7he Academy of DentaI 7herapeutics and

StomatoIogy is an ADACRP RecognizedProvider

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Larn
4 CI crcdits
This coursc was
writtcn for ocntists,
ocntal hygicnists,
ano assistants.
Jhc Progrcssion ol
Icntal Adhcsivcs
A Peer-Reviewed PubIication
Written by Ara Nazarian, DDS
2 ....|reeJce.ccn
ducationaI Ob|ectives
\pon complction of this coursc, thc clinician will lc allc
to oo thc following:
1. Lc knowlcogcallc alout thc cvolution of
lonoing aohcsivcs
2. Know thc attrilutcs of an iocal lonoing agcnt
3. Lc knowlcogcallc alout thc propcrtics of thc
scvcnth-gcncration aohcsivcs ano thc aovantagcs
thcy offcr
+. Know thc applications that scvcnth-gcncration aohc-
sivcs can lc usco for ano unocrstano thc tcchniqucs
that shoulo lc usco
Abstract
Thcrc has lccn oramatic progrcssion in thc aohcsion of
ocntal aohcsivcs ano rcsins to cnamcl ano ocntin in thc +0
ycars sincc Luonocorc
1
introoucco thc tcchniquc of ctching
cnamcl with phosphoric acio to improvc aohcsion to cnamcl.
Thc frst ocntal aohcsivcs lonoco rcsins to cnamcl only,
with littlc or no ocntin aohcsion. Sulscqucnt gcncrations
havc oramatically improvco lono strcngth to ocntin ano
thc scaling of ocntin margins whilc rctaining a strong lono
to cnamcl. \ith morc paticnts ocmanoing mctal-frcc ocn-
tistry, thc usc of ocntal rcsins as ccmcnts as wcll as oircct ano
inoircct rcstorations will continuc to incrcasc. This articlc
oiscusscs thc progrcssion of ocntal aohcsivcs up to thc most
rcccnt gcncration, in which all componcnts arc containco
in a singlc lottlc or unit-oosc containcr ano applico using a
onc-stcp tcchniquc that rcquircs no mixing.
Overview
vcr thc past +3 ycars, ocntal lonoing systcms havc cvolvco
with variations in chcmistry, application, mcchanism, tcch-
niquc, ano cffcctivcncss. This cvolution accompanico thc
ocvclopmcnt of improvco csthctic ocntal matcrials, notally
compositc rcsin ano ccramic, ano an incrcasing ocmano ly
paticnts for csthctic ocntistry. !n 1999, approximatcly 86
million oircct rcsin rcstorations wcrc placco. \ith rcspcct
to inoircct rcstorations, approximatcly 2.3 million vcnccrs,
38 million rcsin/ccramic crowns, ano 1.1 million ccramic/
porcclain inlays wcrc placco, in aooition to mctal-lasco
crowns ano lriogcs ano corc/post ano corc luilo-ups.
2

All oircct rcsin rcstorations rcquirc lonoing, ano inoircct
rcstorations cithcr rcquirc or arc canoioatcs for lonoing. As
thc ocmano for lonoco csthctic rcstorations has continuco
to incrcasc, thc cvolution of lonoing agcnts has accclcratco.
Lct us quickly rcvicw ocntal aohcsivcs accoroing to a scrics
of gcncrations, allowing us to unocrstano thc charactcristics
of cach group.
||| a|rect re.|a re.ter+t|ea.
re|a|re |eaa|a
History of 8onding Agents
Iirst and Second Generation
Thc first- ano sccono-gcncration lonoing agcnts usco
ouring thc 1960s ano 1970s oio not rccommcno ctching
thc ocntin, lut instcao rclico on aohcsion to thc attachco
smcar laycr.
3
Thc wcak lono strcngth (2!Fa6!Fa) to
thc smcar laycr still allowco ocntin lcakagc with clinical
margin stain.
+
7hird Generation
Thc thiro-gcncration systcms of thc 1980s introoucco
acio ctching of ocntin ano a scparatc primcr ocsignco to
pcnctratc thc ocntin tululcs as a mcthoo to incrcasc lono
strcngth.
3
Thcsc systcms incrcasco lono strcngth to ocntin
(12!Fa13!Fa) ano occrcasco ocntin margin failurc. \ith
timc, howcvcr, margin staining causco clinical failurc.
+
Iourth Generation
Thc fourth-gcncration aohcsivc systcms of thc carly 1990s
usco chcmistry that pcnctratco loth ctchco ano occalcifco
ocntin tululcs ano ocntin sulstratc, forming a hylrio
laycr of collagcn ano rcsin. Iusayama
3
ano `akalayashi
6

ocscrilco thc pcnctration of rcsin into ocntin as giving high
lono strcngths ano a ocntin scal. !n fact, Kanca
7
introoucco
thc ioca of wct lonoing with thcsc systcms. Frooucts in
this catcgory incluoc All-Lono

