Bonding and Etching in one?

[grinningrice]

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I might look like a complete fool posting this, but I was wondering if anyone here had any experiance with the bonding and etching in one step? My dentist has been doing etching and bonding seperatly, and does not think "total etching" could be as affective. What do you guys think?

 

[GoGatorsDMD]

It seems pretty counterintuitive to me, as it does to the biomaterials faculty at my school. A big part of the etching process is that you wash away debris after the etch. Wouldn't bonding simultaneously incorporate acid and all the mineral crap that you want to get rid of into the restoration?

Combining primer and bonding agent, that seems to work pretty well if the dentist is smart enough to follow the directions.

Just because a company makes a product and puts it in a pretty box doesn't mean it works. That's one of the things they try to hammer home to you in dental school.

 

[herodontist]

Actually, etching and bonding in one step does work...and i'm speaking from experience. The agent removes the smear layer like an etchant, but does not remove the smear plugs, unlike an etchant. Upshot is that bond strengths are lower than with the conventional 'total etch' systems, but still well within required range for most applications.

 

[DrJeff]

Actually, etching and bonding in one step does work...and i'm speaking from experience. The agent removes the smear layer like an etchant, but does not remove the smear plugs, unlike an etchant. Upshot is that bond strengths are lower than with the conventional 'total etch' systems, but still well within required range for most applications.

Pros and Cons of seperate etch/bond vs. "one step" etch and bond.

Pros of "one step" - less materials, less steps, less chances for operator error (assuming you follow the directions).

Cons of "one step" - lower bond stregths, in reality doesn't save as much time as the manufacturer claims leed one to believe, can't use with dual cure cements/core build up materials

Pros of seperate etch/bond - long standing tried and true chemistry, relatively easy to use, greater bond strengths than "one step", can use with dual cure cements/core build up materials

Cons of seperate etch/bond - extra steps, *may* have greater post-op sensitivity.

From my own clinical experience, I've been a user of the 5th generation (seperate etch/bond) almost my entire career, and I do keep trying other bonding agents and keep going back to my "old faithfull" bonding agent (I use Jeneric Pentron's Bond-1). I like it because it's easy for me to use in my hands, and I have very low post treatment sensitvity issues with it. I started using some of the self etching "one step" systems (6th generation opti-bond solo+ and a 7th generation I-Bond). I found very similiar low sensitivity issues, but I would see some marginal discoloration multiple months out. I did not see anything resembling the decreased bond strengths reports on clinical observations.

In general, what many manufactuers are promoting as a benefit of the self etching bonding agents is lower sensitivty due to the smear plugs remaining intact and occulding the tubules. Often with seperate etch/bond systems the post op sensitivty will be due to inadequate "volumes" of bonding agent being applied. i.e. if the manufacturer says "apply liberally", then put ALOT of coats on there with a SATURATED brush or else your much more likely to hear your patients complaining of post bonding sensitivity.

 

[herodontist]

Pros and Cons of seperate etch/bond vs. "one step" etch and bond.

Pros of "one step" - less materials, less steps, less chances for operator error (assuming you follow the directions).

Cons of "one step" - lower bond stregths, in reality doesn't save as much time as the manufacturer claims leed one to believe, can't use with dual cure cements/core build up materials

Pros of seperate etch/bond - long standing tried and true chemistry, relatively easy to use, greater bond strengths than "one step", can use with dual cure cements/core build up materials

Cons of seperate etch/bond - extra steps, *may* have greater post-op sensitivity.

From my own clinical experience, I've been a user of the 5th generation (seperate etch/bond) almost my entire career, and I do keep trying other bonding agents and keep going back to my "old faithfull" bonding agent (I use Jeneric Pentron's Bond-1). I like it because it's easy for me to use in my hands, and I have very low post treatment sensitvity issues with it. I started using some of the self etching "one step" systems (6th generation opti-bond solo+ and a 7th generation I-Bond). I found very similiar low sensitivity issues, but I would see some marginal discoloration multiple months out. I did not see anything resembling the decreased bond strengths reports on clinical observations.

In general, what many manufactuers are promoting as a benefit of the self etching bonding agents is lower sensitivty due to the smear plugs remaining intact and occulding the tubules. Often with seperate etch/bond systems the post op sensitivty will be due to inadequate "volumes" of bonding agent being applied. i.e. if the manufacturer says "apply liberally", then put ALOT of coats on there with a SATURATED brush or else your much more likely to hear your patients complaining of post bonding sensitivity.

Awesome post 👍 What's your opinion of I-bond? I attended a CE program where the lecturer said that in industry parlance I-bond actually stands for 'I wish it would bond"

 

[DrJeff]

Awesome post 👍 What's your opinion of I-bond? I attended a CE program where the lecturer said that in industry parlance I-bond actually stands for 'I wish it would bond"

I never noticed any significant differences clinically in bond strengths between I-Bond retained restorations, Bond-1 retained restorations and Opti-Bond Solo reetained restorations. The biggest difference that I would notice with the I-Bond restorations is sometimes between 6 to 12 months post placement you'd see some staining out past where I prepped the enamel and some I-Bond was present. Kind of frustrating to have to either buff out the restoration or in some instances replace it due to esthetics. On the flip side, I had a few restorations where I used I-Bond that I would have classified as "future root canal teeth" (i.e. the restoration was very, very close to the pulp when placed) and I still haven't seen one of them flare up (in some cases it's been over 3 years clinically now). As near as I can figure one of the key components of I-Bond, Glutaraldehyde, may very well have just simply caused a "quiet death" of the pulp, if any death all!