Enamel bonding has been routinely and successfully used in dentistry for about thirty

years, but reliable dentin bonding has been possible only during the latter half of that
period. Dozens of dentin/enamel adhesives are available on the market today. Although
the sheer number of materials can be confusing to clinicians, these adhesives can be
easily classified by bonding strategy i. e., etch-and-rinse or self-etch and
complexity. Because each of the two basic strategies can be accomplished using a
more complex or a simplified approach, four types of modern dentin adhesives can be
described. Each has advantages and disadvantages, with varying degrees of proof of
clinical efficacy. The clinician should understand these advantages and disadvantages
to choose appropriate products for use in the practice.
ENAMEL BONDING
The roots of todays adhesive dentistry can be traced to 1955, when Dr. Michael
Buonocore reported that phosphoric acid could alter the surface of enamel to render it
more receptive to adhesion. 1 Inspired by the industrial use of phosphoric acid to
improve adhesion of paints and acrylic coatings to metal, Buonocore discovered that
acrylic resin could be bonded to human enamel that was etched with 85% phosphoric
acid. He predicted that this bonding technique could be used in various dental
procedures, including Class III and Class V restorations and pit and fissure sealants.
Enamel bonding did not become widely used until 20-25 years after Buonocores first
publication on the subject. The technique has now proven successful and reliable over
decades of clinical use and has revolutionized the practice of restorative dentistry and
other disciplines such as esthetic, preventive, and pediatric dentistry and orthodontics.
Currently, phosphoric acid in concentrations of 35-40% is used to etch enamel to
provide micromechanical retention of resin-based materials (Fig. 1).
PROBLEMS IN BONDING TO DENTIN
Interest in adhesion of restorative materials to dentin actually predated Buonocores
1955 paper on enamel bonding. 2 However, bonding of resins to dentin is far more
difficult and less predictable than bonding to enamel. Dentin not only has a more

complex histologic structure than enamel, but and composition occur not only with
differences in depth, but also from region to region of the tooth. The permeability
characteristics of dentin clearly illustrate these regional variations. For example, the
permeability of occlusal dentin is higher over the pulp horns than at the center of the
occlusal surface, proximal dentin is more permeable than occlusal dentin, and coronal
dentin is more permeable than root dentin.

7,8

When attempting to bond to dentin exposed during tooth preparation, the inherent
complexity of the dentin morphology is further complicated by the formation also has
more variation with location. Enamel is roughly 92% inorganic hydroxyapatite by volume,
and dentin is only 45% inorganic. Dentinal hydroxyapatite crystals are not regularly
arranged as they are in enamel, but are randomly arranged in an organic matrix.

Dentin contains numerous fluid-filled tubules that run from the pulp to the dentinoenamel
junction (DEJ) (Fig. 2). The relative area of dentin occupied by tubules decreases
towards the DEJ, from about 22-28% of the cross-sectional area near the pulp to only 14% near the enamel. 4 An odontoblastic process extends from the pulp into the inner
portion of each tubule. 5 The plasma-like fluid in the tubules is under a slight, but
constant, outward pressure from the pulp.

Variations in dentin structure of a smear layer. 9 The smear layer consists of debris
(such as ground enamel and dentin) that is burnished against, and bound to, the dentin
surface during instrumentation. Depending on factors such as the type of cutting
instrument used, the smear layer is typically just 0.5-5.0m thick, but occludes the orifices
of the dentinal tubules. Although the smear layer acts as a diffusion barrier that
decreases dentinal permeability, it also can be considered an obstruction that prevents
resin from reaching the underlying dentin substrate.

10

Alterations in the mineral content and structure of dentin as in caries-affected or

sclerotic areas represent another source of difficulty in bonding resins to
dentin. 11Resin penetration into sclerotic dentin is less than in normal dentin, and this
can compromise the outcome of bonding procedures.
DEVELOPMENT OF DENTIN ADHESIVES

Having begun in the 1950s, research on dentin bonding continued at a slow pace
through the 1960s and 1970s and culminated in the 1975 introduction of a commercial
dentin adhesive system for restoring non-carious cervical lesions. However, this product
had very poor clinical results when used to restore cervical lesions without mechanical
retention. 12
A second generation of dentin bonding agents was introduced in the early 1980s. Most
were halophosphorous esters of unfilled resins such as Bis-GMA (bisphenol A-glycidyl
methacrylate) or HEMA (hydroxyethyl methacrylate). They bonded to dentin via surface
wetting and interaction between their phosphate groups and calcium ions in the smear
layer. 13 Shear dentin bond strengths were only about 1-10 MPa,

