One Adhesive for All Clinical Situations
Since 1955, Buonocore’s acid-etching technique has made bonding to enamel successful.1 However, achieving consistent dentin bonding has been more challenging based on factors such as microleakage, resin infiltration and penetration, hydration versus desiccation, and postoperative sensitivity.2 To mitigate these factors, the evolution of dentin bonding has included a shift from total-etch techniques involving placement of 30% to 40% phosphoric acid on both enamel and dentin surfaces (ie, etch-and-rinse) to self-etch techniques where phosphoric acid esters are contained within the bonding agent and no etchant gel is placed on the preparation.3
Recently, a third bonding technique has emerged that allows for hybridization of the remaining dentin smear layer and includes phosphoric etching of exposed enamel to maximize bond strength and prevent marginal discoloration. The selective-etch technique is designed to harness the positive attributes of both techniques for improved clinical outcomes. In several recent studies, selective-etch adhesives were found to have increased enamel bonding while reporting no postoperative sensitivity.4,5 In a meta-analysis by Heintze and Rousson, they concluded that restorations placed with rubber-dam isolation and enamel-etching technique showed the best overall performance.6
Prime&Bond Elect™ is designed as a one-bottle dental adhesive suitable for all adhesive modes: total-etch, self-etch, and selective-etch. Built off of 13 years of proven PENTA (ie, the adhesive resin dipentaerythritol pentaacrylate monophosphate) technology from Prime&Bond NT™, this new bonding agent provides a unique micromechanical and chemical bond for long-term success.7 It is ideal in cases where the preparation is primarily in enamel and total-etch technique is indicated, in preparations in mostly dentin where a self-etch technique can be used, and for preparations containing significant enamel and dentin where a selective-etch technique is advised. According to Prime&Bond Elect’s directions for use, practitioners should not fear negative sequelae, such as decreased dentin bond strengths, if unintended phosphoric etchant gel contacts exposed dentin.8
1. Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials to enamel surfaces. J Dent Res. 1955;34(6):849-853.
2. Alex G. Is total-etch dead? Evidence suggests otherwise. Compend Contin Educ Dent. 2012;33(1):12-14, 16-22, 24-25.
3. Perdigão J, Geraldeli S, Hodges JS. Total-etch versus self-etch adhesive: effect on postoperative sensitivity. JADA. 2003;134(12):1621-1629.
4. Frankenberger R, Lohbauer U, Roggendorf MJ, et al. Selective enamel etching reconsidered: better than etch-and-rinse and self-etch? J Adhes Dent. 2008;10(5):339-344.
5. Perdigão J. New developments in dental adhesion. Dent Clin North Am. 2007;51(2):333-357.
6. Heintze SD, Rousson V. Clinical effectiveness of direct class II restorations - a meta-analysis. J Adhes Dent. 2012;14(5):407-431.
7. Van Landuyt KL, Snauwaert J, De Munck J, et al. Systematic review of the chemical composition of contemporary dental adhesives. Biomaterials. 2007;28(26):3757-3785.
8. Yazici AR, Akca T, Ozgünaltay G, Dayangaç B. Bond strength of a self-etching adhesive system to caries-affected dentin. Oper Dent. 2004;29(2): 176-181.
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