2 (Lisco), ptiLono

IL
(Kcrr), ano Aopcr Scotchlono !ultipurposc (3!
LSFL). Thcsc lonoing agcnt systcms havc thc longcst track
rccoro as far as rcscarch gocs ano thcy pcrform wcll clinical-
ly. !n fact, ptiLono IL, an 18-ycar-olo proouct, rcccivco
thc Froouct of thc Ycar awaro from Rcolty magazinc.
8
Lono
strcngths for thcsc aohcsivcs wcrc in thc low- to mio-20!Fa
rangc ano signifcantly rcoucco margin lcakagc comparco to
carlicr systcms.
+
This systcm was vcry tcchniquc scnsitivc
ano rcquirco an cxacting tcchniquc of controllco ctching
with acio on cnamcl ano ocntin, followco ly two or morc
componcnts on loth cnamcl ano ocntin. Lccausc of thc
complcxity of multiplc lottlcs ano stcps, ocntists lcgan
rcqucsting a simplifco aohcsivc systcm.
|eart| eaer+t|ea +a|e.|.e ..tem. were
.er tec|a||ae .ea.|t|.e
Iifth Generation
That rcqucst ushcrco in thc ffth-gcncration lonoing sys-
tcms, introoucco ouring thc mio 1990s, which comlinco
primcr ano aohcsivc in onc lottlc whilc maintaining high
lono strcngths. Frooucts in this catcgory incluoc Lxcitc
(!voclar \ivaocnt), ptiLono

Solo Flus (Kcrr), Frimc

ano Lono

`T (Lcntsply), ano Aopcr Singlclono

(3! LSFL). \nit-oosc packaging introoucco ouring this cra
....|reeJce.ccn 3
provioco frcsh chcmistry for cach proccourc. Yct controllco
ctching, surfacc wctncss, ano rcsin placcmcnt continuco to
lc a clinical challcngc for somc clinicians.
Sixth Generation
Thc sixth-gcncration lonoing systcms introoucco in thc
lattcr part of thc 1990s ano thc carly 2000salso known as
thc sclf-ctching primcrswcrc a oramatic lcap forwaro in
tcchnology. Thc scparatc acio-ctching stcp was climinatco
ly incorporating an acioic primcr that was placco on thc
cnamcl ano thc ocntin aftcr tooth prcparation.
3
Scvcral vari-
ations involvco cithcr mixing thc acioic primcr ano aohcsivc
lcforc placcmcnt on thc ocntin ano cnamcl, or lcaving thc
primcr on thc tooth ano thcn placing thc aohcsivc ovcr thc
primcr. Somc prooucts in this class arc Clcarfl

SI Lono
(Kurarray), Simplicity (Apcx), Aopcr Frompt, ano
L-Fop (3! LSFL). Thcsc systcms wcrc also rcportco to
rcoucc thc inciocncc of post-trcatmcnt scnsitivity founo in
prcvious systcms.
8
Howcvcr, thc lono strcngth to ocntin
ano cnamcl is lowcr than fourth- ano ffth-gcncration sys-
tcms
+
(Tallc 1).
IdeaI 8onding Agent Attributes
Attrilutcs of an iocal lonoing agcnt woulo incluoc high
lono strcngth, a thin flm thickncss to cnsurc casy ano com-
plctc scating of rcstorations, shclf stalility, ano post-placc-
mcnt stalility. Thc alility to rclcasc uorioc is ocsirallc to
hclp prcvcnt thc onsct of scconoary carics, which is thc lcao-
ing rcason for rcplaccmcnt of cxisting rcstorations.
9
!n aooi-
tion, thc lonoing agcnt shoulo lc uscr-fricnolyiocally a
onc-stcp proccourc rcquiring no mixing, with thc vcrsatility
to lc usco for multiplc typcs of rcstorations (inoircct ano
oircct, rcsin/ccramic, ano mctal), ano tolcrant of loth moist
ano ory cnvironmcnts (Tallc 2).
I+||e z. |ae+| |eaa|a |eat |ttr||ate.
||| |eaa .treat|
I||a l|m t||c|ae..
||aer|ae-re|e+.|a
.er-lr|eaa|
:a|t+||e ler me|.t +aa ar ea.|reameat.
:t+||||t
Seventh Generation 8onding Systems
Thc latcst catcgory, scvcnth-gcncration lonoing systcms,
is thc all in onc aohcsivcs that comlinc ctch, primc, ano
lono in a singlc solution.
8
This aohcsivc catcgory was intro-
oucco in latc 2002. Laloratory stuoics show lono strcngths
ano margin scaling to lc cqual to sixth-gcncration systcms.
+

