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Survey on protocols focused on adhesion procedures adopted by dentists
Abstract
Objective: The aim of the current study is to assess protocols focused on adhesive procedures practiced by dentists who work in Espírito Santo State (ES), based on questionnaire application. Methods: Dentists working in ES were invited to complete a virtual questionnaire about adhesion procedures associated with their clinical practice. Participants’ responses were tabulated for descriptive analysis purposes and compared to each other, based on the success/failure rate in restorative procedures reported by these professionals and on their understanding about the concept of adhesion. Collected data were subjected to statistical analysis based on using the Chi-square or Fisher's exact test, depending on the case. Results: One hundred and eighteen (118) professionals completed the questionnaire. Approximately 83.9% of them reported low failure rate in their restorative procedures, whereas 16.1% reported high failure rate. Moreover, 95.8% of participants reported to know the concept of adhesion, whereas only 4.2% reported not know it. Conclusion: It is possible concluding that, despite the low rate of failure in, and knowledge about, adhesion reported by the herein interviewed professionals, their knowledge about protocols on adhesive procedures to be adopted by dentists in ES remains incipient.
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It has been well-documented that uncontaminated ground enamel provides the most predictable substrate for the bonding of ceramic veneers, and thus conservative tooth preparation with complete isolation using a rubber dam is key to the long-term success of the restorations presented with five years of follow-up. Rubber dam isolation provides several advantages to the clinician, such as preventing contamination of the working field by saliva, blood, and sulcular fluids, and improving direct visibility. However, it may be a challenge to the younger clinician to properly isolate teeth prior to bonding ceramic veneer. The present case report demonstrated the sequence and some clinical tips for a case in which the rubber dam is placed from a second premolar to the opposite second premolar and held with clamps, the rubber dam is gently invaginated into the sulcus, and clamps are selected and placed on each tooth to create an ideal situation for the adhesion of the ceramic veneer. This step-by-step sequence may help the younger clinician in understanding how to gently manage soft tissue in order to properly provide complete isolation with rubber dam for future bonding of ceramic veneers. Following these methods, the clinician can achieve complete isolation, invaginate the rubber dam in the sulcus without causing tissues to bleed, and reduce the time needed for bonding procedures.
This paper presents state of the art universal adhesive systems and the effect of shelf-life and storage conditions on their bond performance. Three topics are explored in this review: an introduction to the topic, the mechanisms responsible for the degradation of the hybrid layer, and the factors that play a role in the stability of universal adhesives. In addition, issues such as potential durability and clinical importance are discussed. Universal adhesive systems are promising but must be handled and stored according to the manufacturer’s instructions, with careful attention given to the details of shelf-life and storage conditions for maximal success. It appears that the components of universal adhesives play an important role in their stability. Furthermore, HEMA-free formulations using methacrylamides lead to longer shelf-life. Further research is needed to prove these hypotheses.
The essential goal of any adhesive restoration is to achieve a tight and long-lasting adaptation of the restorative material to enamel and dentin. The key challenge for new dental adhesives is to be simultaneously effective on two dental substrates of conflicting nature. Some barriers must be overcome to accomplish this objective. While bonding to enamel by micromechanical interlocking of resin tags within the array of microporosities in acid-etched enamel can be reliably achieved and can effectively seal the restoration margins against leakage, bonding effectively and durably to organic and humid dentin is the most puzzling task in adhesive dentistry.
Much of the research and development of dental adhesives has focused on making the clinical procedure more user-friendly by reducing the number of bottles and/or steps. Although clinicians certainly prefer less complicated and more versatile adhesive materials, there is a trade-off between simplification of dental adhesives and clinical outcomes. Likewise, new materials are launched with claims of being novel and having special properties without much supporting evidence.
This review article discusses dental adhesion acknowledging pioneer work in the field, highlights the substrate as a major challenge to obtain durable adhesive restorations, as well as analyzes the three adhesion strategies and their shortcomings. It also reviews the potential of chemical/ionic dental adhesion, discusses the issue of extensively published laboratory research that does not translate to clinical relevance, and leaves a few thoughts in regard to recent research that may have implications for future adhesive materials.
Objectives: To address contemporary concepts in adhesive dental materials with emphasis on the evidence behind their clinical use.
