In the Beginning
Adhesive dental restorations have had an incredible impact on the clinical dental procedures that are performed today. Before the development of composite materials that could withstand the physical forces of posterior occlusion and wear, the profession’s “go to” affordable material was amalgam. Dental amalgam was easy to place and had remarkable clinical longevity, however, those benefits came at a price. That price was the sacrifice of healthy and viable tooth structure.
While amalgam had easily defined and defensible benefits, there were also drawbacks to its use. The material required a certain amount of bulk to resist fracture. This meant that amalgam preparations needed to have a minimum depth and a minimum width to ensure adequate amounts of material to provide fracture resistance. It also required physical undercuts and dovetails to provide mechanical retention as the material was held in place, not from adhesion, but from mechanical properties built into the preparation.
These prepa
ration design requirements frequently necessitated the removal of healthy and viable tooth structure. Dentistry is a profession built on the concept of conserving tooth structure and, to many of us, this concept was in direct opposition to their philosophy and training.
For a profession that focused on conservative treatment, something needed to change. Dentistry’s focus is now on the concept of “minimally invasive”.
The Dream
What researchers worked towards was a material that made up for the deficiencies of amalgam. If they could create a material that was more like tooth structure and did not require mechanical retention in the preps, it could truly be minimally invasive. The goal was to develop a material that allowed the doctor to remove the diseased and weakened tooth structure and nothing else. Only then would that goal be achieved. The question became “how can we create a retentive filling material without the need for a retentive preparation?
The Critical Change - Adhesive Bonding
Estimates state that over 50% of dental procedures now involve the process of bonding. Whether enamel, dentin, fiber reinforced posts, or restorative materials, the process of bonding is frequently the foundation upon which the vast majority of restorative procedures rest. Due to this fact, it is imperative that the bonding process be as consistently predictable as possible.
Also, as any dentist will understand, controlling of the operative field is a critical component when it comes to successful bonding procedures. Because of the potential for contamination from blood, saliva, crevicular fluid or water, all of which are plentiful in the oral cavity, it is imperative that bonding procedures be done as quickly and efficiently as possible. The longer the restorative procedure takes to perform, the greater the odds of some type of contamination of the operative field.
The current process of material bonding in clinical dentistry is a rather phenomenal feat of chemistry. Biologic components are highly hydrophilic while the inorganic components of the process are hydrophobic. The truly amazing and beneficial aspect of the bonding agent is that, as research and development has continued and been evaluated, the scientific discoveries and benefits have followed in its wake.
When one considers that a liquid, painted on the tooth in a nearly undetectable thin layer, can form a chemical adhesion between restorative material and the tooth that is nearly as strong as the tooth itself, the concept practically defies logic. Yet this identical process is performed hundreds or thousands of times daily by a myriad of clinicians, in a myriad of patients with nearly identical results. These results show the incredible and predictable clinical result that can be achieved through the use of Futurabond U.
The Importance of Chemistry
The chemistry of a bonding agent needs to be universal, meaning that it can be used in any and every clinical situation. Needing to reach for certain chemistry that is only compatible with certain other chemistries and certain procedures is inefficient and can lead to confusion during treatment, which can even create compromise in the final result. Clinicians need the confidence to have one bonding agent that they can count on for every procedure and to know that material will deliver every time it is used.
One of the most important pieces of the bonding puzzle, and one that is within the control of the operator, is the chemistry of the bonding agent. This comes from the makeup of any bonding agent currently on the market. Every bonding agent contains some type of solvent that is highly volatile, meaning the solvent evaporates quickly and easily.
Bonding agents are packaged in several different ways, the best of which is the unidose option. Let’s now take a look at solvent dispensing and why it is so critical to long-term clinical success.
The mistake that can often be made with the bonding agent is to dispense it too early on in the procedure. As previously mentioned, every bonding agent contains a highly volatile solvent. In an ideal restorative procedure, after the bonding agent is placed, a gentle stream of air is used to thin the bonding agent, but it also performs the function of evaporating the solvent, something that is intrinsic to the success of the procedure. Once the solvent is evaporated, the bonding agent can be light cured.
When dispensed too early, the solvent evaporates prior to even being placed on the target. This means decreased bond strengths, sensitivity, staining at the margins and other problems. Oftentimes, in an effort to be procedurally efficient, the assistant will take a bottle of bonding agent and express a few drops into the well as part of the procedural setup. However, sitting out in the open allows the solvent to evaporate well before placement.
This can also happen in bottled systems when the bottle cap is left off. Even though the opening of the bottle is very small, it still allows for the highly volatile solvent to evaporate. The unfortunate effect of this mistake leads to restorative failure for every procedure for which that bottle is used.
Futurabond U SingleDose is a genius development in dispensing and one that took 6 years of careful engineering . It allows the operator to ensure a freshly mixed bonding agent every time. (See video below for more details.) The material comes in a specially-designed blister pack that allows the user to break a seal and stir the components together, meaning the bonding agent is only mixed the moment it is needed. Once the components are mixed, it can be delivered directly to the tooth. A perfect mix, delivered to the patient only seconds after the package is opened, means that the bonding process and the chemistry involved\ is clinically efficient and highly predictable.
Predictability is something that every clinician values and currently, only VOCO delivers a bonding agent in specially-designed fresh mix blister packs. It is truly universal and can be used in every procedure whether the material is light cure, self cure, or dual cure with incredibly predictable results. Futurabond U delivers where others cannot.
VIDEO: WHAT IS THE "SOLVENT EVAPORATION PROBLEM AND HOW DOES FUTURABOND U SOLVE IT?"
