Mission: Possible

Adhesive dentistry is a complex discipline that has greatly evolved, and thus, there are still many misunderstandings regarding what is and is not possible. After eight different generations of adhesive systems, it is more important than ever that we carefully follow the instructions for use (IFU) of our chosen bonding agents and that we appreciate the nuances of the research that has been conducted regarding the techniques and protocols that deliver the best long-term results. Therefore, for Inside Dentistry's 2023 special issue on adhesion, we've assembled some of the most preeminent authorities on adhesive dentistry to provide you with insights.

One of the greatest misunderstandings is the belief that you cannot reliably bond to dentin long term. I've been bonding to dentin for more than 30 years, and in the 1980s, we didn't even have dentin bonding agents. Because the bond to enamel is so strong, if the preparation involves a sufficient amount, the bond strength to dentin is almost immaterial. Nonetheless, a strong bond to dentin can be achieved. With a fourth-generation adhesive, you can separately etch dentin, but with a universal adhesive, excellent dentin bond strength is achieved in the self-etch mode. Exactly how strong of a bond will depend on many factors, such as how long the adhesive was scrubbed, how long it was air-thinned, how many layers were applied, and more. When balancing the desire for long-term success with the need for practice efficiency, the real question is how strong is strong enough? Perhaps the greatest fallacy in adhesive dentistry is that you cannot bond zirconia restorations. Since Kuraray's original patent expired, virtually all adhesive systems contain the monomer 10-MDP, which, when combined with appropriate particle abrasion of the surface of the zirconia, facilitates excellent bond strength.

The science behind adhesive dentistry may be complex, but mastery of it is essential to the future of the profession because it is the main driver of our ability to deliver the most minimally invasive restorations and extend the overall lives of our patients' dentition. Bottom line: when a modern universal adhesive is used with a selective-etch technique and the correct cleaning protocol and primer for the chosen restorative material—you can bond anything.

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com