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KMID : 0623919990090010101
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Dental Materials Journal, Seoul National University
1999 Volume.9 No. 1 p.101 ~ p.114
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BIOLOGICAL BASIS FOR CLINICAL SUCCESS OLD IDEAS
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Cox, Charles F
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Abstract
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The 1991 International Symposium on Adhesives in Dentistry in Omaha NE changed our concept of adhesive bonding for clinicians around the world. Until then, acid etching of vital dentin was viewed with skepticism ; - at least in the US. That symposium provided scientific data by Nakabayashi regarding hybridization of vital dentin to develop an interdiffused substrate of the entire cavity interface. Biological data dispelled several myths ; - the smear layer was inviolate ; - acid etching of vital dentin kills the pulp ; - and calcium hydroxide (CaOH)₂ was the ideal pulp protectant. Until then, many were reluctant to acid etch vital dentin ; - today we routinely acid etch in preparation for hybridization. Today, dentists for most clinical procedures routinely employ hybridization of vital dentin. When properly completed ; - hybridization provides a continuous seal along the entire enamel cavosurface margin to the entire dentin interface ; - and to the pulp. Hybridization strengthens the underlying tissues ; - it prevents postoperative hypersensitivity ; - it provides a uniform substrate to lute all restorations ; - provides long term deterrence of bacterial microleakage and recurrent caries. More recently, hybridization of pulp tissues has been shown to provide a biomemetic substrate for pulp healing and dentin bridge formation. Clinicians routinely practice adhesive bonding to provide immediate patient comfort and to prevent effectual restoration longevity ; - against microleakage.
Biological studies have provided clinicians with scientific answere to a number of previously misunderstood ideas. Since the early 1900´s, H₃PO₄ has been utilized in silicate and other acidic cements ; - H₃PO₄ etches the smear layer and smear pulgs, permitting rapid fluid flow, especially to a cold stimulus or if an air blast is applied at the suspect area. Until the mid-1990´s, acids were credited as the prime irritant to the pulp, leading to inflammation and necrosis. Against prevailing sentiment of his day, Buonocore demonstrated that acid etching enamel produced a microporous interface for adhesive bonding. Today, clinicians routinely place adhesive restorations to prevent caries ; - we routinely hybridize enamel and dentin for the same reasons ; - to seal the restoration interface.
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