Frooucts in this catcgory incluoc iLono (Hcracus), Xcno

!\ (Lcntsply), C-Lono (CC), Complctc (Cosmcocnt),
ano ptiLono

All-!n-nc (Kcrr).
8
Loth ptiLono All-
I+||e . |.e|at|ea el |eaa|a |a|e.|.e.
19s aa6 19Is ||rst aa6 !ecea6 6eaerat|ea
||a aet recemmeaa aeat|a etc||a.
|e||ea ea +a|e.|ea te .me+r |+er.
\e+| |eaa .treat|.
19s Ih|r6 6eaerat|ea
|c|a etc||a el aeat|a.
:ej+r+te jr|mer.
|acre+.ea |eaa .treat|.
M+r|a .t+|a|a c+a.ea c||a|c+| l+||are e.er t|me.
lar| 199s |earth 6eaerat|ea
|c|a etc||a el aeat|a.
:ej+r+te jr|mer.
|acre+.ea |eaa .treat|.
M+r|a .t+|a|a c+a.ea c||a|c+| l+||are e.er t|me.
lar| 199s |earth 6eaerat|ea
'||r|a' |+er el aeat|a +aa ce||+ea.
|eat|a .e+|.
teacejt el 'wet |eaa|a' |atreaacea.
Iec|a||ae .ea.|t|.e.
M|6 199s ||fth 6eaerat|ea
tem||aea jr|mer +aa +a|e.|.e |a eae |ett|e.
M+|at+|aea ||| |eaa .treat|..
a|t-ae.e j+c|+|a |atreaacea.
|ate 199s, lar| 1s !|xth 6eaerat|ea
':e|l-etc||a' jr|mer..
|eaacea |ac|a|eace el je.t-tre+tmeat .ea.|t|.|t.
|eaa .treat|. |ewer t|+a leart|- +aa l|lt|-eaer+t|ea..
|ate 11 !eeath 6eaerat|ea
'|||-|a-0ae'.
tem||ae. etc||a, jr|m|a +aa |eaa|a.
:|a|e .e|at|ea.
0eea |eaa .treat| +aa m+r|a .e+||a.
4 ....|reeJce.ccn
in-nc ano Xcno !\ arc uorioc rclcasing, whilc iLono ano
C-Lono arc not.
Thc all-in-onc aohcsivcs arc uscr-fricnoly, ano most
offcr loth a lottlc ano a unit-oosc vcrsion. Thcrc arc varia-
tions on othcr attrilutcs ocpcnoing on thc proouct usco.
Shcar lono strcngth, a kcy attrilutc in ocntal aohcsivcs,
varics consiocrally ocpcnoing on thc sclf-ctch aohcsivc
usco. (Iigurc 1)
Xcno !\ sclf-ctch scvcnth gcncration aohcsivc is avail-
allc in a lottlc or unit oosc oclivcry ano oocs not rcquirc
mixing. Xcno !\ is pH lalancco to rcoucc gingival irritation
ano scnsitivity. Clcarfl S3 Lono, C-Lono ano iLono arc
availallc in a lottlc. Clcarfl S3 Lono contains watcr to allc-
viatc thc ncco for a surfacc with a spccifc ocgrcc of wctncss
ano to rcsist hyorolysis, provioing for a lasting ano rcliallc
aohcsion. !t rcsists hyorolysis which proviocs for rcliallc
ano ourallc aohcsion.. As with othcr scvcnth-gcncration
aohcsivcs, C-Lono offcrs vcrsatility in thc ocgrcc of wctncss
on thc tooth surfacc at thc timc of ahocsivc application.
I|e +||-|a-eae .e.eat| eaer+t|ea +a|e.|.e.
+re a.er-lr|eaa| +aa me.t eller |et|
+ |ett|e +aa + aa|t-ae.e .er.|ea
AII-In-One 8ond DentaI Adhesive System
ptiLono All-!n-nc is a singlc-componcnt, sclf-ctch
aohcsivc that climinatcs multiplc stcps whcn lonoing oi-
rcct ano inoircct rcstorations. Clinicians havc cvcrything
thcy ncco for ctching, priming ano lonoing in onc matc-
rial. ptiLono All-!n-nc is a light-curco aohcsivc that
proviocs aohcsion to all surfaccs ano sulstratcs. !ts tcrnary
solvcnt systcm proviocs cnhancco shclf-lifc stalility ano cf-
fcctivc cnamcl ctching for long-tcrm lono pcrformancc.
Accoroing to somc inocpcnocnt stuoics provioco ly
Kcrr Corporation, ptiLono All-!n-nc oclivcrs cxccllcnt
||are z. |tc|ea |a+me|
||are 1. 0jt||eaa |||-|a-0ae |a|e.|.e-|eat|a-|eaa|a |aterl+ce
||are 1. |reejer+t|.e \|ew el :m||e
||are !. |reejer+t|.e |etr+ctea \|ew
||are . :|e+r |eaa :treat| - |||-|a-0ae |a|e.|.e :.tem.
S
h
e
a
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o
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S
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e
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z!
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!

