10-year Clinical Evaluation of a Self-etching Adhesive System N Akimoto• M Takamizu • Y Momoi Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 3-10

Introduction Methods and materials Result Discussion Concussion

INTRODUCTION In 1993, Kuraray Co (Osaka, Japan) was the first to introduce a self-etching adhesive system, Clearfil Liner Bond 2. Some researchers and clinicians expressed concern regarding the physiological capacity of such a system to simultaneously demineralize, penetrate and bond to the enamel interface, thus affecting its long-term clinical permanence

INTRODUCTION in vitro bond strength testing to evaluate the clinical performance of Clearfil Liner Bond 2 self-etching adhesive system at 10 years in the same patient population.

Introduction Methods and materials Result Discussion Concussion

METHODS AND MATERIALS Patients were selected from the Dental Clinic of the Department of Operative Dentistry at Tsurumi University Dental Hospital, Yokohama, Japan. Two operator placed a total of 87 restorations were placed in the teeth of 42 patients (14 males and 28 females). 8–Class I 11–Class II 21–Class III 2–Class IV 45–Class V Following the clinical principal minimally invasive dentistry, and utilizing the restorative precepts of Professor T Fusayama

METHODS AND MATERIALS Caries detector Remove caries using ultra low-speed round steel bur without any injection of local anesthesia Rubber dam application Clearfil Liner Bond 2 self-etching adhesive system application

Followed by gentle air dispersion with compressed LB Primer A and B were mixed and applied to the enamel and dentin of the entire cavity for 30 seconds Followed by gentle air dispersion with compressed air for 5-10 seconds. The LB Bond adhesive was immediately applied to the entire surface, gently air dispersed Light cured for 20 s. with Optilux (Demetron, Kerr/Sybron, Orange,CA, USA) Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 4.

Finished using a super-fine diamond point Adhesive lined cavity was immediately restored with one of the following four light–cured composites* and light cured Finished using a super-fine diamond point Polished with Super-snap mini points (Shofu, Kyoto, Japan) or Sof-Lex XT Discs (3M, St Paul,MN, USA). * Clearfil Photo Anterior (Kuraray, Osaka,Japan), Herculite XRV (Kerr/Sybron), Photo ClearfilBright (Kuraray) and Progress (Kanebo, Tokyo, Japan)

METHODS AND MATERIALS Clinical evaluations : Two of the authors collected longitudinal clinical data on the same restorations at 6 months, 1 year, 5 years, 7 years and 10 years. The authors utilized five clinical parameters from published USPHS (table 2)

Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 5.

Introduction Methods and materials Result Discussion Concussion

Result Table 3 : shows the distribution of each restoration by cavity classification at baseline and again at the 10 year longitudinal recall period Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 5.

Result Table 4: shows the results of clinical evaluations at each of the 5 recall periods. Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 5.

Result Figure 1 Figure 2 Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 6.

Result Figure 3A Figure 3B Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 6.

Result Figure 3C Figure 3D Figure 3E Operative Dentistry: January 2007, Vol. 32, No. 1, pp. 6.

Introduction Methods and materials Result Discussion Concussion

Discussion Minimally invasive dentistry The biological issues of pulp vitality associated with certain acidic restorative agents Caries detector The biological of acid etching Total etch system and self-etching adhesive system - Retention and bond strengths - Marginal integrity and marginal discoloration

Discussion Minimally invasive dentistry T Fusayama (1980,1993) recommended for the restoration of resin composite restorations, our profession now readily accepts the niche of minimally invasive dentistry in our daily clinical regimen, displacing the historical use of amalgam, which has been popular since the late 1700s.

Discussion With such issues as technique sensitivity, when to employ certain cavity configurations, the suitability of dentin and enamel substrate and marginal longevity, the user-friendliness associated with resin composite restorations and the immediate positive aesthetic response by patients, the practice of clinical dentistry has dramatically changed for the better in just a few decades.

