RestorativeDentistry

FJ Trevor Burke

Anna Lawson, David JB Green and Louis Mackenzie

What’s New in Dentine Bonding?:

Universal Adhesives
Abstract: The ability to bond restorations to dentine successfully is central to minimally invasive restorative dentistry. While dentine-
bonding agents have gone through a variety of ‘generations’, it is the purpose of this paper to describe the latest dentine-bonding agents,
the Universal Bonding Agents. These materials may be considered ‘Universal’ insofar as they may be considered to be capable of being
used for direct and indirect dentistry, as well as being suitable for use in whichever etching modality the clinician considers appropriate,
namely self-etch, etch and rinse or selective enamel etch. Laboratory investigations and initial clinical studies hold the promise that
Universal Bonding Agents are a forward step in the quest for the ultimate bond to tooth substance.
CPD/Clinical Relevance: New Universal Bonding Agents appear to present a promising advance in bonding to dentine.
Dent Update 2017; 44: 328-340

Dentine-bonding agents play a strategic A dentine-bonding agent A brief history of bonding to

role in the sealing and retention (where should perform the following functions:3 dentine
necessary) of resin composite restorations,  Provide a strong, immediate and In the past, dentine-bonding
which are increasingly placed by dentists permanent bond to dentine; agents were classified into generations.7
worldwide.1 Bonding to dentine is also  Seal the cavity and minimize leakage; However, this means of identifying
central to the practice of minimally invasive  Resist microbial or enzymatic different groups of bonding agents fell
dentistry, given that bonded restorations degradation; into disarray because of the failure of
do not require macro-mechanical retentive  Provide adhesion per se of the authorities on the subject to agree on
features such as locks and keys, which are restoration in cases where this is the type of bonding agent which fitted
a feature of non-adhesive (amalgam) cavity necessary; a given ‘generation’. Until recently, the
preparations.2  Prevent post-operative sensitivity; classification has therefore been simply,
 Reduce the risk of recurrent caries; glass-ionomer materials, and resin-based
 Prevent marginal staining; dentine-bonding agents, the latter being
 Be easy to use. further classified into etch and rinse
FJ Trevor Burke, DDS, MSc, MDS, It is the intention of this materials and self-etch materials, with
MGDS, FDS(RCS Edin), FDS RCS(Eng), paper to update readers on the new some workers classifying the self-etch
FFGDP (UK), FADM, Primary Dental Care group of Universal Dentine-Bonding materials according to their pH.8
Research Group, University of Birmingham Agents, this being a follow-up to a paper There are two principal
School of Dentistry, Anna Lawson, BDS, published in 2004 giving details of the means by which a bond to dentine may
MSc, MPDC(RCS Edin), General Dental last major innovation in bonding to be achieved:9
Practitioner, Nottingham, David JB Green, dentine, the introduction of the so-called  First, glass-ionomer materials (GIC
BDS(Hons), BSc, MFDS RCS(Edin), StR self-adhesive dentine-bonding agents3 – glass-ionomer cements) which were
Restorative Dentistry, Birmingham Dental and to other Dental Update publications developed in the 1970s, initially being
Hospital and Louis Mackenzie, BDS, on the subject which readers may wish derived from the Fluoro-Alumino-
General Dental Practitioner, Birmingham
to read as background or a further Silicate glass used in the silicate cement
and University of Birmingham School of
update, such as those by Green and materials which were used until the
Dentistry, 5 Mill Pool Way, Pebble Mill,
Banerjee,2 Green, Mackenzie and 1960s, but with the phosphoric acid used
Birmingham B5 7EG, UK.
Banerjee4 and others.5,6 in silicate cements being substituted by a
328 DentalUpdate April 2017
 RestorativeDentistry