nameI
Dentin
0jt||eaa
|||-|a-0ae
/eae |\ t|e+rl|
:1 |eaa
0-|eaa" ||eaa"
....|reeJce.ccn 5
pcnctration into ocntin tululcs, offcring cxccptional lono
strcngth ano protcction against microlcakagc ano post-
opcrativc scnsitivity.
!ts uniquc ctching capalility cnallcs thc most cffcctivc
cnamcl ctching of any singlc-componcnt aohcsivc, crcating
a occpcr-ctchco surfacc for highcr mcchanical rctcntion ano
chcmical lonoing. Scanning clcctron microscopy (SL!) of
ctchco cnamcl shows thc occp ctching oltainco using this
capalility (Iigurc 2), ano SL! of thc aohcsivc-ocntin-
lonoing intcrfacc shows thc occp tags that rcsult from usc
of this systcm in ocntin (Iigurc 3).
! havc founo that thc low flm thickncss makcs it casicr
to scat inoircct rcstorations, crcating a lcttcr ft. ptiLono
All-!n-nc is availallc in loth a 3 ml lottlc oclivcry ano a
convcnicnt frcc-stanoing \nioosc ocvicc.
0jt||eaa |||-|a-0ae eller. e\cejt|ea+| |eaa
.treat| +aa jretect|ea ++|a.t m|cre|e+|+e
+aa je.t-ejer+t|.e .ea.|t|.|t
Case Presentations
Scvcnth Ccncration Lonoing Agcnts arc iocal for lono-
ing inoircct rcstorations, ano for oircct compositc rcsin
(whcrc lonoing is manoatory rcgarolcss of thc matcrial
ano tcchniquc lcing usco).
Case Presentation 1
Indirect Restorations
A paticnt sitting for an initial consultation was oissatisfco
with hcr smilc (Iigurc +). Clinical cxamination rcvcalco a
!arylano lriogc from tccth 4648 with failing margins
(Iigurcs 3, 6). Thc paticnt statco that thc lriogc hao lccn
rcccmcntco a couplc of timcs sincc its original placcmcnt
fvc ycars prior. Tooth 410 hao an cxisting vcnccr rcstora-
tion to corrcct a pcg latcral. Also, tooth 411 ano tooth 412
wcrc invcrtco. Froling ocpths wcrc within normal lcvcls in
thc antcrior rcgion, ano thc paticnt`s pcriooontal hcalth was
within acccptallc limits.
Thc 5mlc Gudc ool (Liscus Lcntal) was usco to
complctc thc smilc analysis ncccssary for prcocsigning thc
casc. Hcr cxisting lriogc was asymmctric, ano thc paticnt
prcfcrrco a morc complctc ano uniform smilc. !n orocr to
achicvc this, thc shapc sclcctco woulo lc rounocr ano thc
cmlrasurcs lctwccn thc tccth woulo lc smallcr. Thc lip linc
cogc vcrsus thc incisal cogc of thc tccth suggcstco that thc
paticnt coulo tolcratc lcngthcning of thc incisal cogcs. Thc
rcsults of thc smilc analysis, oiagnostic stuoy moocls, ano
prcopcrativc clinical photography wcrc rcvicwco with thc
paticnt to octcrminc thc ocsirco trcatmcnt plan for improv-
ing hcr smilc ano function. Sincc thc paticnt`s complaint
was cxtrcmc oissatisfaction with thc wholc appcarancc of
hcr smilc, it was occioco to incorporatc a mctal-frcc lriogc
||are . |reejer+t|.e |+|+t+| \|ew
||are I. |rej+r+t|ea.
||are . |e.ter+t|ea.
||are . |e+a|a el \eaeer.
6 ....|reeJce.ccn
matcrial (Lava, 3!) for thc missing latcral ano porcclain
vcnccrs on thc aojaccnt tccth. Thc proposco trcatmcnt plan
of a zirconium lriogc (Lava, 3!) from 4648 ano porcclain
vcnccrs from 49411 was rcvicwco with thc paticnt, ano
shc was cxcitco to start thc trcatmcnt.
Aftcr ancsthctic was aoministcrco, a oiamono lur was
usco to prcparc thc antcrior tccth. !t was vcry important to
aohcrc to thc prcparation guioclincs for thc zirconium lriogc
in orocr to cnsurc functional ano csthctic prcoictalility. Thc
laloratory rcquirco a minimum of 0.8 mm rcouction of thc
facial walls ano a minimum of 1.3 mm of incisal rcouction.
!ntcrnal linc anglcs wcrc to lc rounoco, ano a lutt joint mar-
gin was rcquirco (Iigurc 7). Also, an ovatc arca was crcatco
in thc gingiva at thc pontic sitc of tooth 47 with an oysscy

Lascr (!voclar \ivaocnt) to crcatc a morc harmonious cmcr-
gcncc proflc for thc pontic. !mprcssions wcrc takcn using a
quick-sctting polyvinylsiloxanc (F\S) imprcssion matcrial
(Takc 1

