Which bonding product is best?

There are so many products to choose from for bonding indirect restorations. How do we know which one to choose? Single Bond, Excite, Gluma Comfort Bond + Desensitizer, and Prime & Bond NT - all are being recommended by their manufacturers. In our office, we have not seen any clinical difference between single-component or dual-cure adhesives, like OptiBond, when used with dual-cure luting cements. Please comment.

Michael Miller, DDS

There are so many products to choose from for bonding indirect restorations. How do we know which one to choose? Single Bond, Excite, Gluma Comfort Bond + Desensitizer, and Prime & Bond NT - all are being recommended by their manufacturers. In our office, we have not seen any clinical difference between single-component or dual-cure adhesives, like OptiBond, when used with dual-cure luting cements. Please comment.

Our studies have shown that most of the top adhesives will perform well when bonding indirect restorations, as long as a dual-cure cement is used. This applies to single-component, as well as multi-component adhesives. We even investigated whether you need to precure the adhesive before seating the restoration or whether the adhesive can be cured along with the cement.

When it comes to single-component adhesives, most can be used either way. If you want to be sure the dentin is sealed before seating the restoration, then precuring is your best bet. However, if you want to make sure the adhesive doesn`t pool in the line angles and keep you from completely seating the restoration, then light-cure the adhesive and resin cement together. This applies to restorations 2-mm thick or less.

Self-cure cement is another animal and, to be on the safe side, you always should use a multi-component adhesive such as OptiBond, Prime & Bond NT Dual Cure, All-Bond 2, Scotchbond Multi-Purpose Plus, or the new Cabrio Dual Cure and Dentastic Duo.

Is there a problem in using a heavy-body, vinyl-polysiloxane tray material from one company with a light-body syringe material from another manufacturer?

Probably not, assuming both products have the same setting time. But, unless you have invested a lot of money in either product, you may want to upgrade to one of our choices. They are listed in the Impression Materials section of the 2000 edition of REALITY. We know they work! Examples of these products are Aquasil, Take 1, Imprint II, and Splash. All of these products come in fast and regular set, depending on the number of teeth you are taking impressions of. Splash has the added distinctions of being the fastest setting and the least expensive. Another plus is that they all are more hydrophilic than ever, although still not at the level of the polyethers.

What material would you recommend for an undercut when preparing an inlay or onlay? I`m using Black Fuji with no etchant, primer, or adhesive. I have read that you can use compomers, but that they need etchant, primer, or adhesive for bonding.

We assume you mean Miracle Mix, when you mention "Black Fuji." While it had its time in the sun, its dark color and lack of a light-curing property make it less desirable in contemporary dentistry.

A better choice would be a flowable compomer such as Dyract Flow or Compoglass Flow. If you are bonding just to dentin, you can use Prime & Bond NT without etching and still get reasonably good bond strengths. You also could use a simple self-etching product, such as Prompt or Clearfil SE Bond.

Dr. Miller is the publisher of REALITY and REALITY NOW, the information source for esthetic dentistry. He is an international lecturer and a fellow of the American Academy of Cosmetic Dentistry, as well as a founding member. He maintains a private practice in Houston, Texas. For more information on REALITY and to receive a complimentary issue of his monthly update, REALITY NOW, call (800) 544-4999 or visit www.realityesthetics.com.

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