polyacrylic acid. GICs were found to have score of 5 out of 5 for ease of use since restoration margins are to be produced.
a number of benefits, such as their ability the practice-based research group, the
to form a self-adhesive, reliable bond PREP Panel, commenced its ‘handling
to dentine and the potential to release evaluations’ in 1993.11 Universal Bonding Agents
fluoride initially, but suffered from poor Results of research from With a traditional so-called self-
aesthetics and low flexural strength.9 Leuven12 involving the clinical use etch bonding agent, a principal problem
 Second, since the ability to bond to of the self-etch adhesive Clearfil SE was that they are relatively mild in their
enamel was first described by Buonocore (Kuraray) in 100 non-retentive Class V acidity, with pH values of between 2 and
in 1955,10 bonding to tooth structure cavities (these being considered to be 2.5. This provides a near ideal treatment
has become an essential part of the ultimate test of adhesives as there is of dentine but does not adequately etch
restorative dentistry and has facilitated no macro-mechanical retention, being enamel. In that regard, a bond to enamel
the development of resin composite reliant only on the bonding agent to is essential in order to provide marginal
materials, with these materials becoming retain the restoration) have indicated seal for the restoration and is the first form
increasingly used worldwide,1 principally the need to etch the enamel selectively of defence against microleakage. For this
because of patient concerns regarding with phosphoric acid when using a self- reason, total etch systems have, up to
mercury in dental amalgam and the poor etch dentine-bonding agent, because now, been considered gold standard.14
appearance of such amalgam restorations, the enamel cavity margins indicated However, the so-called self-
alongside patient desires to receive clinical advantages in terms of integrity etch dentine-bonding agents had a
aesthetic restorations in both their anterior and lack of staining when they were number of advantages when compared to
and posterior teeth. However, dentine is etched selectively with phosphoric acid. etch and rinse types, namely:3
a vital substrate with circa 20% organic ‘Selective enamel etching’ is therefore  No post-conditioning rinsing, hence less
and 10% water by weight, and these a relatively new concept in restorative operator sensitive;
factors make bonding to dentine more dentistry, with one of its first uses being  Less sensitive to the degree of wetness/
challenging than to enamel. Early resin- in the study by Peumans and colleagues.12 dryness of the dentine surface;
based dentine-bonding agents were When these workers extended their study  Single unit dose packaging possible,
little more than wetting agents which to eight years,13 the results continued hence reduced risk of cross infection;
penetrated the smear layer, until it was to indicate fewer small marginal defects  Consistent and stable composition;
realized that the smear layer was not well on enamel in the selective enamel etch  Simultaneous demineralization and
attached to the underlying dentine. This group (65% cf 44% in the non-etch resin-infiltration meant that it was not
realization facilitated the development of group), while there was more superficial possible to over etch the dentine, leading
two distinct types of resin-based dentine- marginal discoloration in the non-etch to reduced levels of post-operative
bonding agent: group, with these differences being sensitivity.
1. The etch and rinse (or total etch) only statistically significant for marginal However, among the
materials in which the smear layer was discoloration. In this regard, the so-called disadvantages listed in 20043 was:
dissolved away by the application of self-etch bonding agents were introduced ‘adhesion to enamel requires further
30−35% phosphoric acid, followed by because of dentists’ requests for ease long-term evaluation in some systems’.
washing and drying, and the application of use and speed, with this involving In that regard, it was therefore likely that,
of the bonding agent. These materials, not using phosphoric acid. However, as a result of the recently perceived need
with a four-stage clinical application with the benefit of hindsight, it could to etch the enamel margins when using
protocol, could be considered technique be considered that clinicians were naïve so-called self-etch adhesives, a new group
sensitive because of the risk of a failure to expect materials with a pH of up to of bonding agents, the Universal Bonding
to carry out any stage optimally,3 hence 2.5 to provide similar marginal integrity Agents, have been introduced.
the development of the self-etch dentine- or low incidence/absence of marginal A Universal Bonding Agent
bonding agents. discoloration on enamel margins as may be defined as one which:15
2. In the so-called self-etch bonding could be obtained when these were  Is capable of being used in whichever
systems, the bonding resin is combined etched using phosphoric acid (pH of etching mode that the operator considers
with an acid (generally phosphoric acid) 0.5), remembering that pH operates on appropriate (total etch, self-etch or
in order to reduce the pH to a level which a logarithmic scale. Hence, in this paper, selective enamel etch): the authors
is said to be sufficiently low to carry out the authors have termed these so-called of this paper consider that selective
the etching step at the same time as the self-etch materials in order to indicate enamel etching is appropriate, as will be
bonding. These materials were therefore their skepticism regarding the ability demonstrated when the results of recent
significantly simpler to use than the of these materials to etch the enamel research are discussed later in this paper;
etch and rinse materials and could be margins adequately, given that it may be  May be used for direct and indirect
presented in only one bottle, thereby considered oxymoronic to use the term dentistry, the latter generally in
facilitating their use. An example of these self-etch when it appears that etching of conjunction with a resin-based luting
is G Bond from GC, this being one of the enamel with phosphoric acid is indeed system from the same manufacturer as
few materials to achieve a maximum necessary if long-lasting good quality the bonding agent, with the luting system
April 2017 DentalUpdate 329
 RestorativeDentistry