, Kcrr). Thcsc imprcssions, a litc rcgistration, ano

photos wcrc thcn forwaroco to thc lal for falrication of thc
fnal rcstorations.
ProvisionaIization
A provisional rcstoration, which was significant to thc
ovcrall trcatmcnt, was maoc from an imprcssion of a
compositc mock-up. \sing Iill-!n (Kcrr) tcmporary
matcrial, this molo was quickly fillco ano placco on thc
paticnt`s prcparco ocntition. \ithin a couplc of minutcs,
thc tcmporary hao curco ano was rcaoy for shaping. Cross
shaping ano contouring wcrc achicvco using flcxillc oiscs
(ptiLisc, Kcrr). A flamc-shapco finc oiamono was
usco to shapc ano trim thc margins ano cmlrasurc spaccs.
Thc ncxt oay, thc paticnt rcturnco for cvaluation of sizc,
shapc, color, ano litc. Alrcaoy, shc cxhilitco cxcitcmcnt
ano confiocncc with hcr provisional rcstorations.
Laboratory
Luring thc laloratory phasc, thc full arch polyvinylsilox-
anc imprcssions wcrc usco to pour up a mastcr moocl on
which thc rcstorations woulo lc lasco. Thc mastcr moocl
was scgmcntco into inoivioual oics that wcrc trimmco ano
pinnco to octcrminc thc manncr ly which thc final rcs-
torations woulo intcgratc with thc cxisting soft tissuc. A
siliconc incisal matrix of thc provisional rcstorations was
crcatco to guioc thc placcmcnt of incisal cffccts ano cogc
position in thc sulscqucnt ccramic luiloup. !n aooition,
comprchcnsivc color mapping cnsurco that thc ocfinitivc
csthctic rcsults woulo mcct paticnt cxpcctations.
Cementation
Thc paticnt was ancsthctizco ano a nonlatcx split-rul-
lcr oam was placco. Frior to try-in of thc ocfinitivc
rcstorations to vcrify fit ano shaoc, thc provisional
rcstorations wcrc rcmovco ano any rcmaining ccmcnt
was clcanco off thc prcparco ocntition using Frcppics
Fastc. Thc rcstorations wcrc trico in to vcrify marginal
fit, contour, contacts, ano shaoc (Iigurc 8). Iollowing
paticnt approval of thc final rcstorations, thc ccmcnta-
tion proccss was initiatco.
Thc vcnccr rcstorations wcrc trcatco with 37 pcrccnt
phosphoric acio for 20 scconos, rinsco, silanatco, ano
air orico for onc minutc. ptiLono All-in-nc was ap-
plico to thc prcparations with a scrulling motion for 20
scconos. A sccono application was placco on thc prcpara-
tions with a scrulling motion for 20 scconos ano thcn
gcntly air orico for fivc scconos with a mcoium forcc
of air. Thc aohcsivc was light curco for 10 scconos pcr
tooth. Sincc thc film thickncss of ptiLono All-!n-nc
||are . |e.tejer+t|.e |etr+ctea \|ew
||are . |e.tejer+t|.e |+|+t+| \|ew
||are z. |e.tejer+t|.e \|ew el :m||e
....|reeJce.ccn 7
aohcsivc is approximatcly 3 microns aftcr curing, thcrc
was no conccrn ouring thc scating proccss.
`X3 `cxus