13,14

and were too weak to

counteract the polymerization shrinkage of composite resin. 15In clinical trials, fairly high
percentages of cervical restoration were lost in just one or two years. 16 A major reason
for the poor performance of these agents is that they bonded to the smear layer rather
than to the dentin itself. Thus, bonding was limited by the cohesive strength of the
smear layer or by the weak and unstable adhesion of the smear layer to the underlying
dentin. 17
A third generation of dentin adhesives was introduced in the mid-to late 1980s. These
either modified or removed the smear layer to permit resin penetration into the
underlying dentin. Popular products included Scotchbond 2 (3M), Gluma (Bayer),
Tenure (Den-Mat Corporation), Prisma Universal Bond 2 and 3 (Dentsply Caulk), and
XR Bonding System (Kerr). Generally, their dentin bond strengths were greater than
those of the second-generation agents. Clinical studies of cervical restorations reported
that these systems also had considerably better clinical performance (e. g., retention
and marginal integrity) than earlier adhesives. However, they did not nearly approach
the ideal goal of 100% retention.

16

CURRENT STRATEGIES FOR RESIN-DENTIN BONDING

Total-etch adhesives
In North America, the modern era of resin-dentin bonding began in the late 1980s, with
the introduction of the total-etch concept. Based on the earlier work of Fusayama and

others in Japan, 18 Bertolotti and Kanca proposed a technique for phosphoric acidetching of dentin as well as enamel, followed by the application of relatively hydrophilic
resins that had recently become available.

19,20

The total-etch technique was considered

quite controversial at the time, as earlier research had suggested that dentin etching
could seriously damage the pulp. 21 Dentists in North America and most other regions of
the world had been taught that dentin etching was contraindicated. Eventually, some of
the early pulp studies were revisited, new research was performed, and the total-etch
technique became widely accepted as both effective and safe. Today, total-etch
materials are more commonly described as etch-andrinse adhesives.
THREE-STEP SYSTEMS
Many commercial products based on the total-etch technique were developed and
marketed in the early 1990s. Several of those products, including All-Bond 2 (Bisco,
Inc.), OptiBond FL (Kerr), PermaQuick (Ultradent Products), and Scotchbond MultiPurpose (3M ESPE), remain available today.
Alth
ough their chemical compositions and clinical application techniques vary, these
adhesive systems all include three fundamental steps for achieving a bond of resin to
dentin. 22-24
The first step, acid-etching, removes the smear layer, opens the dentinal tubules, and
demineralizes the intertubular and peritubular dentin (Fig. 3). The depth of
demineralization is affected by the pH, concentration, viscosity, and application time of
the etchant. The acid dissolves hydroxyapatite crystals, leaving a collagen meshwork
that can collapse and shrink due to the loss of inorganic support. Preventing this
collapse is an important consideration for etch-and-rinse adhesive systems, and will be
discussed later in this section.
After the etchant is rinsed off, a primer containing a solvent such as acetone, ethanol,
and/or water and one or more bifunctional resin monomers is applied. Primer resins
such as HEMA contain two functional groups -a hydrophilic group and a hydrophobic
group. The hydrophilic groups have an affinity for the dentin surface and the

hydrophobic (methacrylate) groups have an affinity for resin. The primer wets and
penetrates the collagen meshwork and increases the surface free energy, and therefore
wettability, of the dentin.
The third of the three steps is the bonding agent, which is applied and penetrates into
the primed dentin. The bonding agent typically contains a hydrophobic resin such as
Bis-GMA, but many also contain a hydrophilic resin such as HEMA to improve wetting.
Although most bonding agents are unfilled, specific products (e. g., OptiBond FL)
contain filler particles, as some evidence suggests that filled resins provide stress relief
at the tooth-restoration interface. The bonding agent copolymerizes with the primer to
form an intermingled layer of collagen fibers and resin commonly called the hybrid
layer. This hybrid layer, which was first described by Nakabayashi et al. in 1982,25 is
considered the most important factor for ensuring a good bond between resin and
dentin (Fig. 4).
High bond strengths have been reported for the three-step, etch-and-rinse adhesives; in
fact, dentin bond strengths sometimes have exceeded enamel bond strengths.
28

26-

Performance in microleakage tests has also been generally good. 29In addition to

laboratory studies, a number of clinical trials have now been reported on this group of
adhesives. Retention rates of Class V restorations without mechanical retention have
been in the range of nearly 90% in studies of up to 12 years.