respective clinical applications as opposed

to their chemical formulation, it could be
argued that Optibond XTR should also be
considered as a Universal Bonding Agent,
CH3 even though it does not contain 10-MDP. It
Polymerizable group is a 2-component, light-cured, 15% filled,
bonding agent, which the manufacturers
CH3 = C (Kerr Mfg Co, Orange CA, USA) suggest is
indicated for direct and indirect restorative
procedures. Its chemistry is derived from
C = O previous Kerr bonding agents, using the
monomer GPDM, and contains a separate
O hydrophilic primer, along with a separate
Hydrophobic group hydrophobic adhesive to maximize
CH2
material compatibility. It contains three
CH2 solvents, water, ethanol and acetone: as
CH2
two of these evaporate, the pH reduces
from 2.4 to 1.7, which the manufacturers
CH2 suggest is sufficiently low as not to
CH2 require selective enamel etching. It also
CH2 contains camphorquinone and stabilizer.21
In terms of true universality, it is capable
CH2 of being used for indirect restorations,
CH2 in conjunction with the appropriate Kerr
resin luting material.
CH2
CH2
So, just how good are these
O new Universal adhesives?
As with any recently-introduced
O = P OH material, there is a relative paucity of
evidence relating to these new materials,
Hydrophilic group although this is building with respect to
OH Scotchbond™ Universal Adhesive (SBU)
(3M, St Paul, USA), given that it was the
first of this group of Universal materials to
be released commercially. Regarding SBU
(3M), this is classified as ‘ultra-mild’:22 it also
contains a polyalkenoic acid copolymer
known as Vitrebond copolymer as well
Figure 1. Chemical formula of 10-MDP (after www.Kuraray Dental/Key Technologies). as a silane which may facilitate a bond to
ceramic.23 When used for indirect dentistry,
the manufacturers advise that further
silanating prior to bonding is not required
incorporating a material-specific initiator. only a micromechanical bond via a hybrid to pre-treat a porcelain restoration.
Another factor that the layer, but also bond ionically to calcium, However, stronger bond strengths have
majority of this new group of bonding ie to hydroxyapatite in dentine,18 via the still been reported with a separate
agents have in common is the resin hydrophilic group incorporated in the treatment of silane.24,25 As this is carried out
methacryloyloxydecyl dihydrogen molecule. at the chairside (ie outside the mouth) and
phosphate (10-MDP).16 10-MDP has been The components of some is a simple task to perform, this may not
shown to provide good clinical survival Universal Bonding Agents are presented be considered to be of great consequence.
rates in surveys of Class V restorations, in Table 1 and the function of their various In this regard, when a Universal Bonding
with data using Clearfil SE Bond (Kuraray), components may be considered to be as Agent was used in conjunction with the
which includes this resin, now being indicated in Table 2. luting system from the same manufacturer,
available at 13 years.17 10- MDP (Figure Although the similarities performance has been reported, by Vogl
1) was originally developed by Kuraray between the Universal Bonding Agents in and co-workers26 who used a split-mouth
in the 1980s, this uniquely providing not Table 1 and Optibond XTR relate only to their randomized study design, to be suitable
330 DentalUpdate April 2017
 RestorativeDentistry

Name of Scotchbond Clearfil Universal Futurabond U All Bond Premio Bond (GC) Adhese One Coat 7
Material Universal (Kuraray) (VOCO) Universal Universal Universal
(3M) (Bisco) (Ivoclar) (Coltene)