Thiro Ccncration (Kcrr) light-curc rcsin

ccmcnt was applico to thc vcnccr rcstorations (Iigurc 9).
Thc rcstorations wcrc thcn placco on thc prcpara-
tions ano, whilc thcy wcrc firmly hclo in placc, a rullcr
tip applicator rcmovco all cxccss luting ccmcnt from thc
margins. A thin laycr of glyccrin was thcn applico to thc
margins to prcvcnt thc formation of an oxygcn-inhilit-
ing laycr. Thc rcstorations wcrc tackco at thc gingival
margin. ncc thc vcnccr rcstorations wcrc placco, thc
lriogc rcstoration was scatco using !axccm (Kcrr)
rcsin ccmcnt.
\hilc thc rcstorations wcrc still firmly hclo in placc,
thc rcstorco ocntition was flossco ano any cxccss luting
ccmcnt was carcfully rcmovco. ncc thc majority of thc
cxccss ccmcnt was rcmovco, thc rcstorco ocntition was
complctcly light-curco from loth thc facial ano lingual
siocs. Any rcsioual ccmcnt was rcmovco with a 413
scalpcl ano finishco with a finc oiamono ano polishing
points. Thc occlusion was vcrifico ano aojustco. vcrall
hcalth ano structurc of thc soft tissuc ano rcstorations
wcrc vcry gooo. As sccn in thc postopcrativc photos
immcoiatcly aftcr scating, thc rcstorations cxhilitco a
nicc csthctic look ano thc paticnt was cxtrcmcly happy
(Iigurcs 1012). Also, upon rcvicw two wccks latcr, thc
paticnt hao no complaints of scnsitivity.
Case Presentation 2
Direct Composite Restorations
A paticnt sitting for an initial consultation was conccrnco
alout somc scnsitivity on thc lcft-hano sioc in hcr uppcr
lack tccth. Clinical cxamination rcvcalco that thc occlusal
amalgam rcstorations on tooth 41+ ano tooth 413 wcrc
ocfcctivc, with lcaking margins. Thc two tccth also hao
fracturcs aojaccnt to thc amalgams, carics was cviocnt,
ano a mcsial ocfcct was prcscnt on tooth 413 (Iigurc 13).
All othcr tccth wcrc clinically souno, thcrc was no rcccs-
sion prcscnt, thc paticnt`s pcriooontal hcalth was within
acccptallc limits, ano shc hao no othcr complaints.
Aftcr oiscussion on thc availallc options utilizing
thc LcmoLcnt anatomical moocl (LcmoLcnt FLLC),
thc paticnt clcctco to havc thc rcstorations rcplacco with
lonoco compositc rcstorations. Aftcr ancsthctic was
aoministcrco, oiamono lurs wcrc usco to rcmovc thc
ocfcctivc amalgams ano aojaccnt carics (Iigurc 1+).
\pon rcmoval of thc amalgams, it was founo that car-
ics was prcscnt in thc occpcst rcgions of thc prcparations.
This was carcfully rcmovco using a slow-spcco hanopiccc
with largc rouno lurs. Thc prcparations wcrc cxtcnoco
to rcmovc thc carics in thc palatal fissurc rcgions, ano to
prcparc thc mcsial lox in tooth 413. A scctional matrix
lano (Carrison) was placco ovcr thc mcsial margin of
tooth 413 in such a way that its position ano shapc woulo
||are 1. |reejer+t|.e \|ew el |m+|+m |e.ter+t|ea.
||are 1. |m+|+m |e.ter+t|ea. |eme.ea
||are !. |rej+r+t|ea. w|t| 0jt||eaa |||-|a-0ae
||are . ||a|.|ea temje.|te |e.ter+t|ea.
8 ....|reeJce.ccn
cnallc placcmcnt of a compositc with an optimal mcsial
contour. ncc tooth 413 was isolatco ly thc matrix lano,
loth molars wcrc orico ano an all-in-onc aohcsivc (pti-
Lono All-in-nc) was applico to thc prcparations ano
aojaccnt cnamcl for 20 scconos, ano thcn gcntly air orico
for fivc scconos (Iigurc 13).
Thc rcstorations wcrc complctco using light-curco
flowallc compositc (Frcmisc flow ano Frcmisc, Kcrr),
aftcr which thc matrix lano was rcmovco, thc occlusion
was vcrifico ano aojustco, ano thc rcstorations wcrc fin-
ishco ano polishco (Iigurc 16).
Summary
Lcntal aohcsivcs havc oramatically changco thc options
availallc for rcstoration placcmcnt sincc thcir introouction
morc than forty ycars ago. !nitially, thcsc rcquirco a longcr
ctching timc ano wcrc only rccommcnoco for ctching ano
lonoing of thc cnamcl. Lcntal aohcsivc ocvclopmcnts
shortcnco thc ctching timc ano cnallco ctching ano lono-
ing of ocntin as wcll as cnamcl. Howcvcr, carly gcncration
aohcsivcs hao wcakcr lono strcngth ano allowco marginal
lcakagc at thc rcstoration margin. Tooay, clinicians havc a
varicty of csthctic ano functional matcrials to choosc from
whcn facco with thc ncco to pcrform cosmctic ocntistry.
As ocntists, wc arc always looking for prooucts that arc