30,31

ONE-BOTTLE SYSTEMS
Because the three-step etch-andrinse adhesives require multiple clinical steps, there are
numerous opportunities for errors to occur. 32 Therefore, manufacturers attempted to
simplify the systems, developing so-called one-bottle systems. While these still require
etching as the first step, the primer and bonding functions are combined into a single
solution; hence the term one-bottle. For several years, these products including
Prime & Bond NT (Dentsply Caulk), OptiBond Solo
Plus (Kerr), and Adper Single Bond Plus (3M ESPE) were the most widely used
adhesives and remain fairly popular today.

One-bottle adhesives contain mixtures of hydrophilic and hydrophobic resins in a

solvent such as acetone or ethanol. Their bonding mechanism is the same as that of the
three-step etch-and-rinse systems, and like some of the three-step systems many
require a moist bonding technique. 33
When dentin is etched, the surface is depleted of the hydroxyapatite crystals that
support the collagen framework. Thus, etching leaves a porous, collagen-rich surface
that can collapse if dried, limiting the penetration of resins. In a moist bonding
technique, the surface is not dried after etching and rinsing, and therefore the collagen
remains in position and behaves almost as a sponge. The acetone or ethanol solvent
displaces water and carries the resins into the collagen network.

34,35

If the surface must be dried e. g., to check the enamel etch it should be remoistened. Various materials have been tested as re-wetting agents, including water,
which does not re-wet the surface rapidly. Better alternatives are aqueous solutions of
HEMA such as Aqua-Prep (Bisco, Inc.), Gluma Desensitizer (Heraeus Kulzer), or G5
(Clinicians Choice).36,37 The latter two products also contain glutaraldehyde, which might
stabilize the collagen layer, thus facilitating resin penetration.

37

As with the three-step etch-and-rinse systems, the one-bottle systems generally have
demonstrated good performance in laboratory testing of dentin bond strengths and
marginal seal. 38-40 Most also bond very well to either dry or moist
enamel. 41Unfortunately, only a few clinical trials have been reported on the one-bottle
systems. However, the studies that have been published generally have reported good
results. A recent study on two such adhesives reported an eight-year retention rate of
about 90% for Class V restorations placed without mechanical retention.

42

As mentioned, the etch-and-rinse one-bottle adhesives remain relatively popular and

development of these materials has not ceased. New products in this category include
XP Bond (Dentsply Caulk) and MPa Direct (Clin icians Choice). In a recent study, the
dentin bond strength of MPa Direct was higher than that of four other systems, with the
difference being statistically significant for three of those. 43 In addition, MPa Direct was
very effective for bonding self-cure composite when the adhesives oxygen-inhibited
layer was removed with alcohol.

Despite the good laboratory and clinical performance of the etch-and-rinse adhesives,
some clinicians have reported problems with post-operative sensitivity. Once the dentin
is etched, it must be sealed well, which is not always possible under clinical conditions.
The problem of postoperative sensitivity is most common in situations that magnify the
effects of composite polymerization shrinkage. An example of this is a simple Class I
posterior composite restoration. The Class I has a configuration factor (or C-factor) of 5,
which indicates that the ratio of bonded to unbonded walls is 5:1.44 When the
composite shrinks during polymerization, some stress relief occurs at the occlusal
(unbonded) surface, but inevitably some stress also occurs at the bonded interfaces.
Furthermore, most of the dentin bonding occurs at a single location, the pulpal floor. The
entire circumference of the restoration is bonded to enamel. If the bond of resin to the
enamel periphery exceeds the bond to the dentin, the composite may partially debond
from the pulpal floor, leaving a gap between resin and dentin. When the patient
functions on the tooth, hydraulic forces within the fluid-filled gap and underlying tubules
stimulate pulpal nerve endings, causing a sensation of sensitivity or pain. 45 Incremental
placement of the composite can reduce post-operative sensitivity. 45 Resin-modified
glass ionomer liners (e. g., Vitrebond Plus, 3M ESPE) are also effective for reducing
early sensitivity after a restoration is placed. 46 Some clinicians also incorporate a
HEMA/glutaraldehyde desensitizer into their bonding protocol, although evidence for its
efficacy with composite restorations remains largely anecdotal. 47 If used, the
desensitizer should be applied after etching and rinsing, prior to application of the
combined primer/bonding agent.
SELF-ETCH SYSTEMS
Perhaps because of frustration over post-op sensitivity with etch-and-rinse adhesives,
much of the current adhesive product development and clinician interest is focused on
self-etching systems. These were popular for several years in Japan prior to their
introduction in North America. One class of self-etch systems includes two steps an
acidic, self-etching primer (containing, for example, an acidic phosphate monomer)
followed by a s
eparate bonding resin. Another class of adhesives is considered all-in-one, and
contains etch, prime, and bond functions in a single solution. The former group of

