Clinical Findings Using A Self-Etching Primer

(Continued)

Application Technique

Figure 4 shows an unprepared tooth. Following initial preparation according to established protocols, caries detector dye was applied to verify removal of all carious tooth structure (Figure 5). When the final preparation was achieved (Figure 6), Clearfil SE Bond primer was applied (Figure 7) for 20 seconds, followed by SE Bond bonding liquid (Figure 8). The bonding liquid was then air thinned and light cured for 10 seconds. The final restoration is shown in Figure 9.

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Clinical Observations

In practice, Clearfil SE Bond provides a simple material for direct dentinal bonding that ensures patient comfort. The table documents actual use of the material in practice and records patients' subjective responses of postoperative discomfort. The restorative procedures involved in the cases consisted of using Clearfil SE Bond and Clearfil AP-X anterior/posterior hybrid composite resin. The hybrid composite resin is a light-cured radiopaque material formulated to provide accurate color matching, high polishability, and optimal consistency to facilitate handling and placement.

The 10 cases recorded in this chairside study involved 32 teeth restored according to the protocols established by the manufacturer for the specific materials employed. Of the 10 patients treated, four reported discomfort associated with biting pressure, and only one patient reported sensitivity to hot and cold stimuli. Of all the patients reporting sensitivity, only one case (patient No. 8) involved restoration replacement. In this case, the tooth exhibited a fracture that required a large restoration and could not be treated successfully with a direct restoration. Subsequent restoration consisted a crown.

Of the patients (Nos. 1, 4, and 9) who reported postoperative sensitivity, five, six, and four restorations were involved respectively. Patient No. 1 had a caries exposure that was quite large and subsequently required a root canal to relieve the symptoms. The other two patients exhibited biting sensitivity. In these cases, the occlusion was tested with articulating paper, and the bites were adjusted to alleviate hyperocclusion. The symptoms described by the patients resolved within 24 to 48 hours. Patients who reported no sensitivity to hot or cold stimuli or biting pressure underwent restoration of three or fewer teeth each. It is apparent that the greater the number of restorations involved in a specific case, the greater the potential for reports of relative discomfort, which may not, however, be related to the materials used but rather to the extensive nature of the treatment required. The occlusion schemes with a greater number of restorations are somewhat more difficult to check because of clinical factors of patient numbness and extent of the restorations.

Conclusion

Used according to the manufacturer's directions and following established restorative protocols, the self-etch bonding system provided significant desensitization to temperature on the restored teeth in nine out of 10 patients. Postoperative discomfort associated with biting pressure was completely resolved with occlusal adjustment. Although the number of cases treated and recorded for this preliminary study is limited, the effectiveness of the self-etch material is apparent. Thus, it is my opinion and belief that the self-etch bonding system meets the requirements needed to balance the art, science, and business of dentistry. This is accomplished by allowing for the delivery of successful, aesthetic, and functional restorations that result in patient satisfaction and comfort.

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