Dentaltown November 2015 - (Page 56)

general practice feature Adhesives: 60 Years of Clinical and Chemical Improvement by Kyle Patton, Associate Editor, Dentaltown Magazine Dentaltown Magazine interviewed Drs. Byoung I. Suh and Paul L. Child Jr., both experts on dental adhesion. Suh founded Bisco in 1981, and in 2013, wrote "Principles in Adhesion Dentistry." He has also published more than 150 articles in various dental journals and magazines. Child is the former executive vice president of Bisco, and an international lecturer. He maintains a private practice in the greater Chicago area. The doctors addressed the ins and outs of adhesion. What are the biggest advancements in adhesive chemistry during the past 60 years? Suh: Ever since Buonocore introduced the concept of acid-etching enamel for resin bonding in 1955,1 dental adhesives have evolved from first- to seventh-generation adhesive systems, from total-etch to self-etch, and from complex, multistep, multicomponent to simplified, single-step, single-component adhesives. However, each category has both advantages and disadvantages. For example, the "gold standard" three-step, etch-and-rinse systems (fourth generation) are less convenient, but the most convenient single-step self-etch systems (seventh generation) have some potential issues such as incompatibility with self-cure materials, permeability, and faster bond degradation. The most recent class of "universal" adhesives such as All-Bond Universal (BISCO) and Scotchbond Universal (3M ESPE) are the biggest advancement in adhesive technology. Universal adhesives can have both the advantage of a single-step system, and the performance of a gold-standard adhesive if the formulation optimizes the acidity (pH), bond strength, hydrophobicity and solvent system. 56 NOVEMBER 2015 // Why do you use a universal adhesive for all procedures? Even veneers? Child: Universal adhesives are designed to work with all procedures-even veneers! However, some cured universal adhesives have a higher fi lm thickness, which may interfere with seating of a veneer, especially if allowed to pool on a margin. Universal adhesives not only give me flexibility in the etching mode I select, but the chemistry has improved significantly to be compatible with anything from basic operative procedures to complex cementation protocols. Some researchers mistakenly refer to universal adhesives as simply "multi-modal" regarding the etching mode. But they are more than that. They have taken the best of the previous generations and combined it into one bottle. How does a clinician read between the lines with all the confusing marketing and KOL information? Child: A clinician needs to consider several factors when choosing an adhesive to use in her or his practice. Evidence-based dentistry has been defined by the American Dental Association as: "an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences."2 This definition dictates that a clinician should use his or her own clinical expertise, the patient's needs, and the most current scientific evidence when deciding upon what materials to place in a patient's teeth. However, many dentists simply look to a key opinion leader in Continued on p. 58

Table of Contents for the Digital Edition of Dentaltown November 2015

HOWARD SPEAKS: Avoid a Perfect Storm: Focus on Infection Control
PROFESSIONAL COURTESY: Suffering from Arithmophobia?
Continuing Education Update
Industry News
Check Out This Broken Implant
Disaster Case— Hail Mary
Internal Marketing Begets Referrals
When to Refer to a Periodontist
Parents in the Operatory: Friend or Foe?
What You Need to Know to Hire the Perfect Hygienist
Space Maintenance: The Right Appliance at the Right Time
Practice Solutions: AMD LASERS
Practice Solutions: Planmeca
Product Profi le:
Adhesives: 60 Years of Clinical and Chemical Improvement
Product Profi le: DEXIS
Misaligned Anterior Teeth Straightened with Direct Composite Bonding
Five Common Web Design Mistakes
You’re a Public-Health Dentist and You Didn’t Even Know It!
Retirement Planning Made Simple
Young Patient Redefi nes the Face of Dentures
New Products
Healthy Mouth, Healthy Body: A Patient Info Sheet
Ad Index
You Should Know: Synergy Dental Partners
Practice Growth Fueled by Technology
The Clinical Algorithms of Rehabilitation
Dentally Incorrect

Dentaltown November 2015