Introduction

Current Issues in Adhesive Restorative Dentistry

Edmond R. Hewlett, DDS

Contributing Editor

Edmond R. Hewlett, DDS, is an associate professor and vice chair of the Division of Restorative Dentistry at the University of California at Los Angeles School of Dentistry.

Copyright 2003 Journal of the California Dental Association.

It is difficult to imagine day-to-day dental practice without the ability to bond materials to enamel and dentin surfaces. It is equally hard to comprehend the breadth and depth of knowledge created in this area since Michael Buonocore’s watershed paper on bonding acrylic to acid-etched enamel was published nearly 50 years ago. Adhesive materials pervade today’s restorative dentistry armamentarium. The quality of adhesion to tooth structure and range of associated techniques have advanced to the degree that “biomimetic” and similar terms are finding their way into the restorative lexicon. The state-of-the-art is inching ever closer to the “holy grail,” i.e., the ability to permanently graft bioactive enamel and dentin analogues to teeth in situ.

Myriad questions regarding the key element of adhesive techniques -- the restorative-tooth interface -- nonetheless remain to be answered. With each discovery or technological advance, a host of new issues is unearthed, driving scientists back to the lab bench to develop yet the next generation of adhesive alchemy. Central to this cycle is the extraordinary complexity of the aforementioned interface. Structural variability of tooth substrates alone, particularly that of dentin, is significant enough to render a reasonable technique successful on one tooth and unsuccessful on another. Add to this the range of host factors and biologic variability commonly encountered in our patients, and one is left in awe that adhesive dental materials perform as well as they do.

Adhesive restorative systems are not unlike other complicated tools (such as powerful software programs or professional digital cameras) in that full exploitation of their capabilities requires more than a cursory understanding of how they work. It is in this spirit that the following three articles addressing different aspects of adhesive restorative dentistry are respectfully submitted for your perusal.

The first article focuses on the restorative-tooth interface, reviewing many of the factors that influence its predictability and durability. Strategies for enhancing these qualities based on available scientific data are provided as well.

Procedural issues such as field isolation, pulp capping, and use of adjunctive products such as caries detector dyes and desensitizers are addressed in the second article. Influences of these aspects on the final outcome in adhesive restorative procedures are highlighted.

Glass ionomer cements -- an often-overlooked group in a resin-dominated market -- are reviewed in the final article. Rationale for incorporating these useful materials into common restorative procedures is provided.

The authors hope you will enjoy this issue and find the information useful and thought-provoking.