Components BisGMA, 10-MDP Liquid 1: 10-MDP, 4-META, 10-MDP, 10-MDP,

10-MDP, BisGMA, BisGMA, HDDMA, Phosphate 10-MDP, Methacrylated Methacrylated
Vitrebond 2-HEMA, UDMA, HEMA, monomer, 10-Methacroyldecyl carboxylic acid polyacid,
Copolymer, Hydrophilic fumed silica, HEMA, dihydrogen polymer, HEMA,
HEMA, aliphatic CQ, 10-MDP BisGMA, thiophospate, HEMA, Urethane
Ethanol, dimethacrylate, Liquid 2: Ethanol, Methacrylate ester, BisGMA, di-methacrylate,
Water, Colloidal silica, Ethanol, water, Water, Acetone, D3MA, Photoinitiators,
Filler, Silane, catalyst Initiators Distilled water, Filler,
Silane, Camphorquinone, Photoinitiators, Ethanol,
Initiators Ethanol, Silica fine powder Water
Water

Table 1. Components of some Universal Bonding Agents.

 BisGMA is a proven ‘backbone’ of a majority of today’s resin composite materials which facilitates compatibility of hydrophilic
substances such as HEMA and hydrophobic resins and imparts high mechanical strength.9
 10-MDP makes a bonding agent acidic and is a functional monomer which forms a strong chemical bond to hydroxyapatite surfaces,
ie promotes adhesion to tooth substance by formation of insoluble MDP-Ca2+ salts18 and providing high mechanical strength.
 Vitrebond copolymer has been a constituent of 3M bonding agents since 1993, it being a methacrylate-modified polyalkenoic acid
copolymer. It provides for moisture tolerant performance to dentine as it is resistant to changes in the humidity of the dentine surface.19
 HEMA promotes wetting of surfaces and assists in penetration of dentinal tubules.
 D3MA is a hydrophobic dimethacylate which enables the reaction of the adhesive with other monomers in the restorative composite
or luting material. Table 2???
 4-META, originally described by Nakabayashi et al20 faciliates a bond to hydroxyapatite, but will also bond to metal surfaces.
 Urethane dimethacrylate (UDMA) fulfils a similar function to BisGMA.
 Camphorquinone is an initiator which is sensitive to blue light at 460 nanometers.
 Ethanol, acetone and water are solvents.

Table 2. Function of the principal components of Universal Bonding Agents (although not all materials are in all the bonding agents).

for the clinical task for which they are and the performance of SBU has been Care therefore must be taken when
intended, with SBU and Rely X™ Ultimate reported to be comparable with the ‘gold interpreting laboratory-based studies −
(3M, St Paul, USA) demonstrating consistent standard’ two-bottle self-etch adhesives there is evidence to be gained from in vitro
results at 18 months and with the authors in non-carious cervical lesions.28 It is early studies but it should be used with caution.
stating that this combination may be days, but bonding of restorations with Nevertheless, laboratory studies may be
recommended for luting partial ceramic SBU in conjunction with Rely X™ Ultimate of some value as they may provide an
crowns. (3M) appears to be providing promising early assessment of the different variables
Scotchbond™ Universal (3M) results.26 which may affect the performance of a
is the only Universal Bonding Agent to It is considered by the authors given material, but the studies should be
contain both 10-MDP and Vitrebond that there are a number of useful and selected with care.31
copolymer (3M). However, in a study by relevant clinical and laboratory studies
Muñoz et al,27 Scotchbond™ Universal worth mentioning. In this regard, clinical
performed suboptimally and one suggested studies may be considered superior, Laboratory studies
potential mechanism for failure was that since Ferracane, and Bayne, two of  In an extensive laboratory study on
the two molecules (10-MDP and Vitrebond the world’s leading dental materials Universal Bonding Agents, Loguerico
Copolymer) could have been competing to scientists, have independently come and co-workers,32 using microshear bond
bond with calcium and therefore potentially to the conclusion that there is little strength testing, concluded that selective
cancelling each other out.27 This evidence correlation between laboratory studies enamel etching with phosphoric acid
is not supported elsewhere in the literature and clinical performance of materials.29,30 might not be crucial for their adhesion to
332 DentalUpdate April 2017
 RestorativeDentistry