materials can be described as self-etch primer systems, and the latter can be called
self-etch adhesives.
SELF-ETCH PRIMERS
Examples of current two-step, or self-etch primer, systems include Clearfil SE Bond
(Kuraray), Peak SE (Ultradent), and Adper Scotchbond SE (3M ESPE). These materials
are simple to use and, at least anecdotally, are associated with very little post-operative
sensitivity. However, controlled clinical trials generally have reported no difference in the
incidence or severity of post-operative sensitivity using etch-and-rinse and self-etch
adhesives. Of course, one could argue that clinical trials are conducted under conditions
that do not precisely duplicate real world dentistry.

48-50

The chief concern about the self-etch systems is that they might not etch enamel
effectively. 51 Bonding to uninstrumented enamel is particularly challenging, so enamel
should be instrumented in some way before etching with these systems. 52Some
manufacturers even recommend that if a restoration will involve uninstrumented enamel,
it should be etched with phosphoric acid first. Bonding of self-etch systems to sclerotic
or caries-affected dentin also might be problematic. 53,54 Regardless, the most popular
product in this category Clearfil SE Bond has performed extremely well in a fiveyear clinical study. 55 There is some evidence that the bond durability of this material is
partially due to chemical bonding of its adhesive monomer, 10-MDP, with residual
hydroxyapatite crystals in the hybrid layer.

56

SELF-ETCH ADHESIVES
The most recent developments in dentin bonding have been in the area of the self-etch
adhesives, or all-in-one systems such as Adper Easy Bond and Adper Prompt L-Pop
(3M ESPE), Bond Force (Tokuyama), Brush & Bond (Parkell), and OptiBond All-in-One
(Kerr). These materials deliver the etching, priming, and bonding functions in a single
solution and are the most hydrophilic type of adhesive. 57 The hydrophilicity of these
materials is not particularly advantageous, and some evidence even suggests that their
performance could be improved by application of an overlying hydrophobic

resin. 58,59 Regardless, they have rapidly gained popularity because of their apparent
simplicity of use and perceived lack of post-operative sensitivity.
Because this is the newest category of adhesives, less independent research has been
reported on these than on the other categories. The first all-in-one adhesive, Prompt LPop (ESPE)* performed poorly in short-term clinical trials of Class V restorations. One
study reported a 35% retention loss at just one year. 60 As a group, the self-etch all-inone adhesives tend to have the lowest enamel and dentin bond strengths and the least
proven clinical performance. 61-63 That said, some improvements do seem to be
occurring.
CONCLUSIONS
Two primary strategies are currently available for bonding resin to dentin: etch-and-rinse
and self-etch. For each strategy, simplified approaches are available, so that four distinct
categories of dentin adhesives can be identified: (1) three-step etch-and-rinse; (2) onebottle etch-and-rinse; (3) self-etch primers; and (4) self-etch, or all-in-one, adhesives.
Each category has advantages and disadvantages, but more laboratory and clinical
data are available concerning the etch-and-rinse systems. At present, the profession
seems to be moving in the direction of the self-etch, all-in-one adhesives, but the clinical
performance of these materials is not yet proven.
Regardless of the bonding approach the clinician selects, he or she must be aware that
proper technique and attention to detail are critical to success.

64-66

In addition, dentin is a

highly variable substrate, and this variability may lead to failures in specific cases.
OH
Edward J. Swift, Jr., DMD, MS, is Professor and Chair, Department of Operative
Dentistry, University of North Carolina. ed_swift@dentistry.unc.edu
Marcos A. Vargas, BDS, DDS, MS, is Professor, Department of Family Dentistry,
College of Dentistry, The University of Iowa, Iowa City, IA.
* The current Adper Prompt is an improved version of this original material.

