DENTSPLY Caulk’s Universal Adhesive and Cement Products Take Aim at Restoration Failure
Nicholas R. Conte, DMD, Director, Clinical Research and Education, DENTSPLY Caulk, remarks on a troubling reality in adhesive dentistry: Despite advances in material technology, the longevity of restorations has actually declined. He says two different types of products from DENTSPLY Caulk help dentists prevent common causes of restoration failure. They are Prime&Bond Elect®, a universal adhesive designed to aid clinicians in obtaining the optimum bond to both enamel and dentin, and Calibra® Universal, a self-adhesive resin cement whose longer gel phase facilitates clean-up, thus avoiding failure due to residual cement.
While, Conte says, the definition of “universal” may vary from one manufacturer to another, DENTSPLY Caulk’s Prime&Bond Elect accommodates any etching technique and is applicable for both indirect and direct adhesive dental procedures. “For us, ‘universal’ really implies the ability to use the adhesive in three separate modalities: self-etch, total-etch, or selective-etch. Our objective was to use the most vulnerable interface in a Class II restoration, which is the floor of the proximal box, to show the product’s strength as a universal adhesive.”
This is achieved, according to Conte, by offering “the best of both worlds” of self-etch and total-etch. “Commonly, the dilemma dentists face involves choosing between self-etch or total-etch. If they choose self-etch—that is, not putting the phosphoric acid on the dentin—it could reduce the chance of postoperative sensitivity at the expense of creating the best and most durable bond, which is with etched enamel. If they choose total etch—which many consider is worth the risk because of the benefit of the best bond to enamel—they could induce discomfort in a patient who came in with none. So, if the goal was to turn the weakest link, the floor of the proximal box, into a strength for the restoration, Prime&Bond Elect accomplishes this,” he explains.
Prime&Bond Elect, Conte asserts, is not as acidic as existing self-etch adhesives but is capable of creating an excellent bond to enamel without inducing postoperative sensitivity on the dentin. This, he says, is especially important with Class II restorations.
“One of the main reasons Class IIs fail is because of recurrent decay at the floor of the proximal box,” he says. “Prime&Bond Elect’s pH level makes it safer to use in combination with phosphoric acid, giving clinicians the benefits of increased bond strength to enamel without the negative sequelae of postoperative sensitivity following over-etching of dentin.”
Preventing restoration failure on another front, Conte continues, is Calibra Universal. The self-adhesive resin cement differs from others in the category in that after tack-curing for 5 to 10 seconds, it remains in the gel phase for approximately 45 seconds. This, he says, offers clinicians ample time to complete clean-up, minimizing the chances of leaving excess cement behind.
“This was a response to the same trend of reduced restoration longevity,” he explains. “Cements are getting better, but crowns don’t seem to be lasting as long as they used to.” He notes a significant amount of evidence in the literature that residual cement can compromise the long-term health of the crown. “This is most likely because it is irregular, leading to the accumulation of plaque and biofilm on the surface, which, in turn, causes inflammation.”
Conte adds that Calibra Universal’s wider curing window also also prevents over-curing to the point that the cement requires removal with a bur, which is “something we never want to use on a freshly cemented crown.”
Calibra Universal’s 5- to 10-second tack-cure window and approximately 45 seconds of gel phase time, Conte adds, make it unique on both ends—“it is easier to find the gel phase, and once you’re in it, you have more time for clean-up.”
Conte says that in addition to seeking solutions to dental dilemmas through product development, DENTSPLY Caulk offers “three pillars of support” for clinicians, including: 1) a product that’s differentiated; 2) continuing education programs; and 3) customer service with field and professional service reps to answer questions and demonstrate proper technique.
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