of the materials which they tested but,

by entitling the paper ‘Old wine in new
bottles’, they imply that there is nothing
new in the adhesive molecules employed,
further stating that the manufacturers are
using techniques akin to the mixing of
cocktails by skilled bartenders! However,
when previous bonding resins were
classified as etch and rinse or, so-called
self-etch, it was not possible to use a
self-etch type of bonding agent with an
etch and rinse approach, or vice versa. By
Figure 2. Dentine exposed on the palatal surfaces of a 40-year-old patient who had previously suffered contrast, it appears, from the results of the
from bulimia.
research by Chen et al,35 that the Universal
approach of etching in whatever mode the
clinician identifies as correct, is actually
possible with these Universal Bonding
Agents. In that regard, the authors express
surprise that ‘it is inexplicable why bonds
created by Scotchbond™ Universal in the
etch and rinse mode were relatively stable’.
 Cardenas and colleagues36 used resin-
enamel microshear testing to test three
Universal adhesives [SBU (3M), All-Bond
Universal™ (Bisco Inc), Futurabond U
(VOCO, Cuxhaven, Germany)] in self-etch
and etch and rinse modes at application
times of 20 seconds and 40 seconds,
Figure 3. Filtek™ Supreme XTE restorations bonded to the palatal dentine surfaces of UL123, UR123 of also agitating the resin on the dentine
the patient in Figure 2, using Scotchbond Universal (3M). surface by using manual pressure of 35g
on a microbrush. The results indicated
improved degree of conversion of the
resins at 40 seconds when applied in
enamel and that ‘the application of such performance of the resins, that SBU (3M)
self-etch mode, with the authors adding
adhesives in self-etch mode may be a performed similarly in self-etch and
that the acidity of the Universal Bonding
practical alternative to enamel etching in etch and rinse modes, with the authors
Agents tested did not have sufficient
specific clinical situations’. going on to discuss that it could be the
acidity to produce retentive etching
 On the other hand, da Rosa and presence of 10-MDP as well as Vitrebond™
patterns on enamel equivalent to those
co-workers,33 in a systematic review and Copolymer in the Scotchbond™ Universal produced by 35% phosphoric acid,
meta-analysis, considered that the enamel (3M) which results in this performance, with the authors concluding that ‘active
bond strength of Universal adhesives given the improved adhesive performance and prolonged application of universal
was improved with prior phosphoric acid reported.34 adhesives in the self-etch mode may be a
etching.  Chen and co-workers35 carried out an viable alternative to increase the enamel
 Muñoz and co-workers34 carried out an extensive laboratory evaluation of five etching pattern and resin-enamel bond
extensive laboratory assessment which Universal Bonding agents [Prime & Bond strength’.
compared the microtensile bond strength Elect® (Dentsply), Scotchbond™ Universal  Takamizawa and co-workers37 used
of three Universal adhesives: All-Bond™ (3M), All-Bond Universal™ (Bisco Inc), fatigue testing to evaluate the dentine-
Universal (Bisco, Schaumburg, USA), Clearfil™ Universal (Kuraray), Futurabond U bonding ability of three Universal Bonding
G-Bond Plus™ (GC Corporation, Tokyo, (VOCO)] using two bonding modes (etch Agents in total-etch and self-etch modes.
Japan) and Scotchbond™ Universal (3M) and rinse and self-etch) for microtensile Their results indicated that Prime and
in etch and rinse and self-etch modes bond strength testing and electron Bond Elect® (Dentsply: Milford DE, USA)
and using Heliobond™ (Ivoclar Vivadent, microscopy, having thermocycled 50% of performed better in total etch mode,
Liechtenstein) as control. In addition, these the specimens. When bonded to dentine, whereas SBU (3M) and All-Bond Universal™
workers applied an additional layer of the adhesives performed differently in the (Bisco Inc, Schaumburg, IL, USA) did not
hydrophobic resin over the polymerized shear bond testing and the etching mode show a difference in performance in either
adhesive in some groups. Their results did not make a difference to the results. etching mode.
indicated that this layer improved the The authors praise the increased versatility  Thanaratikul and colleagues38 from
April 2017 DentalUpdate 335
 RestorativeDentistry

is a potential for setting up post-operative

sensitivity?