Overview: Adhesive dentistry has undergone major transformations within the last 20 years. New dental adhesives and composite resins have been launched with special focus on their user-friendliness by reducing the number of components and/or clinical steps. The latest examples are universal adhesives and universal composite resins. While clinicians prefer multipurpose materials with shorter application times, the simplification of clinical procedures does not always result in the best clinical outcomes. This review summarizes the current evidence on adhesive restorative materialswith focus on universal adhesives and universal composite resins.
Conclusions: (a) Although the clinical behavior of universal adhesives has exceeded expectations, dentists still need to etch enamel to achieve durable restorations; (b) there is no clinical evidence to back some of the popular adjunct techniques used with dental adhesives, including glutaraldehyde-based desensitizers and matrix metalloproteinase inhibitors; and (c) the color adaptation potential of new universal composite resins has simplified their clinical application by combining multiple shades without using different translucencies of the same shade.
Clinical Significance: New adhesive restorative materials are easier to use than their predecessors, while providing excellent clinical outcomes without compromising the esthetic quality of the restorations.
Objectives
The present study aimed to investigate the changes in the enamel bond strengths of universal adhesives in the early phase of specimen creation and evaluate the effect of double-layer application on enamel bond effectiveness using different etching modes.Method
Four universal adhesives, namely Clearfil Universal Bond Quick, G-Premio Bond, Scotchbond Universal, and Tokuyama Universal Bond, were used. Clearfil SE Bond two-step self-etch adhesive system was used as a comparison. Fifteen specimens per group were used for determining the shear bond strength (SBS) to bovine enamel in the etch-and-rinse or self-etch mode. The adhesive was applied to specimens in accordance with the manufacturers’ instructions (single-layer application), or the adhesive was applied twice (double-layer application). The bonded specimens were stored in distilled water at 37 °C for 5 min or 1, 6, 12, or 24 h before SBS testing. The flexural properties of the resin composite Clearfil AP-X were measured for the same storage periods.ResultsAll universal adhesives exhibited increased SBS values with prolonged storage periods regardless of the application technique or etching mode used. Double-layer application was associated with higher SBS values than single-layer application for most universal adhesives over the same storage period.Conclusion
Phosphoric acid pre-etching and double-layer application of universal adhesives resulted in increased enamel bond strength in the early phase of specimen bonding.Clinical relevanceCare should be taken when using universal adhesives in the self-etch mode for enamel bonding because the enamel adhesion is sensitive to the duration after filling.
Introduction:
This review aimed to describe dental radiometers and discuss their effectiveness compared to other light-testing devices.
Materials and methods:
The search for light-curing units (LCUs), radiometers, and other light-measuring tools available on the market was accomplished on data found on PubMed, Wikipedia, and Google.
Results:
LCUs are prone to deterioration due to several reasons such as the light's limited life span, the worsening of the LCU's filters, light guide, and light tip end; consequently, decreased photopolymerization and insufficient resin conversion may occur. A regular light output assessment is highly recommended in dental daily practice as well as before any new LCU purchase to make sure the light features meet the factory specifications delivered by the manufacturer and they remained stable through time.
Discussion:
Irradiance values reported by radiometers do not match accurately with those delivered by laboratory power meters. Therefore, dental practitioners as well as dental students are advised to control regularly every LCU by using the same handheld radiometer.
Objectives
This study aimed to measure the microtensile bond strength (μTBS) of a new universal adhesive (UA) bonded to dentin following a quick bonding mode.
Materials and methods
The experimental UA ‘SKB-100,’ now commercialized as Clearfil Universal Bond Quick (‘C-UBq’; Kuraray Noritake), was investigated, with Scotchbond Universal (‘SBU’; 3M Oral Care) and the two-step self-etch (SE) adhesive Clearfil SE Bond 2 (‘C-SE2’; Kuraray Noritake) serving as references. The adhesives were employed separately in etch&rinse (E&R) and SE modes on each tooth half following a split-tooth design and following their respective instructions for use, except for C-UBq that besides the manufacturer’s instructed quick bonding mode was also applied and left untouched for 20 s prior to light curing (‘C-UBq_20s’) and for C-SE2 that was also applied in the E&R mode. μTBS of half of the specimens was measured upon 1 week (1w), with the other half tested after 6-month (6m) storage in distilled water at 37 °C. Data were statistically analyzed using linear mixed-effects modeling and three-way ANOVA (p < 0.05). The adhesive–dentin interfaces were ultrastructurally characterized by TEM.
