CLINICAL STATUS OF 10 DENTIN ADHESIVE SYSTEMS

Laboratory testing of dentin adhesive systems still requires corrobora tion by long-term clinical trials for their ultimate clinical effectiv eness to be validated. The objective of this clinical investigation wa s to evaluate, retrospectively, the clinical effectiveness of earlier- investigated dentin adhesive systems (Scotchbond, Gluma, Clearfil New Bond, Scotchbond 2, Tenure, and Tripton), and to compare their clinica l results with those obtained with four modern total-etch adhesive sys tems (Bayer exp. 1 and 2, Clearfil Liner Bond System, and Scotchbond M ulti-Purpose). In total, 1177 Class V cervical lesions in the teeth of 346 patients were restored following two cavity designs: In Group A, enamel was neither beveled nor intentionally etched, as per ADA guidel ines; in Group B, adjacent enamel was beveled and conditioned. Clinica l retention rates definitely indicated the improved clinical efficacy of the newest dentin adhesives over the earlier systems. With regard t o adhesion strategy, adhesive systems that removed the smear layer and concurrently demineralized the dentin surface layer performed clinica lly better than systems that modified the disorderly layer of smear de bris without complete removal. Hybridization by resin interdiffusion i nto the exposed dentinal collagen layer, combined with attachment of r esin tags into the opened dentin tubules, appeared to be essential for reliable dentin bonding but might be insufficient by itself. The addi tional formation of an elastic bonding area as a polymerization shrink age absorber and the use of a microfine restorative composite apparent ly guaranteed an efficient clinical result. The perfect one-year reten tion recorded for Clearfil Liner Bond System and Scotchbond Multi-Purp ose must be confirmed at later recalls.