title: Buonocore memorial lecture. Adhesion to enamel and dentin: current status and future challenges.
abstract: Bonding to tooth tissue can be achieved through an "etch&rinse," "self-etch" or "glass-ionomer" approach. In this paper, the basic bonding mechanism to enamel and dentin of these three approaches is demonstrated by means of ultramorphological and chemical characterization of tooth-biomaterial interfacial interactions. Furthermore, bond-strength testing and measurement of marginal-sealing effectiveness (the two most commonly employed methodologies to determine "bonding effectiveness" in the laboratory) are evaluated upon their value and relevance in predicting clinical performance. A new dynamic methodology to test biomaterial-tooth bonds in a fatigue mode is introduced with a recently developed micro-rotary fatigue-testing device. Eventually, today's adhesives will be critically weighted upon their performance in diverse laboratory studies and clinical trials. Special attention has been given to the benefits/drawbacks of an etch&rinse versus a self-etch approach and the long-term performance of these adhesives. Correlating data gathered in the laboratory with clinical results clearly showed that laboratory research CAN predict clinical effectiveness. Although there is a tendency to simplify bonding procedures, the data presented confirm that conventional three-step etch&rinse adhesives still perform most favorably and are most reliable in the long-term. Nevertheless, a self-etch approach may have the best future perspective. Clinically, when adhesives no longer require an "etch&rinse" step, the application time, and probably more importantly, the technique-sensitivity are substantially reduced. Especially "mild," two-step self-etch adhesives that bond through a combined micromechanical and chemical interaction with tooth tissue closely approach conventional three-step systems in bonding performance.
authors.affiliation: Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-facial Surgery, Catholic University of Leuven, Belgium. bart.vanmeerbeek@med.kuleuven.ac.be
authors.forename: Bart
authors.initials: B
authors.lastname: Van Meerbeek
authors.forename: Jan
authors.initials: J
authors.lastname: De Munck
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Inoue
authors.forename: Marcos
authors.initials: M
authors.lastname: Vargas
authors.forename: Padmini
authors.initials: P
authors.lastname: Vijay
authors.forename: Kirsten
authors.initials: K
authors.lastname: Van Landuyt
authors.forename: Paul
authors.initials: P
authors.lastname: Lambrechts
authors.forename: Guido
authors.initials: G
authors.lastname: Vanherle
mesh_terms: D000134:Acid Etching, Dental / Q000379:methods; D000269:Adhesives / Q000737:chemistry; D001672:Biocompatible Materials / Q000737:chemistry; D001840:Dental Bonding / Q000379:methods; D003743:Dental Enamel / Q000648:ultrastructure*; D003764:Dental Materials / Q000737:chemistry*; D003804:Dentin / Q000648:ultrastructure*; D005544:Forecasting; D005899:Glass Ionomer Cements / Q000737:chemistry; D006801:Humans; D013314:Stress, Mechanical; D013499:Surface Properties
chemical_list: D000269:Adhesives; D001672:Biocompatible Materials; D003764:Dental Materials; D005899:Glass Ionomer Cements