Results
C-UBq revealed a significantly lower μTBS than C-SE2. The highest μTBS was recorded for C-UBq_20s_1w and C-SE2_1w, both when applied in E&R mode. However, μTBS of C-UBq_20s significantly decreased upon aging in both modes. C-SE2 presented the significantly highest ‘aged’ μTBS.
Conclusion
C-UBq applied in the quick bonding mode did not underperform to the UAs applied for 20 s. Superior bonding effectiveness was achieved by C-SE2 in SE and E&R bonding modes.
Clinical relevance
Extended application time of C-UBq improved solely its immediate but not aged bonding effectiveness.
This study evaluated the immediate and 6-month dentin bond strength of universal adhesives used in etch-and-rinse or self-etch bonding strategies. The adhesives tested were Ambar Universal, G-Bond, Single Bond Universal, Tetric N-Bond Universal, and Ybond Universal. Gold standard adhesives (Scotchbond Multipurpose Plus and Clearfil SE Bond) were controls. Microtensile dentin bond strength (n=5 teeth), pH, and C=C conversion (n=3) were evaluated. Data were analyzed at α=0.05. All adhesives showed differences in pH. Ybond had intermediately strong aggressiveness, whereas the others were ultra-mild. The C=C conversion was different in most adhesives. In the etch-and-rinse strategy, all adhesives showed similar results generally except for G-Bond, which had lower bond strength than most adhesives. G-Bond and Tetric-N-Bond showed lower bond strengths after 6 months compared with 24 h, whereas the other adhesives had stable dentin bonds. In the self-etch strategy, G-Bond had lower bond strength than most adhesives. After 6 months, Ambar was the only adhesive showing lower dentin bond strength compared with 24 h. Most adhesives had discreet drops in bond strength during aging when used in the self-etch strategy. The failure modes were also material dependent, with a general pattern of increased adhesive and/or pre-testing failures after storage. In conclusion, the bonding performance of universal adhesives to dentin is material dependent. Most adhesives had stable dentin bonds with results comparable to the gold standard materials, particularly when applied in the self-etch mode. In general, it seems the use of universal adhesives in dentin should not be preceded by phosphoric acid etching.
Increasing demand for simplified and user‐friendly adhesive systems has led to the development of a new class of adhesives termed as Universal Adhesives (UAs). The term “Universal” reflects manufacturers' claims that these adhesives can be applied with any adhesion strategy and offer the versatility of use with a variety of direct and indirect restorative materials. The aim of this review was to synthesize the literature regarding the current status of UAs, their adhesion potential to various substrates and their performance in different restorative situations. In vitro studies, clinical trials and systematic reviews were identified utilizing controlled vocabulary and keyword searches in Medline and EMBASE databases. About 282 studies (272 in vitro studies; 11 clinical studies) were included. Available laboratory and clinical evidence does not support the claim that UAs can be used with any adhesive strategy. Although, they can chemically bond to various tooth and direct/indirect restorative substrates, the stability of this bond is material‐dependent and subject to hydrolytic degradation. Hence, additional measures are still needed to ensure long‐term durability. which undermines the versatility of UAs. The lack of long‐term data regarding the clinical performance of UAs further complicates clinical decision‐making. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res B Part B: 00B: 000–000, 2019.
Currently, the long-term success of esthetic rehabilitation with ceramics is required. Hence, professional knowledge about the most indicated dental material for each clinical situation as well as its usage protocol is essential. The aim of this systematic review of clinical and laboratorial studies was to compare the bond strength of prostheses using silane incorporated to universal adhesives or applied separately. The literature search in databases “Cochrane Library,” “MEDLINE,” “Web of Science,” “Scopus,” “LILACS,” “Scielo,” and “Google Scholar” was based on the keywords “Silane;” “Silanes;” “Silane coupling agent;” “Universal adhesive;” and “Universal adhesives.” A total of five articles were included in this review. In general, the studies showed better results for ceramic etching with hydrofluoric acid and application of silane separately to the universal adhesive. As a conclusion, the treatment with pure silane or as an additional pretreatment with universal adhesives improved the bond strength of glass ceramics. Hence, higher shear bond strength can be achieved, resulting in treatment longevity.
