By Peter A. Gardell, DDS
Many dentists are creatures of habit. This makes a lot of sense in light of the fact that so much of what we do is driven by efficiency. The more practiced we are at a technique, the more efficiently we can perform it. This explains why when we find a product that we judge to be acceptable for our needs, we often stay loyal regardless of the introduction of newer products with more bells and whistles. Often there's no harm in this, but in some cases we might actually be ignoring tools that can help improve efficiency even more.
Universal bonding agents are a great example. Adhesives represent one of the most technique-sensitive product categories, so many dentists tend to stick with their chosen adhesives after they've used them for long enough to judge their reliability. However, in the past several years, the introduction of universal bonding agents has significantly changed the adhesive process. If you're still using a fifth, sixth, or seventh generation bonding system because you're accustomed to your technique and don't see any need to change, consider the potential benefits of a universal system.
No more wasted product
With one adhesive that works for direct and indirect restorations, on dentin and enamel, you no longer need to stock multiple systems and risk your lesser-used product expiring. By switching to a universal bonding agent, not only will you not have to throw out unused products, you'll know that the product you're using is fresh, because you'll be reaching for it every day.
Not only can a universal bonding agent eliminate the need to purchase multiple adhesive systems, it can also eliminate the need for other products such as silane or desensitizers. My preferred adhesive, 3M™ ESPE™ Scotchbond™ Universal Adhesive, has silane incorporated into the formula, so it can chemically bond to glass ceramic surfaces without a separate ceramic primer. Its formula is also optimized to prevent postoperative sensitivity, via a combination of ingredients that allows the collagen network to be rehydrated and a hybrid layer to be formed whether the dentin is moist or dry. These properties can give dentists the confidence to leave products such as desensitizers behind.
Streamlining also makes life much easier for the dental assistant, who no longer has to keep track of one set of materials for direct procedures and another set of materials for indirect procedures. There is simply one kit for any adhesive procedure.
A simple application process
With fewer bottles to use or specialized techniques to master, you can work quickly and effectively. To apply my adhesive, I simply scrub it on the tooth surface for 20 seconds, briefly air dry, and then light cure. If a total-etch or selective-etch technique is necessary, the etchant is simply applied and rinsed beforehand. The technique is otherwise the same, meaning there are no other procedures to learn for the various types of cases for which the adhesive is used. This helps ensure that things flow smoothly in the operatory, with no need to stop work to double-check the instructions for a lesser-used product.
Confidence in a family system
Several years ago, I was using an adhesive that I had been told was compatible with a number of different cements. Unfortunately, after seeing several debonded indirect restorations, I came to the conclusion that the adhesive was not as compatible with various cements as I had been led to believe. However, my current universal adhesive is paired with a cement from the same manufacturer that has an integrated dark-cure activator for the adhesive. Not only does this give me confidence that the two products are compatible, but I also know that if I'm working in an area that is hard to reach with a curing light, the materials will still fully cure when they are used together. Knowing that these materials have been tested thoroughly in combination and that they are specifically designed to be complementary gives me greater confidence that I won't see issues with debonding like I've seen in the past.
There are enough things that make life complicated in any dental office. When new technology gives me the opportunity to simplify my techniques and procedures, I want to learn more. Universal bonding agents are a great example of why we sometimes need to step away from our standby products to try something new. Sometimes that new offering can bring about great benefits for productivity and simplicity.
Peter A. Gardell, DDS, graduated from New York University College of Dentistry with honors and maintains a private practice in Stamford, Conn., that emphasizes cosmetic and high-tech dentistry. Dr. Gardell is a faculty member of CerecDoctors.com and a faculty member in the CAD/CAM Department at the Scottsdale Center for Dentistry. Dr. Gardell can be reached via email at email@example.com.
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