Here’s how to make sure you have an adhesive winner every time.
By Victoria L. Wallace, CDA, RDA
As we continue our discussion about adhesive dentistry from the previous article, please keep in mind that the dental assistant plays a huge role to ensure that the bonded restoration being placed does not fail. I say this because after presenting to a group of dentists and dental assistants on adhesive troubleshooting and adhesive updates, a dental assistant came up to me and said that (my presentation) was a waste of her time. I was flabbergasted! (I had promised myself, and all those I present to, that I would never bore them or make them sit through three hours of misery. I pride myself on giving fun and educational presentations, and I believe I pretty much fulfill that requirement.) I asked her why she thought that way, and she said that dental assistants don’t need to know all about adhesive materials and how they work, that was the doctor’s job. She was serious.
Once again, I was flabbergasted. I truly did not know how to respond. I apologized that she felt that way, and let her walk away mumbling. Wow! I just didn’t get it. All I can think of is if she feels that way, it is probably a good thing she doesn’t have to handle any of the adhesive items. But wait ... who dispenses them? Who hands them to the doctor? Who orders them? Who makes sure the doctor is getting the right chemistry in the right order? The answer is ... the dental assistant! So by gosh, we had better know about the products we are handling and what we are giving to the doctor. The dentist depends on us to provide him or her the right product at the right time of the procedure.
I hope you all feel the same way. It is important for you, the dental assistant, to know just as much about the products and procedures as the dentist, especially if you are an expanded functions dental assistant. That would be like a surgical assistant not knowing what to hand to the surgeon. Can you imagine? At least if someone messes up during a surgery, more than likely the patient is sedated, so no one has to know the difference. That is so opposite of how we work, so I still think it is best for us to know what to hand the doctor and when. Great. Glad that’s settled. Thanks for listening, I feel so much better.
So, back to where we left off. We discussed the different “generations” of bonding resins, starting with the fourth. I failed to mention that there were others before that. Of course, it is safe to assume that the first three generations are pretty much obsolete, so we won’t go there. Let’s stick with the here and now.
We made it through the sixth generation, or the self-etch and how it is applied. Remember, self-etching systems incorporate the etchant and primers together and require no rinsing, just air thinning. Next, place bonding resin, air thin (if instructed so) and light cure.
The newer generations of bonding resins have combined hydrophilic (like water) and hydrophobic (don’t like water) chemistry together, so I would like to share a couple of tips to increase your knowledge of what you are working with.
- Don’t over purchase, be aware of the expiration date, and store in a cool, dry place. It’s not a bad idea to place the resins in the refrigerator overnight. If you have a spare operatory for emergencies, make sure not to leave the resins in the room. Place in refrigerator and pull out when you need them. Gently shake before applying.
- If you are using a self-etching system, and you are placing a Class IV restoration, you might consider placing some phosphoric acid (35+%) along the enamel margin prior to self-etching to help ensure a deeper penetration of the primers into the enamel to help strengthen the bond. If this isn’t of interest to you, then place the self-etching primer on the enamel first and let it sit a little bit longer, then finish placing through the whole prep and margins.
- Most importantly, do not desiccate (over dry) tooth structure before placing adhesive.
More new resin science was presented to the dental public in 2004. This new system includes all the chemistry in one bottle, and has been classified as a seventh generation system.
One might think that this will absolutely speed up the whole bonding process, but in some cases it may take longer to apply than a two or three step product. It is important to read the instructions provided by the manufacturer so as not to compromise the end result. You need to be aware that you don’t just dispense, place on prep and cure. Here are some instructions provided by a leader in dental products for placing their one-step bonding resin.
Shake, open and dispense into dappen dish. Immediately replace cap on the resin bottle.
Dip micro applicator brush and gently scrub into prep for 20 seconds. Then re-dip brush into solution and re-apply a second application for another 20 seconds.
Gently air thin, and then increase PSI of air for another five seconds.
Light cure for 20 seconds.
This whole process takes at least one minute for proper application. No big deal, you say. Well, do this for me next time you are assisting the doctor. Time the 20 seconds! No kidding, it seems like forever. And then do it again. I’ve spent way too many hours assisting doctors and I know that 20 seconds is a long time. When I am giving a hands-on course, I time it for everyone ... what an eye opener. You get the idea.
Also, some of the newer generations will have you apply the material and not air thin. They are all a little bit different.
The research is still out on the newer seventh generation systems, so if you are going to use these, make sure you follow the directions to a tee. Here are a few more tidbits to help ensure a predictable bond with these types of systems:
- Do not over purchase, and pay attention to the shelf life or expiration date. If expired, throw away.
- Due to the mix of chemistries in one bottle, it is important to shake before dispensing and agitate while applying
- Keep stored in a cool, dry place
- Replace cap as soon as you are done dispensing
- Don’t be alarmed by the smell ... the stronger the better as that means a fresher product.
So there you have it. Clear as a bell, right? Well, it just doesn’t seem to be as simple as that. All I can say is know what you are using and make sure you are using it properly. I truly believe this is, at least in part, the responsibility of the chairside assistant. It’s not a bad idea to quickly review the instructions every time you open up a new package of bonding resin. Sometimes applications are changed without any notification given to the clinician. Again, dental assistants, make this your responsibility. It will make you feel reassured you are playing an important part in providing a long lasting, non-leaking hybrid layer. Your patients will love you for this.
As for the classifications of adhesive bonding systems, it would be beneficial for all dental clinicians if we had a system in place that was easier for everyone to understand, like a total etch two step, or a self-etch one step, etc. It may be in the works as we speak, and if so I will keep you up to date on the changes.
I guess it really doesn’t matter if you know the “generations” off the top of your head, but knowing how to properly apply the system you use does matter.
Next, let’s talk about curing lights. What do you think? If you have any specific questions or topics you would like to see discussed, please feel free to e-mail me at [email protected] and I will see what I can put together. If I don’t know it, I will research it and share. I love to learn new things, don’t you? Good dental brain food is what I say.
I hope to see you all at the September ADAA and ADA in lovely San Francisco. Look for the ads for the ADAA Star Studded Reception. It will have lots of goodies and gifts and just downright great company. So let’s get ready to party!
Until next time...
Be safe, be happy, and never stop smiling!
Your dental assisting friend,
Victoria L. Wallace, CDA, RDA has been a CDA, RDA since 1976. Her chairside career included general dentistry, and cosmetic/esthetic dentistry. Since 1996, Wallace has been employed by Ultradent Products, Inc. She currently works with the West coast and Nebraska dental schools and residency programs. She lectures and gives hands-on programs nationwide with a focus on adhesive dentistry and tooth whitening. Wallace is an active member of the ADAA, president of the Nevada DAA, and serves as a director for the ADAAF.