Oral Health welcomes this original article.

REFERENCES
1. Buonocore MG. A simple method of increasing the adhesion of acrylic filling materials
to enamel surfaces. J Dent Res 1955; 34: 849-853.
2. McLean JW, Kramer IRH: A clinical and pathological evaluation of a sulphinic acid
activated resin for use in restorative dentistry. Br Dent J 1952; 93: 255-269.
3. Aasen SM. History of dentinal bonding. Esthet Dent Update 1990; 1:43-46.
4. Heymann HO, Bayne SC. Current concepts in dentin bonding: Focusing on dentinal
adhesion factors. J Am Dent Assoc 1993; 124:27-36.
5. Thomas HF, Carella P. Correlation of scanning and transmission electron microscopy
of human dentinal tubules. Arch Oral Biol 1984; 29:641-646.
6. Terkla LG, Brown AC, Hainisch AP, Mitchem JC. Testing sealing properties of
restorative materials against moist dentin. J Dent Res 1987; 66:1758-1764.
7. Pashley DH, Andringa HJ, Derkson GD, et al. Regional variability in the permeability
of human dentine. Arch Oral Biol 1987; 32:519-523.
8. Pashley DH, Pashley EL. Dentin permeability and restorative dentistry: A status report
for the American Journal of Dentistry. Am J Dent 1991; 4: 5-9.
9. Eick JD, Wilko RA, Anderson CH, Sorensen SE. Scanning electron microscopy of cut
tooth surfaces and identification of debris by use of the electron microprobe. J Dent Res
1970; 49: 1359-1368.
10. Pashley DH, Michelich V, Kehl T. Dentin permeability: Effects of smear layer
removal. J Prosthet Dent 1981; 46:531-527.
11. Kwong S-M, Tay FR, Yip H-K, et al. An ultrastructural study of the application of
dentine adhesives to acid-conditioned sclerotic dentin. J Dent 2000; 28:515-528.

12. Jendresen MD. Clinical performance of a new composite resin for Class V erosion
(abstract 1057). J Dent Res 1978; 57:339.
13. Eliades GC, Caputo AA, Vougiouklakis GJ. Composition, wetting properties and
bond strength with dentin of 6 new dentin adhesives. Dent Mater 1985; 1:170-176.
14. Chan DCN, Reinhardt JW, Boyer DB. Composite resin compatibility and bond
longevity of a dentin bonding agent. J Dent Res 1985; 64: 1402-1404.
15. Davidson CL, de Gee AJ, Feilzer A. The competition between the composite-dentin
bond strength and the polymerization contraction stress. J Dent Res 1984; 63:13961399.
16. Van Meerbeek B, Peumans M, Verschueren M, et al. Clinical status of ten dentin
adhesive systems. J Dent Res 1994; 73:1690-1702.
17. Davidson CL, de Gee AJ, Feilzer A. The competition between the composite-dentin
bond strength and the polymerization contraction stress. J Dent Res 1984; 63:13961399.
18. Fusayama T, Nakamura M, Kurosaki N, Iwaku M. Non-pressure adhesion of a new
adhesive restorative resin. J Dent Res 1979; 58: 1364-1370.
19. Bertolotti RL. Total-etch The rational dentin bonding protocol. J Esthet Dent 1991;
3: 1-6.
20. Kanca J. Bonding to tooth structure: A rational rationale for a clinical protocol. J
Esthet Dent 1989; 1:135-138.
21. Macko DJ, Rutberg M, Langeland K. Pulpal response to the application of
phosphoric acid to dentin. Oral Surg Oral Med Oral Pathol 1978; 45:930-946.
22. Van Meerbeek B, Inokoshi S, Braem M, et al. Morphological aspects of the resindentin interdiffusion zone with different dentin adhesive systems. J Dent Res 1992;
71:1530-1540.