Discussion The biological issues of pulp vitality associated with certain acidic restorative agents As reported by Manley (1942) and Schroff (1946,1947) That solutions would be rapidly buffered by oral fluids. The research of Fusayama (1980,1993), Brännström & Nordenvall (1978) and Brännström, Vojinovic & Nordenvall (1979) -- Bacterial microleakage >> recurrent and secondary caries >> Irreversible pulp damage

Discussion Caries Detector For consideration is the use of minimal reduction of insensitive dentin Local anesthesia?? >> is equally or even more fear provoking than the actual restorative drilling experience. Painless

Discussion This clinical observation supports the clinical-scientific significance of Fusayama’s research (1979, 1980, 1993), which states that caries may be removed without anesthesia and tooth substrate can be restored in a painfree manner.

Discussion The biological of acid etching the biological acceptance of acid etching prepared dentin and exposed vital pulps, routine wet bonding via acid-etching with various inorganic acids, such as phosphoric acid the concept of total-etch for adhesive dentistry is now generally accepted by clinicians worldwide.

Discussion At the same time, self-etching adhesive system has evolved and is now widely applied throughout Japan and many international countries. “All-in-one adhesive”

Discussion Total etch system & self-etching adhesive system Many of these studies have reported good clinical performance and, as a consequence, many self etch systems are now readily accepted by worldwide clinicians. Long-term clinical evaluation of previous traditional studies : Qvist and Strom (1993) Shimizu and other (1995)

Discussion In the authors’ 10-year longitudinal clinical study Marginal integrity : 40 out of 44 restorations (90.9%) were rated Bravo for marginal integrity Slight tactile measurement of step irregularities >> overfilling No gap formation between the tooth and resin composites

Discussion Marginal discoloration : 39 out of 44 restoration (88.6%) were rated Bravo for marginal discoloration Due to the oral habits of patients (smoking coffee tea or wine)

Discussion Although the failure rate of marginal integrity and discoloration in this study was slightly higher than that reported for total-etch systems, the results of retention loss, secondary caries and postoperative sensitivity of the self-etching adhesive system Clearfil Liner Bond 2 was excellent at 10 years.

Discussion Total – etch system : Enamel bond strength is higher than dentin bond strength Bond durability of the composite system depends on: Enamel bond strength

Discussion Self – etching adhesive system : Enamel bond strength was similar to or less than dentin bond strength Adhesion to the cavity and sealing against bacterial micro leakage depends on : Dentin bond strength and durability

Discussion Some literature has suggested that certain adhesive and resin composite systems are the primary cause of pulp irritation and eventual necrosis. However, other studies continue to demonstrate that pulp inflammation is due primarily to the marginal leakage of bacteria and the invasion of toxic factors.

Discussion The literature does report that the Clearfil Liner Bond 2 system is biocompatibly acceptable to pulp tissues when placed directly on non exposed dentin or mechanical pulp exposures.

Introduction Methods and materials Result Discussion Concussion

Concussion The retention rate and pulpal response of Clearfil LinerBond 2 self-etching adhesive system is excellent after 10-year placement. Some marginal discoloration was evident; however, these changes were not severe, as clinical conditions requiring replacement from recurrent caries were not present. Clinically, these data demonstrate that this self-etching adhesive system is acceptable for placement of a long-term adhesive restoration in human teeth.

รายชื่อสมาชิก นทพ. พัชรวรรณ อยู่สุข 50610209 นทพ. พัชรวรรณ อยู่สุข 50610209 นทพ. วารีวัณน์ ภุมรินทร์ 50610506 นทพ. ฐาปกรณ์ สุรัจกุลวัฒนา 50610766 นทพ. พนมกร ใจกว้าง 51610062 นทพ. ฉัตรณรงค์ พึ่งพา 51610178 นทพ. สุพรรณมาศ เขียวมีศรี 51610291 นทพ. มลภิรา กะแก้ว 51610390 นทพ. ชารัญญา นุชิตประสิทธิชัย 51610499 นทพ.รพีพรรณ นะภิใจ 51610581 นทพ. สุธาทิพย์ คำเรืองศรี 51610666

QUESTION ??