quick ano simplc to usc yct high-pcrforming ano cffcc-
tivc. ptiLono All-!n-nc singlc componcnt sclf-ctch-
ing ocntal aohcsivc ano othcr similar scvcnth-gcncration
aohcsivcs offcr grcat lcncfts, whcthcr usco as thc main
aohcsivc or as an aojunctivc lonoing agcnt. Thc vcrsatil-
ity of scvcnth-gcncration ocntal aohcsivcs cnallcs thcir
usc for loth inoircct ano oircct rcstorations, provioing for
cxccllcnt marginal scal ano high lono strcngth.
References
1. Luonocorc KC. A sinlc nctnoJ of incrc+sin tnc +Jncsion
of +crylic nllin n+tcri+ls to cn+ncl surf+ccs. ] Lcnt Rcs.
1,3|.8|83.
2. Ancric+n Lcnt+l Associ+tion. 1nc 1 Survcy of Lcnt+l Scrviccs
RcnJcrcJ. 2002.
3. Lunn ]R. iLonJ 1nc Scvcntn Ccncr+tion, Cnc-Lottlc Lcnt+l
LonJin Acnt. ConcnJiun. 2003,2|;2).1|18.
|. V+n Kccr|cck L, Inouc S, FcJi+o ], ct +l. In IunJ+ncnt+ls of
Ccr+tivc Lcntistry, 2nJ LJ. C+rol Strc+n, Ill. Quintcsscncc
Fu|lisnin. 2001,1|21|.
. Ius+y+n+ 1, ct +l. Non-rcssurc +Jncsion of + ncw +Jncsivc
rcstor+tivc systcn. ] Lcnt Rcs. 17,8.13o|.
o. N+k+|+y+sni N. Rcsin rcinforccJ Jcntin Juc to innltr+tion of
nononcrs into Jcntin +t tnc +Jncsivc intcrf+cc. ] ]n Lcnt K+t
Lcviccs. 182,1.7881.
7. K+nc+ ] III. Rcsin |onJin to wct su|str+tc. LonJin to Jcntin.
Quintcsscncc Int. 12,23.3|1.
8. Killcr KL. Sclf-ctcnin +Jncsivcs, solvin tnc scnsitivity
conunJrun. Fr+ct FroccJ Acstnct Lcnt. 2002,1|.|0o.
. K+cInnis VA, Isn+il A, Lro+n H. Fl+ccncnt +nJ rcl+ccncnt
of rcstor+tions in + nilit+ry oul+tion. ] C+n Lcnt Assoc.
11,7;3).227231.
10. Rittcr R C. Vncrc Arc Vc +nJ Vncrc Arc Vc Coin: AJncsivc
UJ+tc, FcnnVcll Fu| Co. ]uly 2007.
Author ProfiIe
Ara `azarian, LLS, is a graouatc of thc \nivcrsity of
Lctroit-!crcy School of Lcntistry. \pon graouation hc
complctco an ALCL rcsiocncy in San Licgo, Calif., with
thc \nitco Statcs `avy. Hc is a rccipicnt of thc Lxccllcncc
in Lcntistry Scholarship ano Awaro. Currcntly, hc main-
tains a privatc practicc in Troy, !ich., with an cmphasis
on comprchcnsivc ano rcstorativc carc. His articlcs havc
lccn pullishco in many popular ocntal pullications. Lr.
`azarian also scrvcs as a clinical consultant for thc Lcn-
tal Aovisor., tcsting ano rcvicwing ncw prooucts on thc
markct. Hc has conouctco lccturcs ano hanos-on work-
shops on csthctic matcrials ano tcchniqucs throughout
thc \ntico Statcs. Lr. `azarian is also thc crcator of thc
LcmoLcnt paticnt coucation moocl systcm. Hc can lc
rcachco at 2+8.+37.0300 or at www.ocmo-ocnt.com.
DiscIaimer
Thc author of this coursc has no commcrcial tics with thc
sponsors or thc proviocrs of thc unrcstrictco coucational
grant for this coursc.
Reader Ieedback
\c cncouragc your commcnts on this or any ALTS coursc.
Ior your convcnicncc, an onlinc fccolack form is availallc at
www.inccocc.com.
....|reeJce.ccn 9
Questions
1. Jhc tcchniquc ol ctching cnancl with
phosphoric acid was lirst introduccd to
dcntistry ly _________.
a. C.\. Llack
l. Linohc
c. Luonocorc
o. nonc of thc alovc
2. In 1999, approinatcly _________
dircct rcsin rcstorations wcrc placcd.
a. 23 million
l. +6 million
c. 73 million
o. 86 million
3. Jhc lirst- and sccond-gcncration
londing agcnts uscd during thc 1960s
and 190s _________.
a. oio not rccommcno ctching thc ocntin
l. allowco ocntin lcakagc with clinical margin stain
c. rclico on aohcsion to thc attachco smcar laycr
o. all of thc alovc
4. Jhird-gcncration adhcsivc systcns
wcrc introduccd _________.
a. in thc 1960s
l. in thc 1970s
c. in thc 1980s
o. nonc of thc alovc
$. Jhird-gcncration adhcsivc systcns
_________.
a. introoucco acio ctching of ocntin
l. occrcasco ocntin margin failurc
c. incrcasco lono strcngth ovcr first- ano sccono-
gcncration systcms
o. all of thc alovc
6. Iourth-gcncration adhcsivc systcns
lorncd a 'hylrid' laycr ol collagcn
and rcsin.
a. Truc
l. Ialsc
. _________ and _________ dcscrilcd
thc pcnctration ol rcsin into dcntin
as giving high lond strcngths and a
dcntin scal.
a. Iusayama, Luonocorc
l. `akalayashi, Haggar
c. Iusayama, `akalayashi
o. nonc of thc alovc
8. Jhc idca ol 'wct londing' was
introduccd ly _________.
a. Tanika
l. Kanca
c. Iujiyama
o. all of thc alovc
9. An advantagc ol lourth-gcncration
adhcsivc systcns ovcr carlicr adhcsivc