23. Inokoshi S, Hosoda H, Harnirattisai C, Shimada Y. Interfacial structure between

dentin and seven dentin bonding systems revealed using argon ion beam et
ching. Oper Dent 1993; 18:8-16.
24. Swift EJ, Heymann HO, Perdigo J. Bonding to enamel and dentin: A brief history
and state of the art, 1995. Quintessence Int 1995; 26:95-110.
25. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by the infiltration
of monomers into tooth substrates. J Biomed Mater Res 1982; 16:265-273.
26. Chappell RP, Eick JD. Shear bond strength and scanning electron microscopic
observation of six current dentinal adhesives. Quintessence Int 1994; 25:759-768.
27. Tjan AHL, Castelnuovo J, Liu P. Bond strength of multi-step and simplified-step
systems. Am J Dent 1996; 9:269-272.
28. Mason PN, Ferrari M, Cagidiaco MC, Davidson CL. Shear bond strength of four
dentinal adhesives applied in vivo and in vitro. J Dent 1996; 24: 217-222.
29. May KN, Swift EJ, Wilder AD, Futrell SC. Effect of a surface sealant on
microleakage of Class V restorations. Am J Dent 1996; 9: 133-136.
30. Peumans M, De Munck J, Van Landuyt KL, et al. Restoring cervical lesions with
flexible composites. Dent Mater 2007; 749-754.
31. Wilder AD, Swift EJ, Heymann HO, et al. 12-year clinical evaluation of a three-step
dentin adhesive in non-carious cervical lesions. J Am Dent Assoc 2009 (in press).
32. Peutzfeldt A, Vigild M. A survey of the use of dentin-bonding systems in Denmark.
Dent Mater 2001; 17:211-216.
33. Van Meerbeek B, Yoshida Y, Snauwaert J, et al. Hybridization effectiveness of a
two-step versus a three-step smear layer removing adhesive system examined
correlatively by TEM and AFM. J Adhes Dent 1999; 1:7-23.

34. Kanca J. Resin bonding to wet substrate. I. Bonding to dentin. Quintessence Int
1992; 23:39-41.
35. Gwinnett AJ. Moist versus dry dentin: Its effect on shear bond strength. Am J Dent
1992; 5: 127-129.
36. Gwinnett AJ. Dentin bond strength after air drying and re-wetting. Am J Dent 1994;
7: 144-148.
37. Ritter AV, Heymann HO, Swift EJ, et al. Effects of different re-wetting techniques on
dentin shear bond strengths. J Esthet Dent 2000; 12: 85-96.
38. El-Kalla IH, Garcia-Godoy F. Saliva contamination and bond strength of single-bottle
adhesives to enamel and dentin. Am J Dent 1997; 10: 83-87.
39. Gallo JR, Comeaux R, Haines B, et al. Shear bond strength of four filled dentin
bonding systems. Oper Dent 2001; 26:44-47.
40. Castelnuovo J, Tjan AHL, Liu P. Microleakage of multi-step and simplified-step
bonding systems. Am J Dent 1996; 9: 245-248.
41. Swift EJ, Perdigo J, Heymann HO, Ritter AV. Shear bond strengths of one-bottle
adhesives to moist enamel. J Esthet Dent 1999; 11: 103-107.
42. Ritter AV, Swift EJ, Heymann HO, et al. An eight-year clinical evaluation of filled and
unfilled one-bottle dental adhesives. J Am Dent Assoc 2009; 140:28-37.
43. Walter R, Swift EJ, Ritter AV, et al. Dentin bonding of a new etch-and-rinse adhesive
using self-and light-cured composites. Am J Dent 2009 (in press).
44. Feilzer AJ, De Gee AJ, Davidson CL. Setting stress in composite resin in relation to
configuration of the restoration. J Dent Res 1987; 66: 1636-1639.
45. Opdam NJM, Feilzer AJ, Roeters JJM, Smale I. Class I occlusal composite resin
restorations: In vivo postoperative sensitivity, wall adaptation, and microleakage. Am J
Dent 1998; 11;229-234.

