Current aspects on bonding effectiveness and stability in adhesive dentistry
Current aspects on bonding effectiveness and stability in adhesive dentistry
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DOI：
10.1111/j.1834-7819.2011.01294.x
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发表时间：
2011-06-01
影响因子：
2.1
通讯作者：
Van Meerbeek, B.
中科院分区：
文献类型：
--
作者：
Cardoso, M. V.;Neves, A. de Almeida;Van Meerbeek, B.
改良的牙胶技术广泛地影响了现代恢复性牙科的概念。从微创牙科的角度来看，这种新方法促进了一种更保守的腔体设计，它基本上依赖于当前牙釉质-牙本质粘接剂的有效性。如今，粘合剂与牙基质的相互作用基于两种不同的策略，通常被描述为蚀刻-冲洗和自蚀刻方法。为了简化粘接技术，制造商减少了完成粘接过程所需的步骤。因此，两步蚀刻-冲洗和一步（自蚀刻）粘合剂被引入，并因其声称的用户友好性和较低的技术敏感性而在牙科市场迅速普及。然而，人们对这些简化粘合剂的粘合效率提出了许多担忧，特别是在耐久性方面，尽管这往往是非常依赖于材料的。为了将所有的胶粘剂成分混合到一个单一的溶液中，一步胶粘剂被制成更酸性和亲水性。不幸的是，这些特性引起了各种各样看似无关的问题，这些问题可能会危及与牙基体粘附的有效性和稳定性。与多步骤粘合剂相比，这些粘合剂更容易受到水吸附和纳米泄漏的影响，更容易发生粘结降解，并且容易过早失效。顺便提一下，另一个可能干扰粘合剂粘合效果的因素是用于龋齿去除和空腔准备的技术。目前市场上有几种工具可以有效地去除龋齿组织，从而符合目前最少干预的趋势。尽管这些技术具有良好的性能，但它们在不同方面改变了牙基板，可能影响粘接效率。综上所述，我们可以得出结论，为了实现稳定的粘接界面，不仅要考虑粘合剂的配方，还要考虑基质的性质，从而使修复治疗在临床性能方面更具可预测性。在这篇综述中，我们分析了目前牙釉质和牙本质粘连的理论和临床方面，并讨论了克服目前仍然挑战临床医生在实现更稳定和有效的牙釉质和牙本质粘连方面的各种可能性。
Improved dental adhesive technology has extensively influenced modern concepts in restorative dentistry. In light of minimal-invasive dentistry, this new approach promotes a more conservative cavity design, which basically relies on the effectiveness of current enamel-dentine adhesives. Nowadays, the interaction of adhesives with the dental substrate is based on two different strategies, commonly described as an etch-and-rinse and a self-etch approach. In an attempt to simplify the bonding technique, manufacturers have decreased the number of steps necessary for the accomplishment of the bonding procedure. As a consequence, two-step etch-and-rinse and one-step (self-etch) adhesives were introduced and gained rapid popularity in the dental market due to their claimed user-friendliness and lower technique sensitivity. However, many concerns have been raised on the bonding effectiveness of these simplified adhesives, especially in terms of durability, although this tends to be very material dependent. In order to blend all the adhesive components into one single solution, one-step adhesives were made more acidic and hydrophilic. Unfortunately, these properties induce a wide variety of seemingly unrelated problems that may jeopardize the effectiveness and stability of adhesion to the dental substrate. Being more susceptible to water sorption and thus nanoleakage, these adhesives are more prone to bond degradation and tend to fail prematurely as compared to their multi-step counterparts. Incidentally, another factor that may interfere with the bonding effectiveness of adhesives is the technique used for caries removal and cavity preparation. Several tools are on the market today to effectively remove carious tissue, thereby respecting the current trend of minimum intervention. Despite their promising performance, such techniques modify the tooth substrate in different aspects, possibly affecting bonding effectiveness. Altogether, we may conclude that not only the adhesive formulation, but also substrate nature must be taken into account to achieve a stable bonding interface, rendering the restorative treatment more predictable in terms of clinical performance. In this review, we analyse the current theoretical and clinical aspects of adhesion to enamel and dentine, and discuss the diverse possibilities to overcome problems which nowadays still challenge clinicians in their achievement of a more stable and effective bond to tooth enamel and dentine.