Clinical studies
 In a clinical evaluation of 134
restorations at three years, Loguerico and
colleagues40 evaluated the restorations,
using FDI criteria, bonded using SBU in
four etching modalities, concluding that
there was no statistical difference among
bonding strategies, but adding that there
were signs of degradation when the
adhesive was applied in self-etch mode.
 Perdigão and colleagues41 placed 200
Figure 4. Labial view of patient in Figures 2 and 3, showing the incisal edges also restored, although Class V resin composite restorations using
the bonding to the incisal edges will be a mixture of enamel and dentine bonding.
SBU (3M), using four different etching
modes. Five restorations were lost after 18
months. Regarding marginal adaptation,
self-etch (ie no etching) resulted in
significantly more restorations with
more than 30% of their margins showing
marginal discrepancy in comparison
with the other groups in which the
enamel cavity margins were etched, a
clear message supporting the etching of
enamel margins when using SBU.
 A further clinical evaluation, by
Lawson et al42, of SBU (3M) compared
the clinical use of this material in self-
etch or total-etch modes in 42 Class
V cavities. These researchers used
Scotchbond™ Multipurpose (3M) as
control, recalling 38 restorations at two
years. The results indicated 100% retention
Figure 5. Dentinal sensitivity led this 24-year-old patient to seek treatment: there were no aesthetic for the total-etch group and the loss of
concerns. five restorations in the self-etch group.
Marginal discoloration increased over
time in all groups, but restorations placed
using SBU in self-etch mode exhibited
Thailand tested the microshear bond SiC paper (as in laboratory studies)
greater marginal staining and the SBU
strength of three adhesives to primary and that shortened application times
total-etch restorations received the most
dentine, concluding that SBU (3M) (always a temptation for the clinician!)
‘perfect’ ratings. However, the downside
resulted in similar bond strength produced a reduced bond strength.
was that the ‘sensitivity to cold’ score
whether it was used in self-etch mode or The clinical message being, follow the in the total-etch group was marginally
etch and rinse mode. manufacturers’ instructions and do not be higher than the others. Nevertheless, in
 Finally, Saikaew and co-workers39 tempted to cut corners! light of the findings of Lawson et al,42 and
evaluated the effects of dentine surface  A further message which may be the increased sensitivity in the total etch
preparation and reduced application applied in the clinic is that there group, the present authors consider that
times on microtensile bond strength, appears to be little difference in selective enamel etching is worthy of
using three Universal Bonding Agents bonding performance for many consideration.
[SBU (3M), G-Premio Bond™ (GC, Tokyo, Universal Bonding Agents, but that The laboratory work of
Japan) and Clearfil™ Universal (Kuraray)]. Scotchbond™ Universal, in particular, Loguerico and co-workers32 and Muñoz
The results demonstrated that clinical has had more testing than other and co-workers,34 described above, could
methods of preparing dentine (ie with Universal Bonding Agents, whether the be considered to be in agreement with
a bur) produce lower bond strengths dentine is etched or not: therefore, why unpublished clinical research by Burke
than when the dentine is treated using bother etching the dentine when there and colleagues,15 who used a split mouth
336 DentalUpdate April 2017
 RestorativeDentistry

indicates that selective etching of the

enamel when using SBU might not be
essential, but it is the authors’ view that
it makes sense, if the clinician wishes
to achieve unstained, perfect margins
over a period of time, to etch the enamel
selectively. Does that statement apply
to all Universal Bonding Agents? It is
the authors’ view that, in view of the
similarities between many of the Universal
Bonding Agents, and the fact that their
pH values tend to lie between 2 and 3
that, until the need to etch the enamel
selectively is proven by a voluminous
body of opinion not to be necessary, it is
prudent to suggest that this is carried out
if the clinician wishes to achieve stain-free
margins over a period of time.
Finally, with regard to the
Figure 6. Worn dentine surfaces on the palatal of UL12, UR12 of the patient in Figure 5, restored using clinical use of Universal Bonding Agents,
a dentine-bonding agent and resin composite. it is worth adding that, while isolation
with rubber dam is optimal (although not
universally used43) and moisture control
(by whatever means) is essential, it may
be considered that a further advantage
is the reduced number of steps, and
concomitant reduced technique
sensitivity, of these new adhesive systems.