46. Akpata ES, Sadiq W. Postoperative sensitivity in glass-ionomer versus adhesive

resin-lined posterior composites. Am J Dent 2001; 14: 34-38.
47. Sobral MA, Garone-Netto N, Luz MA, Santos AP. Prevention of postoperative tooth
sensitivity: a preliminary clinical trial. J Oral Rehabil 2005; 32:661-668.
48. Perdigo J, Anauate-Netto C, Carmo AR, et al. The effect of adhesive and flowable
composite on postoperative sensitivity: 2-week results. Quintessence Int 2004; 35:777784.
49. Casselli DS, Martins LR. Postoperative sensitivity in Class I composite resin
restorations in vivo. J Adhes Dent 2006; 8:53-58.
50. Browning WD, Blalock JS, Callan RS, et al. Postoperative sensitivity: A comparison
of two bonding agents. Oper Dent 2007; 32:112-117.
51. Pashley DH, Tay FR. Aggressiveness of contemporary self-etching adhesives. Part
II: etching effects on unground enamel. Dent Mater 2001; 17:430-444.
52. Perdigo J, Gomes G, Duarte S, Lopes MM. Enamel bond strengths of pairs of
adhesives from the same manufacturer. Oper Dent 2005; 30:492-499.
53. Yoshiyama M, Urayama A, Kimochi T, et al. Comparison of conventional vs selfetching adhesive bonds to caries-affected dentin. Oper Dent 2000; 25:163-169.
54. Tay FR, Kwong S-M, Itthagarun A, et al. Bonding of a self-etching primer to noncarious cervical sclerotic dentin: Interfacial ultrastructure and microtensile bond strength
evaluation. J Adhes Dent 2000; 2:9-28.
55. Peumans M, De Munck J, Van Landuyt K, et al. Fiveyear clinical effectiveness of a
two-step self-etching adhesive. J Adhes Dent 2007; 9: 7-10.
56. Inoue S, Koshiro K, Yoshida Y, et al. Hydrolytic stability of self-etch adhesives
bonded to dentin. J Dent Res 2005; 84:1160-1164.

57. Van Landuyt KL, Mine A, De Munck J, et al. Technique sensitivity of water-free onestep adhesives. Dent Mater 2008; 24:1258-1267.
58. Van Landuyt KL, Peumans M, De Munck J, et al. Extension of a one-step self-etch
adhesive into a multi-step adhesive. Dent Mater 2006; 22:533-544.
59. Brackett WW, Ito, S, Tay FR, et al. Microtensile dentin bond strength of self-etching
resins: effect of a hydrophobic layer. Oper Dent 2005; 30:733-738.
60. Brackett WW, Covey DA, St. Germain HA. One-year clinical performance of a selfetching adhesive in class V resin composites cured by two methods. Oper Dent Res
2002; 27:218-222.
61. De Munck J, Van Landuyt K, Peumans M, et al. A critical review of the durability of
adhesion to tooth tissue: methods and results. J Dent Res 2005; 84:118-132.
62. Brackett WW, Tay FR, Looney SW, et al. Microtensile dentin and enamel bond
strengths of recent selfetching resins. Oper Dent 2008; 33:89-95.
63. Peumans M, Kanumilli P, De Munck J, et al. Clinical effectiveness of contemporary
adhesives: a systematic review of current clinical trials. Dent Mater 2005; 21:864-881.
64. Finger WJ, Balkenhol M. Practitioner variability effects on dentin bonding with an
acetone-based one-bottle adhesive. J Adhes Dent 1999; 1: 311-314.
65. Frankenberger R, Krmer N, Petschelt A. Technique sensitivity of dentin bonding:
Effect of application mistakes on bond strength and marginal adaptation. Oper Dent
2000; 25:324-330.
66. Miyazaki M, Onose H, Moore BK. Effect of operator variability on dentin bond
strength of two-step bonding systems. Am J Dent 2000; 13: 101-104.
67. Adebayo OA, Burrow MF, Tyas MJ. Bond strength test: role of operator skill. Aust
Dent J 2008; 53:145-150.

68. Soderholm KJ, Soares F, Argumosa M, et al. Shear bond strength of one etch-andrinse and five selfetching dental adhesives when used by six operators. Acta Odont
Scand 2008; 66:243-249.

ABSTRACT
This paper briefly describes the development of dentin/enamel bonding systems, and
describes the current strategies for bonding resin-based materials to tooth structure.

Buonocore discovered that acrylic resin could be bonded to human enamel that was
etched with 85% phosphoric acid

Resin penetration into sclerotic dentin is less than in normal dentin, and this can
compromise the outcome of bonding procedures

In North America, the modern era of resin-dentin bonding began in the late 1980s, with
the introduction of the total-etch concept

When dentin is etched, the surface is depleted of the hydroxyapatite crystals that
support the collagen framework

In a recent study, the dentin bond strength of MPa Direct was higher than that of four
other systems, with the difference being statistically significant for three of those

Of course, one could argue that clinical trials are conducted under conditions that do not
precise
ly duplicate real world dentistry