Bonding plays a major role in dentistry nowadays. Dental adhesives are used in association with composites to solve many restorative issues. However, the wide variety of bonding agents currently available makes it difficult for clinicians to choose the best alternative in terms of material and technique, especially when different clinical situations are considered. Moreover, although bonding agents allow for a more conservative restorative approach, achieving a durable adhesive interface remains a matter of concern, and this mainly due to degradation of the bonding complex in the challenging oral environment. This review aims to present strategies that are being used or those still in development which may help to prevent degradation. It is fundamental that professionals are aware of these strategies to counteract degradation as much as possible. None of them are efficient to completely solve this problem, but they certainly represent reasonable alternatives to increase the lifetime of adhesive restorations.
Objectives:
This study aimed to investigate dentists' exposure to curing light and to obtain information about the dentists' knowledge on practical use and technical features of their curing lights as well as their safety awareness.
Methods:
A pre-coded questionnaire was sent electronically to all dentists (n=1313) in the Public Dental Service (PDS) in Norway in 2015.
Results:
The Response rate was 55.8%. The dentists spent on average 57.5% of their working days placing restorations, ranging from 1 to 30 (mean 7.7, SD 3.6) restorations per day. The average length of light curing one normal layer of composite was 27s. The longest individual mean curing time per day was about 100 times higher than that of the lowest. The mean curing time for lamps of the lower reported irradiances was similar to the time representing exceedance of international guidelines for limit values for blue light to the eyes. Almost one-third of the dentists used inadequate eye protection against blue light. The odds of using adequate eye protection were significantly higher among young dentists (p<0.01). The majority of the respondents (78.3%) were unaware of the irradiance value of their curing lights, thus rendering the curing time uncertain. More dentists in this group did not perform regular maintenance of their curing lights compared with all respondents (17.1% vs. 3.3%, p<0.01).
Conclusions:
This study revealed considerable variations among Norwegian dentists in the Public Dental Service with respect to performance of light curing of restorations, safety awareness and technical knowledge of the curing light. CLINICAL SIGNIFICANCE (MAX. 50 WORDS): The questionnaire study identifies specific knowledge gaps among Norwegian dentists with regard to curing lights and use of personal protection. Today's dependence on technology in dentistry necessitates that the operator possesses knowledge of essential technical specifications and safe use of devices and instruments routinely used in dental treatment.
Este artigo apresenta o estado da arte de sistemas adesivos autocondicionantes.
Quatro temas são apresentados nesta revisão: o histórico desta categoria de agentes
de união, o mecanismo de adesão, as características/propriedades, e a formação da
zona ácido-base resistente nas interfaces esmalte/dentina-adesivo. Além disso, as
vantagens relativas aos sistemas de condicionamento total ( etch-and-rinse ) e as
classificações dos sistemas adesivos autocondicionantes de acordo com o número de
passos e acidez são abordados. Por fim, são discutidas questões como a durabilidade
potencial e a importância clínica. Sistemas adesivos autocondicionantes são materiais
promissores porque são fáceis de usar, unem-se quimicamente à estrutura do dente e
preservam a hidroxiapatita dentinária, o que é importante para a durabilidade da
ligação.
Background:
The effective control of moisture and microbes is necessary for the success of restoration procedures. The rubber dam, as an isolation method, has been widely used in dental restorative treatments. The effects of rubber dam usage on the longevity and quality of dental restorations still require evidence-based discussion. This review compares the effects of rubber dam with other isolation methods in dental restorative treatments. This is an update of the Cochrane Review first published in 2016.
Objectives:
To assess the effects of rubber dam isolation compared with other types of isolation used for direct and indirect restorative treatments in dental patients.
Search methods:
Cochrane Oral Health's Information specialist searched the following electronic databases: Cochrane Oral Health's Trials Register (searched 13 January 2021), Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 12) in the Cochrane Library (searched 13 January 2021), MEDLINE Ovid (1946 to 13 January 2021), Embase Ovid (1980 to 13 January 2021), LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 13 January 2021), and SciELO BIREME Virtual Health Library (1998 to 13 January 2021). We also searched Chinese BioMedical Literature Database (CBM, in Chinese) (1978 to 13 January 2021), VIP database (in Chinese) (1989 to 13 January 2021), and China National Knowledge Infrastructure (CNKI, in Chinese) (1994 to 13 January 2021). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform, OpenGrey, and Sciencepaper Online (in Chinese) for ongoing trials. There were no restrictions on the language or date of publication when searching the electronic databases.
