Dental News June 2021

Page 10

Adhesion: Restorative Dentistry George Freedman DDS, DiplABAD, FIADFE, FAACD, FASDA Adjunct Professor, Western University of Dental Medicine, Pomona CA

Past, Present, and Future Bonding agents were tentatively introduced in the early 1970s. Since then, the evolution of adhesive techniques has transformed the scope of dental practice. Arguably, the high impact of bonded, appearance-transforming dental restoratives has propelled the dental profession into its greatest prominence in history. In fact, most direct and indirect restorations are adhered to natural tooth structure rather than cemented or mechanically retained. For more than 30 years, highly competitive research and aggressive product development have improved adhesives, initiating, and then fueling, patient demands for conservatively improved oral appearance. The widespread demand and universal use of dental adhesives has largely been a function of two factors: composite restorations are more esthetic than their precursors, and the adhesive margin is more clinically predictable than a non-

bonded interface. The rapid and intensive development of better and easier dental adhesives has focused on simplifying the clinical procedure; decades ago, resin practitioners were faced with a veritable chemistry set of materials to mix and match, in very specific sequences, in order to develop a suitable micromechanical bond between the tooth and the restoration. Adhesion, as defined by most current materials, is micromechanical attachment, not chemical bonding, to enamel and dentin. Dentists were inundated by successive “generations” of adhesive materials in relatively rapid succession. While there is no scientific basis for the term “generation” in dental adhesives, and the classification is to some extent arbitrary, it has served a very useful purpose in the organization of hundreds of commercially available products into a small number of more comprehensible and readily manageable categories.

Generational designations assist in classifying the specific adhesive chemistries involved. They are also very useful in predicting the strengths of the dentinal bond and the ease of clinical use. Generational classification benefits both dentist and patient by simplifying the clinician’s chairside tasks and workflow. The last disruptive advance in adhesive generations (7th generation iBond) was introduced in 2002. Since then, many competitive and innovative bonding agents have been developed, ranging from 4th to 7th generation. The vast majority of these adhesives


Dental News

June 2021