Alex Gary
Private Practice, Huntington, New York.
Compend Contin Educ Dent. 2015 Jan;36(1):15-26; quiz 28, 40.
Every so often a new material, technique, or technological breakthrough spurs a paradigm shift in the way dentistry is practiced. The development and evolution of reliable enamel and dentin bonding agents is one such example. Indeed, the so-called "cosmetic revolution" in dentistry blossomed in large part due to dramatic advances in adhesive technology. It is the ability to bond various materials in a reasonably predictable fashion to both enamel and dentin substrates that enables dentists to routinely place porcelain veneers, direct and indirect composites, and a plethora of other restorative and esthetic materials. In fact, the longevity and predictability of many (if not most) current restorative procedures is wholly predicated on the dentist's ability to bond various materials to tooth tissues. Adhesive systems have progressed from the largely ineffective systems of the 1970s and early 1980s to the relatively successful total- and self-etching systems of today. The latest players in the adhesive marketplace are the so-called "universal adhesives." In theory, these systems have the potential to significantly simplify and expedite adhesive protocols and may indeed represent the next evolution in adhesive dentistry. But what defines a universal system, and are all these new systems truly "universal" and everything they are claimed to be? This article will examine the origin, chemistry, strengths, weaknesses, and clinical relevance of this new genre of dental adhesives.
每隔一段时间,一种新的材料、技术或技术突破就会促使牙科实践方式发生范式转变。可靠的牙釉质和牙本质粘结剂的发展与演变就是这样一个例子。事实上,牙科领域所谓的“美容革命”在很大程度上得益于粘结技术的巨大进步。能够以合理可预测的方式将各种材料粘结到牙釉质和牙本质基底上,使得牙医能够常规地放置瓷贴面、直接和间接复合材料以及大量其他修复和美学材料。实际上,许多(如果不是大多数)当前修复程序的持久性和可预测性完全取决于牙医将各种材料粘结到牙齿组织上的能力。粘结系统已从20世纪70年代和80年代初基本上无效的系统发展到如今相对成功的全酸蚀和自酸蚀系统。粘结市场上的最新产品是所谓的“通用粘结剂”。从理论上讲,这些系统有可能显著简化和加快粘结流程,并且确实可能代表了粘结牙科的下一步发展。但是,什么定义了一个通用系统,以及所有这些新系统是否真的“通用”,是否具备它们所宣称的一切特性呢?本文将探讨这类新型牙科粘结剂的起源、化学性质、优点、缺点及临床相关性。