Department of Oral Biological and Medical Sciences, Division of Biomaterials, University of British Columbia, Vancouver, Canada.
Dent Mater. 2012 Jan;28(1):72-86. doi: 10.1016/j.dental.2011.09.011.
Resin-dentin bond strength durability testing has been extensively used to evaluate the effectiveness of adhesive systems and the applicability of new strategies to improve that property. Clinical effectiveness is determined by the survival rates of restorations placed in non-carious cervical lesions (NCCL). While there is evidence that the bond strength data generated in laboratory studies somehow correlates with the clinical outcome of NCCL restorations, it is questionable whether the knowledge of bonding mechanisms obtained from laboratory testing can be used to justify clinical performance of resin-dentin bonds. There are significant morphological and structural differences between the bonding substrate used in in vitro testing versus the substrate encountered in NCCL. These differences qualify NCCL as a hostile substrate for bonding, yielding bond strengths that are usually lower than those obtained in normal dentin. However, clinical survival time of NCCL restorations often surpass the durability of normal dentin tested in the laboratory. Likewise, clinical reports on the long-term survival rates of posterior composite restorations defy the relatively rapid rate of degradation of adhesive interfaces reported in laboratory studies. This article critically analyzes how the effectiveness of adhesive systems is currently measured, to identify gaps in knowledge where new research could be encouraged. The morphological and chemical analysis of bonded interfaces of resin composite restorations in teeth that had been in clinical service for many years, but were extracted for periodontal reasons, could be a useful tool to observe the ultrastructural characteristics of restorations that are regarded as clinically acceptable. This could help determine how much degradation is acceptable for clinical success.
树脂-牙本质黏结强度耐久性测试已广泛用于评估黏结系统的有效性和新策略的适用性，以改善该性能。临床效果取决于非龋性颈领病变（NCCL）中修复体的存活率。虽然有证据表明，实验室研究中产生的黏结强度数据与 NCCL 修复体的临床结果有些相关，但从实验室测试中获得的黏结机制知识是否可以用于证明树脂-牙本质黏结的临床性能，这是值得怀疑的。在体外测试中使用的黏结基底与 NCCL 中遇到的基底之间存在显著的形态和结构差异。这些差异使 NCCL 成为黏结的恶劣基底，产生的黏结强度通常低于正常牙本质中获得的强度。然而，NCCL 修复体的临床存活时间通常超过实验室中测试的正常牙本质的耐久性。同样，关于后牙复合树脂修复体长期存活率的临床报告也与实验室研究中报告的黏结界面快速降解相矛盾。本文批判性地分析了目前如何衡量黏结系统的有效性，以确定在哪些方面存在知识差距，可以鼓励开展新的研究。对在临床服务多年后因牙周原因而被提取的牙齿中树脂复合修复体的黏结界面进行形态和化学分析，可能是观察被认为临床可接受的修复体超微结构特征的有用工具。这有助于确定多少降解是可接受的临床成功。
