Dentaltown May 2017 - 94
Fig. 1
self-etch adhesive over the entire surface of the
tooth to be bonded.
Newer simplified self-etch materials have
milder acids incorporated into the system and
do not require phosphoric acid etching. Self-etch
adhesives that eliminate the "etch, wash and
dry" step streamline the adhesive portion of the
restorative process.
Efficacy of total-etch versus self-etch adhesives
has been the subject of much debate. According
to one study on primary enamel that compared
total-etch versus self-etch systems in vitro, no
statistically significant difference was found in efficacy.7,8 A study comparing
microleakage and beveling versus nonbeveling of cavo-surface margins, as well
as total-etch and self-etch systems to primary and permanent teeth, found
less microleakage with total-etch systems. However, the effect of the beveled
or nonbeveled cavo-surface margin was of greater significance in reducing
microleakage than the type of adhesive system used.9
Given the simplicity of use of self-etch universal systems and similar efficacy,
for pediatric patients, a simpler choice of a self-etch adhesive is the better choice.
Fig. 2
Use of adhesives in primary enamel in pediatric dentistry
Can it be assumed that primary and permanent tooth structure behave
similarly?
Manufacturer directions for use of adhesives don't differentiate between
primary and permanent tooth structures. There are no products in existence for
use solely on primary teeth. We must ask if the morphology of primary versus
permanent teeth warrants a difference in technique for adhesion, but clinical
studies of primary dentition adhesion are scarce.10,11
In the available literature, an aprismatic zone is reported in primary enamel.
An aprismatic zone is more highly mineralized because of the perpendicular
alignment of the crystals, and a longer etching time has been suggested as
being required.12 That zone has been reported as inconsistent, however, and
reported frequency and distribution ranges from less than 20 percent to as
much as 100 percent.13-15 Several studies do show that bond strength, in general,
interfacial micromorphology and adaptation to primary and permanent enamel
and dentin are similar in primary and permanent teeth.16-26
Techniques using universal self-etch adhesives
Use of universal self-etch adhesives in pediatric dentistry offer many
advantages to dentists and patients. Universal self-etch adhesives offer flexibility
of technique. Universal self-etch adhesives work well with multiple clinical
procedures: self-etch technique (otherwise called non-etch technique), total-etch
technique and selective-etch techniques.
The self-etch technique is particularly useful for noncompliant patients,
when a phosphoric acid etch and a thorough wash-and-dry simply can't be
94
MAY 2017 // dentaltown.com
http://www.dentaltown.com
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