Selection criteria:
We included randomised controlled trials (including split-mouth trials) over one month in length assessing the effects of rubber dam compared with alternative isolation methods for dental restorative treatments.
Data collection and analysis:
Two review authors independently screened the results of the electronic searches, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. We strictly followed Cochrane's statistical guidelines and assessed the certainty of the evidence using GRADE.
Main results:
We included six studies conducted worldwide between 2010 and 2015 involving a total of 1342 participants (of which 233 participants were lost to follow-up). All the included studies were at high risk of bias. Five studies compared rubber dam with traditional cotton rolls isolation. One study was excluded from the analysis due to inconsistencies in the presented data. Of the four remaining trials, three reported survival rates of the restorations with a minimum follow-up of six months. Pooled results from two studies involving 192 participants indicated that the use of rubber dam isolation may increase the survival rates of direct composite restorations of non-carious cervical lesions (NCCLs) at six months (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.05 to 4.99; low-certainty evidence). However, the use of rubber dam in NCCLs composite restorations may have little to no effect on the survival rates of the restorations compared to cotton rolls at 12 months (OR 1.38, 95% CI 0.45 to 4.28; 1 study, 30 participants; very low-certainty evidence) and at 18 months (OR 1.00, 95% CI 0.45 to 2.25; 1 study, 30 participants; very low-certainty evidence) but the evidence is very uncertain. At 24 months, the use of rubber dam may decrease the risk of failure of the restorations in children undergoing proximal atraumatic restorative treatment in primary molars but the evidence is very uncertain (hazard ratio (HR) 0.80, 95% CI 0.66 to 0.97; 1 study, 559 participants; very low-certainty evidence). None of the included studies mentioned adverse effects or reported the direct cost of the treatment.
Authors' conclusions:
This review found some low-certainty evidence that the use of rubber dam in dental direct restorative treatments may lead to a lower failure rate of the restorations compared with cotton roll usage after six months. At other time points, the evidence is very uncertain. Further high-quality research evaluating the effects of rubber dam usage on different types of restorative treatments is required.
Objective. This study systematically reviews the literature on self-healing microcapsule tech- nology and evaluates the biocompatibility of self-healing microcapsules and the efficiency of crack repair within resin-based dental composites.
Methods. An electronic search was carried out using the following databases: MedLine (PubMed), Embase, the Cochrane Library and Google Scholar. All titles and abstracts of the arti- cles and patents found were analysed and selected according to the eligibility criteria. Only studies published in English were included; the outcomes sought for this review were den- tal resin composites with self-healing potential. There were no restrictions on the type of self-healing system involved in dental resin composites.
Results. The search yielded 10 studies and 2 patents involving self-healing approaches to dental resin composites. According to the current literature on self-healing dental resin com- posites, when a crack or damage occurs to the composite, microcapsules rupture, releasing the healing agent to repair the crack with a self-healing performance ranging from 25% to 80% of the virgin fracture toughness.
Significance. Self-healing strategies used with resin composite materials have, to date, been bioinspired. So far, self-healing microcapsule systems within dental composites include poly urea-formaldehyde (PUF) or silica microcapsules. The main healing agents used in PUF microcapsules are DCPD monomer and TEGDMA-DHEPT, with other agents also explored. Silica microcapsules use water/polyacid as a healing agent. All self-healing systems have shown promising results for self-repair and crack inhibition, suggesting a prolonged life of dental composite restorations. More investigations and mechanical enhancements should be directed toward self-healing technologies in dental resin composites.
From the conception of resin–enamel adhesion to today's contemporary dental adhesive systems, clinicians are no longer afraid of exploring the many advantages brought by adhesive restorative concepts. To maximize the performance of adhesive-based restorative procedures, practitioners must be familiar with the mechanism of adhesion, clinical indications, proper handling, the inherent limitations of the materials and the biological challenges. This review provides an overview of the current status of restorative dental adhesives, their mechanism of adhesion, mechanisms of degradation of dental adhesive interfaces, how to maximize performance, and future trends in adhesive dentistry.
