Advances in Dentistry Give Clinicians Lots of
Options For Posterior Composites
BOSTON, MA - Recent advances in composite core
materials offer clinicians a wide array of options when
performing posterior composites. Coupled with either a
total-etch or self-etch adhesive, composite resin can be
bonded to both enamel and dentin with good strength,
which permits conservative core preparation. But with
all the new products emerging, the waters become
murky about how best to proceed.
That is why Jeff T. Blank, DMD, told an audience
at the Yankee Dental Congress that it is important to
understand the basics of total- and self-etch adhesives.
The total-etch systems require phosphoric acid etching
and are applied in 1 or 2 layers, and the self etchers
have the acid built into the adhesive. For both adhe-
sives, there is a certain amount of calcium and phos-
phate ions that is removed from the tooth. This process
creates tiny voids in the enamel and dentin.
“Total etching dentin removes the smear layer and
opens up dentinal tubules,” Dr. Blank said. “The fluid
moves in the tubules during thermal and tactile stresses,
which in turn stimulates nerve fibers in the pulpal tissue,
which leads to postoperative sensitivity.”
Technique Pearls
However, Dr. Blank said, there is a place for total-
etch adhesives in the dental armamentarium. He offered
some technique pearls for successful wet bonding with
total etchers, notably:
1. etching with phosphoric acid, rinsing, and leaving
water in the prep. “Moisture must be present,” Dr.
Blank said, adding that if the dentin is overdried, it
could lead to collagen collapse,
2. getting bonding material ready for use, and then
3. applying suction over the prep and applying
immediately.
Self-etching Adhesives
Although there are many uses for total-etch systems,
Dr. Blank said that increasing demand has led to more
simplified systems. The primary advantage of self-etch
systems is that they avoid the vulnerable period that
occurs after the phosphoric acid etching required with
total-etch adhesives. By eliminating this step, the fear of
collagen fibril collapse has been eliminated, Blank said.
The limitation of many self-etch adhesives is that they
contain water, and systems high in water content are less
effective in removing moisture from hydrophilic dentin,
Dental Learning
which could lead to nanoleakage. However, Dr. Blank
cited one product in particular that creates a strong bond.
Dr. Blank discussed the course sponsor Pentron’s
Bond 1 Solvent Free. Bond-1 SF is indicated for all di-
rect composite bonding and also can be used with dual-
cure materials when the initial layer of such materials is
light-cured. Blank touted the product, which he helped
develop, particularly its unique delivery style. According
to Pentron, the unique handling properties of Bond-1
SF enable an even spread, ensuring complete coverage;
Dr. Blank agreed. He said one of the main positive at-
tributes of this product is its quick drying and strong
bond, which reduces microleakage.
For a product that puts less stress on the bond, Dr.
Blank advocates Pentron’s Fusio Liquid Dentin. This
product’s ability to bond to both dentin and enamel
without a separate adhesive opens up new possibilities
for this segment of restorative materials, he said. “You
can use it for a Class V restoration, it is a light-cured,
low pH self-adhesive flowable,” Dr. Blank said. “This
product contains nano-sized silica and glass fillers that
bond to dentin and seals the dentin.”
Dr. Blank urged the audience to pay careful atten-
tion to the cement when placing veneers, especially
those that are sheer. He touts the Mojo veneer cement,
which is a light cure, esthetic cementation system that is
designed for use with porcelain, ceramic, and composite
veneer restorations. Dr. Blank said that this cement of-
fers 2 important features: try-in gels that consistently
match the polymerized cement, and no detectable shade
shift. He said since this product is available in different
shade selections, the material can be used with a wide
range of veneer cases.
Put Patients First
Summarizing his talk, Dr. Blank urged attendees to
pay careful attention to etching technique, as well as
choice of adhesives to provide the best for their patients.
—Colleen Platt
Jeff T. Blank, DMD
is an adjunct instructor in the department of operative
dentistry at the Medical University of South Carolina
College of Dental Medicine, and he maintains a private
practice in Rock Hill, SC
www.dentallearning.net