Van Meerbeek Bart, De Munck Jan, Yoshida Yasuhiro, Inoue Satoshi, Vargas Marcos, Vijay Padmini, Van Landuyt Kirsten, Lambrechts Paul, Vanherle Guido
Leuven BIOMAT Research Cluster, Department of Conservative Dentistry, School of Dentistry, Oral Pathology and Maxillo-facial Surgery, Catholic University of Leuven, Belgium.
Oper Dent. 2003 May-Jun;28(3):215-35.
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.
与牙齿组织的粘结可以通过“酸蚀冲洗”、“自酸蚀”或“玻璃离子”方法来实现。在本文中，通过对牙齿-生物材料界面相互作用的超微形态学和化学表征，阐述了这三种方法与牙釉质和牙本质的基本粘结机制。此外，还评估了粘结强度测试和边缘封闭效果测量（实验室中确定“粘结效果”最常用的两种方法）在预测临床性能方面的价值和相关性。利用最近开发的微旋转疲劳测试装置，引入了一种在疲劳模式下测试生物材料与牙齿粘结的新动态方法。最终，将根据当今粘合剂在各种实验室研究和临床试验中的表现进行严格权衡。特别关注了酸蚀冲洗法与自酸蚀法的优缺点以及这些粘合剂的长期性能。将实验室收集的数据与临床结果相关联清楚地表明，实验室研究能够预测临床效果。尽管有简化粘结程序的趋势，但所呈现的数据证实，传统的三步酸蚀冲洗粘合剂在长期来看仍然表现最佳且最可靠。然而，自酸蚀方法可能具有最好的未来前景。在临床上，当粘合剂不再需要“酸蚀冲洗”步骤时，应用时间，可能更重要的是，技术敏感性会大幅降低。特别是通过与牙齿组织的微机械和化学相互作用相结合来粘结的“温和”两步自酸蚀粘合剂，其粘结性能已非常接近传统的三步系统。
