Critical appraisal: adhesive-composite incompatibility, part I.
Apart from some questions related to the repairability of resin composite restorations, dentists have always assumed that methacrylate-based resins are compatible with each other. For example, there is no clinically relevant problem in using a microfilled composite to laminate a Class IV restoration made with a hybrid composite, even if they are not of the same brand or manufacturer. In the context of adhesive systems, we have always believed that resin composites, regardless of their type or composition, bond well to all types of bonding agents. However, unexpected debonding of self-cured, core buildup composites that had been bonded with single-bottle adhesive systems was reported about 5 years ago. Subsequent studies demonstrated that there were, indeed, compatibility problems between simplified adhesive systems and self- or dual-cured resin composites. Apparently, when such combinations are used, reduced bond strengths and subsequent failures at the resin-adhesive interface can occur because of adverse reactions between the acidic resin monomers, an integral part of the simplified adhesive systems, and the chemicals involved in the polymerization mechanism of the self- or dual-cured composites, particularly the basic tertiary amines. At least one research group has expanded the information on this issue by further investigating the mechanisms involved in this phenomenon. This group demonstrated that not only adverse chemical reactions but also the permeability of such simplified systems contribute to the compromised bonding. This issue has profound clinical implications in view of the wide use of self- and dual-cured composites as core buildup materials and in the bonding of indirect restorations and endodontic posts. Some of the most representative studies of this group are described in this Critical Appraisal. Part II will appear in the next issue of the Journal.
Carvalho
Ricardo M
RM
Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil. ricfob@fob.usp.br
Garcia
Fernanda Cristina P
FC
E Silva
Safira M A
SM
Castro
Fabrício L A
FL