Light Curing Units (LCUs) are used daily in almost every dental office to photocure resins, but because the light is so bright, the user is unable to tell visually if there are any differences between different LCUs. This study evaluated the light output from six dental LCUs: Elipar Deep Cure-S (3M ESPE), Bluephase G2 (Ivoclar Vivadent), Translux 2Wave (Heraeus Kulzer), Optilight Prime (Gnatus), Slim Blast (First Medica) and Led.B (Guilin Woodpecker) with a fully charged battery, after 50, and again after 100, 20 second light exposures. For each situation, the radiant power was measured 10 times with a laboratory-grade power meter. Then, the emission spectrum was measured using a fiber-optic spectrometer followed by an analysis of the light beam profile. It was found there were significant differences in the LCU power and the irradiance values between the LCUs (p < 0.01). The Optilight Prime and Slim Blast LCUs showed a significant reduction in light output after a 50 and 100 exposures, while Bluephase G2 exhibited a significant reduction only after 100 exposures (p < 0.01). The Bluephase G2 and Translux 2 Wave delivered an emission spectrum that had two distinct wavelength emission peaks. Only the Elipar Deep Cure-S and Bluephase G2 LCUs displayed homogeneous light beam profiles, the other LCUs exhibited highly non-homogeneous light beam profiles. It was concluded that contemporary LCUs could have very different light output characteristics. Both manufacturers and researchers should provide more information about the light output from LCUs.
Introduction:
To evaluate the influence of storage time on the elastic modulus, micromorphology, nanoleakage, and micromechanical behavior of the dentin-adhesive interfaces of five adhesive systems (Scotchbond Multi-Purpose, Clearfil SE Bond, One Up Bond F, Adper Easy One, and Filtek LS Adhesive) after 24h (T0) and 12 months (T1).
Methods:
Fifty teeth were restored and distributed according to each adhesive system (n=10). At least four specimens were obtained from each tooth. One specimen was evaluated under SEM to obtain the micromorphology of dentin-adhesive interface (DAI). Two specimens were used to assess nanoleakage, one tested in T0 and the other in T1. The last specimen was used for nanoindentation, in T0 and T1, to obtain the initial and final mechanical properties of DAI structures. Two non-restored teeth were evaluated under SEM to obtain the dentin morphology. Laboratorial data were used to build 15 finite element models to assess the maximum principal stress in each time of analysis.
Results:
Storage resulted in hydrolysis of the dentin-adhesive interfaces for all groups. Silver impregnation increased for all groups after 1 year storage (p<.05), except for Clearfil SE Bond. In general, a decrease in elastic modulus values was observed for all groups from T0 to T1 (p<.05), mainly at the hybrid layer. The FEAs showed higher stress levels at T1 than T0 simulations for all adhesives.
Conclusion:
At T1, degradation occurred at the dentin-adhesive interface formed by all adhesives, and the intensity of degradation differed depending on the type of adhesive system used. The interface formed by the self-etching primer containing the 10-MDP functional monomer showed the highest stability among the adhesive systems after 12 months of storage.
The laboratory-based enamel acid-etching doctrine with 30% to 50% phosphoric acid for 60 seconds to generate the maximum amount of Type 1 and/or Type 2 etch pattern has been established for more than 30 years. However, this recommendation may not be clinically relevant.
The purpose of this systematic review was to compare clinically accepted protocols of enamel acid etching with the laboratory protocol.
Studies were identified by searching 4 electronic databases: Medline, CINAHL Plus, Embase, and Cochrane Library. The final search was run on November 8, 2012. All clinical studies published in English that investigated enamel acid pretreatment methods on human permanent teeth were included. Additional publications were obtained from the reference lists of the included studies. The clinical evidence of all included studies was tabulated.
Initially, 4543 publications were retrieved from the databases. A total of 4508 articles were excluded, including 2285 duplicates, 1805 publications according to exclusion criteria by their titles and abstracts, 368 laboratory articles, 49 reviews, and 1 pilot study. Only 1 study was added from reference lists of the included studies. Finally, 36 clinical publications were included. The included clinical studies provided different levels of clinical evidence on the efficacy of acid-etching protocols to enable successful enamel adhesion.
Clinical protocols of enamel acid etching differ from the laboratory-generated doctrine, which may imply that maximization of the Type 1 and/or Type 2 etch pattern is not important in the clinical acid etching of human enamel.
Evaluation of bond strength and thickness of adhesive layer according to the techniques of applying adhesives in composite resin restorations
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