systcns was that thcy signilicantly
rcduccd nargin lcakagc.
a. Truc
l. Ialsc
10. A disadvantagc ol lourth-gcncration
adhcsivc systcns was _________.
a. thc complcxity of multiplc lottlcs ano stcps
l. thc highcr lono strcngth achicvco
c. thc vcry tcchniquc-scnsitivc naturc of thc systcm
o. a ano c
11. Iilth-gcncration londing systcns
_________.
a. wcrc introoucco ouring thc mio 1990s
l. comlinco primcr ano aohcsivc in onc lottlc
c. wcrc usco only to ctch cnamcl
o. a ano l
12. \nit-dosc packaging was introduccd
_________.
a. with thiro-gcncration aohcsivc systcms
l. with fourth-gcncration aohcsivc systcms
c. with fifth-gcncration aohcsivc systcms
o. all of thc alovc
13. Jhc lond strcngth to dcntin and
cnancl ol sith-gcncration adhcsivc
systcns
a. was highcr than in fourth- ano fifth-gcncration
aohcsivc systcms
l. was lowcr than in fourth- ano fifth-gcncration
aohcsivc systcms
c. was cqual to that in fourth- ano fifth-gcncration
aohcsivc systcms
o. a ano l
14. Attrilutcs ol an idcal londing agcnt
includc _________.
a. high lono strcngth
l. thin film thickncss, to cnsurc casy ano complctc
scating of rcstorations
c. post-placcmcnt stalility
o. all of thc alovc
1$. Jhc lcading rcason lor rcplaccncnt ol
cisting rcstorations is _________.
a. rcstoration fracturc
l. scconoary carics
c. oiscoloration of thc rcstoration
o. all of thc alovc
16. 'All in onc' adhcsivcs conlinc
_________ in a singlc solution.
a. ctch, lono, ano rcstoration
l. ctch, primc, ano lono
c. watcr, ctch, ano primc
o. nonc of thc alovc
1. Scvcnth-gcncration londing systcns
wcrc introduccd in _________.
a. 1999
l. 2001
c. 2002
o. 200+
18. _________ is a kcy attrilutc in dcntal
adhcsivcs.
a. High pH
l. Shcar lono strcngth
c. !arginal octcction
o. all of thc alovc
19. A tcrnary solvcnt systcn providcs
cnhanccd shcll-lilc stalility and cllcc-
tivc cnancl ctching lor long-tcrn lond
pcrlornancc.
a. Truc
l. Ialsc
20. Pcnctration ol an adhcsivc systcn into
dcntin tululcs _________.
a. offcrs protcction against microlcakagc
l. offcrs protcction against postopcrativc
scnsitivity
c. offcrs cxccptional lono strcngth
o. all of thc alovc
21. Iccp pcnctration ol an adhcsivc into
dcntinal tululcs is cvidcnccd on SIX
ly _________.
a. arcas of rcmincralization
l. occp rcsin tags
c. wiocr tululcs
o. nonc of thc alovc
22. Low adhcsivc liln thickncss nakcs it
casicr to scat indircct rcstorations.
a. Truc
l. Ialsc
23. Adhcring to thc prcparation
guidclincs lor zirconiun lridgcs is vcry
inportant _________.
a. to cnsurc acsthctic prcoictalility
l. to cnsurc that soft tissuc oocs not ncco to lc
rctractco
c. to cnsurc functional prcoictalility
o. a ano c
24. An ovatc arca can lc crcatcd in
thc gingiva at thc sitc ol a pontic to
_________.
a. crcatc a morc harmonious cmcrgcncc profilc for
thc pontic
l. rcoucc thc amount of porcclain palatally
c. hclp rcoucc carics
o. nonc of thc alovc
2$. In thc laloratory, a siliconc incisal
natri ol provisional rcstorations can
lc uscd to _________.
a. guioc thc placcmcnt of incisal cffccts
l. guioc thc placcmcnt of cogc position in thc
sulscqucnt ccramic luiloup
c. cut a corncr
o. a ano l
26. According to thc articlc, vcnccr
rcstorations can lc ctchcd _______.
a. with 37 pcrccnt phosphoric acio for 20 scconos
l. with 37 pcrccnt phosphoric acio for 60 scconos
c. with lactic acio for +3 scconos
o. nonc of thc alovc
2. All dircct rcsin rcstorations arc
candidatcs lor dcntin londing.
a. Truc
l. Ialsc
28. All scvcnth-gcncration adhcsivc
systcns arc availallc in loth lottlc and
unit-dosc vcrsions.
a. Truc
l. Ialsc
29. Iluoridc-rclcasing londing agcnts arc
dcsigncd to _________.
a. promotc ocmincralization
l. hclp prcvcnt scconoary carics
c. incrcasc salivary flow
o. all of thc alovc
30. Jhc vcrsatility ol scvcnth-gcncration
dcntal adhcsivcs _________.
a. cnallcs thcir usc in loth inoircct ano oircct
rcstorations
l. proviocs cxccllcnt marginal scal
c. proviocs high lono strcngth
o. all of thc alovc
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ADH07l0PATT
ANSwLP SHLLT
The Progresslon of Dental Adheslves
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AJJ.ess. |n.||.
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