If bonding is as good as
this, what are the clinical
applications?
Figures 2 to 9 present a variety
of the clinical applications for today’s
Universal Bonding Agents.

Conclusions
In summary, Universal Bonding
Agents hold promise and:
 Can be used in total etch, self-etch,
selective enamel etch modes, depending
on the clinician’s choice, although the
need to etch the enamel has not been
demonstrated in many of the studies
quoted in this review. In view of the
potential to cause post-operative
Figure 7. Dentine-bonding agents are required to seal the margins of resin composite restorations: sensitivity as a result of (over) etching
application of adhesive. dentine, it is the authors’ view that this
is not necessary or desirable and that
selective enamel etching is the etching
method of choice.
design study to assess SBU (3M) in self- with the results, when 45 restorations were  Are compatible with direct and indirect
etch mode (ie no etching with phosphoric evaluated at three years, indicating no procedures.
acid) against total-etch mode (all surfaces difference in the quality of the margins.15  Can be used with self and dual cure
in the cavity etched with phosphoric acid), There is, therefore, a body of opinion which luting materials, usually from the same
April 2017 DentalUpdate 337
 RestorativeDentistry

Dent Update 2011; 38: 439−450.

3. Burke FJT. What’s new in dentine
bonding? Self-etch adhesives. Dent
Update 2004; 31: 580−589.
4. Green DJB, Mackenzie L, Banerjee
A. Minimally invasive long-term
management of direct restorations:
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5. Burke FJT. Dentine bonding agents
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6. Burke FJT. Dentine adhesives: the
current status. Dent Update 1987; 14:
201−211.
7. Burke FJT, McCaughey AD. The four
Figure 8. Dentine-bonding agents are required to seal the margins of resin composite restorations: generations of dentine bonding. Am
adhesive application completed. J Dent 1995; 8: 88−92.
8. Van Meerbeck B, Yoshihara K,
Yoshida Y, Mine A, De Munck J, Van
Landuyt KL. State of the art of self-
etch adhesives. Dent Mater 2011; 27:
17−28.
9. Combe EC, Burke FJT, Douglas W.
Dental Materials. Chicago: Kluwer,
1999.
10. Buonocore MG A simple method
of increasing the adhesion of acryl
filling materials to enamel surfaces.
J Dent Res 1955; 34: 849−853.
11. Burke FJT, Crisp RJ. PREP Panel
Clinical Evaluation: GC G-Bond. Dent
Practice 2006; March: 8−9.
12. Peumans M, De Munck J, Van
Landuyt K, Lambrehts P, Van
Meerbeck B. Three year clinical
effectiveness of a two step self-etch
adhesive in cervical lesions.
Eur J Oral Sci 2005; 113: 1−7.
13. Peumans M, De Munck J, Van
Figure 9. Completed resin composite restorations in the teeth in Figure 8.
Landuyt K, Poitevin A, Lambrehts P,
Van Meerbeck B. Eight year clinical
evaluation of a 2-step self-etch
manufacturer as the bonding agent as this this article. adhesive with and without selective
will contain a separate activator. enamel etching. Dent Mater 2010;
26: 1176−1184.
 Are suitable primers for silica and zirconia.
References 14. Helvey G. Adhesive dentistry: the
 Can bond to different substrates.
1. Burke FJT. Amalgam to tooth-coloured development of immediate dentin
 However, as with any new material or
materials − implications for clinical sealing/selective etching bonding
technique, long-term clinical evaluations
practice and dental education: technique. Compend Contin Educ
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governmental restrictions and Dent 2011; 32: 22−35.
these Universal Bonding Agents adequately.
amalgam-usage survey results. J Dent 15. Burke FJT, Crisp RJ, Cowan AJ,
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