Effect of Adhesive Systems and Bevel on Enamel Margin Integrity in Primary and Permanent Teeth

Resident: Adam J. Bottrill
Date: 17NOV10
Region: Providence
Article title: Effect of Adhesive Systems and Bevel on Enamel Margin Integrity in Primary and Permanent Teeth
Author(s): Swanson T.K. et al.
Journal: Pediatric Dentistry
Page #s: 134-140
Date: V30/No2 Mar/Apr 08
Major topic: Marginal Integrity, Enamel Beveling, Self Etching
Minor topic(s): NA
Type of Article: In vitro, factorial-designed study
Main Purpose: The study compared the effectiveness of self-etch and total-etch adhesive systems in bonding to the beveled and nonbeveled margins of primary and permanent teeth.
Key points in the article discussion:

I. General:

A. Bonded interfaces are NOT perfect and confidence in their long-term durability is not complete.
B. "Self-etching" adhesives are being ADVERTISED as less technique sensitive, less time consuming yet just as effective as total-etch adhesives.
C. Three total steps... ETCH, PRIMER, ADHESIVE
D. Recent studies have shown there is no difference with current self-etch materials and whether or not the preparation is beveled.

II. Methods:

A. 3 Factors: tooth type, presence of a bevel, adhesive type
B. 2 preparations (beveled and non-beveled) completed on B surfaces of 60 extracted molars (30 primary, 30 permanent)
C. Randomely assigned self-etech vs total etch
D. Thermocycling.... staining.... sectioned.... measured for microleakage.


III. Results:

A. Beveled margins had less microleakage for both types of teeth.
B. Total-etch had less microleakage than self-etch adhesives. (53% primary 22% permanent !!!)
C. Self-etch had considerably more leakage on non-beveled preps
D. Comparably less microleakage for both types of etch on beveled margins.

IV. Conclustions:

A. Total etch AND beveled margins result in less leakage.
B. Beveling has greater effect on minimizing microleakage than type of adhesive.

Assessment of article: SHENANIGANS.
A. This should have been three studies. Not one... in my opinion.
B. With the self-etch method they used two coats.... WHAT'S THE POINT.
C. I rarely appreciate in vitro studies that attempt to mimic actual patient/clinical conditions.
D. Thermocycling? 131 degrees to 41 degrees? 500 times? Silver nitrate immersion?... come on man. That may be the closest they can achieve to actual conditions... still not the same as a mouth.