower when pre-etching with phosphoric acid. Has unidose option.
WEAKNESSES To achieve high dentin bond strengths, you have to apply the adhesive twice, which is somewhat more labor-intensive than others. In addition, the application requires scrubbing, which is a more diffi cult protocol than gentle agitation. Our clinical evaluation found at least fi ve lost restorations when the application technique that we suggest was not followed. There was also several instances of sensitivity plus three cases of relatively severe gingival “burns” due to overfl ow of adhesive onto the soft tissue.
BOTTOM LINE One-component self-etcher with Prime & Bond’s legacy has great potential, but its application protocol is not easily achieved clinically.
Contax STRENGTHS More conventional (and less risky) approach to being able to bond across-the-board when it comes to direct restorations by having the sequential application of a primer and bond for light-cured procedures, but you merely mix the activator with the bond for self-cure materials. In the light-cured mode, its dentin bond strength is right on par with the control. Etching enamel with phosphoric acid before applying it had virtually no effect on bond strength. Our clinical evaluation found no incidences of sensitivity and one evaluator reported no lost restorations after two years of use. And, even though there is no indication by the manufacturer that it can be used for indirect restorations, one evaluator has had success using it in this manner.
WEAKNESSES Enamel bond strengths are somewhat lower. With self-cure composite, bond strength was weak at 5 minutes and only mediocre at 24 hours. One evaluator experienced three lost dual-cure core buildups, one at the preparation appointment and two when the provisionals were removed at the seating appointment. No unidose option.
BOTTOM LINE Multi-components suggest less worry about water trees, but mediocre self-cure performance may limit its versatility.
Tyrian SPE/One-Step Plus
STRENGTHS Etching with Tyrian SPE produced bond strengths on par with the phosphoric acid version in the light-cured mode. Unique purple color.
WEAKNESSES Application protocol (leave it shiny wet) that Application protocol (leave it shiny wet) that is mandatory for optimal performance. Cannot match its is mandatory for optimal performance. Cannot match its conventional sibling in the dual-cure and self-cure modes. conventional sibling in the dual-cure and self-cure modes.
BOTTOM LINE Only self-etcher in this group that can be used for all types of restorations, direct or indirect.
