1. Clinical evaluation of a self-etching and a
one-bottle adhesive system at two years
S¸ebnem L. Tu¨rku¨n*
Department of Restorative Dentistry and Endodontics, School of Dentistry, Ege University,
Izmir 35100, Turkey
Received 30 January 2003; revised 1 May 2003; accepted 21 May 2003
KEYWORDS
Self-etching adhesive;
One-bottle adhesive;
Clinical performance
Summary Objectives. The clinical performances of a self-etching adhesive system,
Clearfil SE Bond, and a one-bottle adhesive system, Prime&Bond NT, were evaluated in
non-carious Class V restorations for a period of two years.
Methods. Ninety-eight restorations were made by one operator for 32 patients. The
resin composite used to restore the teeth were Clearfil AP-X and Spectrum TPH for
Clearfil SE Bond and Prime&Bond NT, respectively. Two clinicians at the baseline, 6th,
12th and 24th months evaluated the posterior composites according to the modified
Ryge criteria’s. For this, color match, marginal discoloration, marginal adaptation,
recurrent caries, anatomic form, postoperative sensitivity and retention rates were
considered. The changes across time and across groups were evaluated statistically.
Results. At two years, 88 restorations were reviewed in 28 patients. The retention
rates for Clearfil SE Bond were 93 and 91% for Prime&Bond NT. The percentages of the
retention rates of both adhesive systems were not found to be different when
calculating the failure rates. Recurrent caries, anatomic form and postoperative
sensitivity were scored as Alpha for all restorations. Two cases of both adhesive
systems showed slight marginal discoloration problems. Three restorations of
Prime&Bond NT and one of Clearfil SE Bond had marginal adaptation problems at
two years. One case for each adhesive system had slight color change after the same
period.
Conclusion. We can conclude that both adhesive systems tested exhibited very good
clinical performance at the end of two years.
Q 2003 Elsevier Ltd. All rights reserved.
Introduction
The history of polymeric dental adhesives goes back
to the early mid-fifties, with Dr Michael Buono-
core’s1
discovery of resin bonding to enamel as
the most prominent milestone. A few years later,
the concept of bonding to enamel was broadened to
include dentin.
Clinical evidences have proved long lasting
adhesion between enamel and resin; however,
bonding to dentin was far more challenging com-
pared to enamel. The enhanced bonding between
resin and dentin was established by dentin hybrid-
ization.2
One major reason why successful bonding
to dentin was so difficult to achieve is that dentin is
an intrinsically wet substrate. The bonding areas
0300-5712/03/$ - see front matter Q 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S0300-5712(03)00107-6
Journal of Dentistry (2003) 31, 527–534
www.elsevier.com/locate/jdent
*Tel.: þ90-232-388-03-28; fax: þ90-232-388-03-25.
E-mail address: sebnemturkun@hotmail.com

2. are connected with the pulp by dentin tubules that
are filled with fluid. Another obstacle to an intimate
contact between resin and dentin is the so-called
smear layer consisting of damaged collagen and
apatite, which covers the dentin after cavity
preparation and caries excavation.3 – 6
This layer
prevents infiltration of monomers into dentin, and
even when it is removed with acid etching followed
by bonding agent application, fluid flow from pulp
might interfere with a stable bonding.
The new paradigm of minimal preparation was
achieved by the introduction and application of
caries detecting solutions, as well as the utilization
of the dentin adhesives.7
Today, adhesive cavity
preparation is being practiced without the tra-
ditional concern for mechanical retention form, or
extension for prevention. Extensive cavity prep-
arations have been replaced by more conservative
techniques, with careful removal of the infected,
permanently damaged carious tissue, and preser-
ving sound tooth substance.7
Since minimal cavity
preparation is preferred to traditional mechanical
retention, the clinical and biological longevity of
the final restoration is dependent on the perform-
ance of the adhesive, the bonding and the resin
composite systems.
Bonding procedures to tooth structures require
generally multiple-step clinical applications.
Therefore, clinical success with these adhesive
systems depends on technique-sensitive and
material-related factors.8
In an effort to simplify
the bonding procedures, several new adhesive
systems rely on simultaneous etching enamel and
dentin with a phosphoric acid or a self-etching
primer.
Most of the current dentin adhesive systems
require two-step procedures and can generally be
divided into two groups. One group includes one-
bottle adhesive systems with a total etching step
(with phosphoric acid) and an application step
(primer and adhesive combined). The other group
includes self-etching primer systems with a treat-
ment step (with a self-etching primer) followed by
an adhesive resin application step.9 – 12
Recently, in
order to simplify clinical procedures and reduce
technique sensitivity, several one-step, so-called
‘all-in-one’, adhesive systems have been devel-
oped.13,14
In recent years, the increased use of adhesive
resin composites in posterior teeth has become
more popular in the area of adhesive dentistry. With
this trend, it is of importance for the clinicians to
recognize the probable longevity and the possible
modes of failure of the restorations. Long-term
clinical survival of resin composite restoration is
apparently dependent on the factors that cause
clinical failure of the restorations, such as marginal
adaptation, wear, color match, marginal discolor-
ation, fracture and recurrent caries.5,6,8,9,15
It is
recognized that laboratory studies cannot simulate
all the clinical conditions to which restorations
might be exposed because factors like pH cycling,
masticator stresses, food abrasion, hardness of an
antagonist tooth, presence of bacteria, etc. are not
taken into account when doing an in vitro study.
Clinical testing of dentinal adhesive systems remains
the ultimate proof of effectiveness, because lab-
oratory studies may only speculate on clinical
behavior.5,6,8,9,11,15,16
The purpose of this study, therefore, was to
evaluate the clinical performance of a self-etching
two-step adhesive system Clearfil SE Bond and a
one-bottle adhesive system Prime&Bond NT in Class
V cavities for a period of two years.
Materials and methods
Selection criteria
Thirty-two patients, 19 females and 13 males, with
an average age of 46 (the range of age was between
26 and 60), referred to the Department of Restora-
tive Dentistry of the Dental School in Ege University
(Izmir/Turkey) and who demonstrated good oral
hygiene were enrolled in this study. Written patient
consents were obtained at the start of the project
and the protocol was approved by the Human
Ethical Research Committee of Ege University
(Izmir/Turkey). A total of 98 restorations were
placed in non-carious cervical lesions (caused by
abrasion, erosion or abfraction) with no undercuts.
Class V carious lesions were excluded, although
small areas of caries were removed from two teeth
in one patient. In general, no more than 50% of the
cavosurface margin involved enamel, and at least
75% of the surface area of the restoration was in
contact with dentin. All restored teeth contacted
the opposing teeth in a normal occlusion relation-
ship and had normal periodontal health.
To minimize the possible effects of patient
related factors, no more than three restorations
per patient were allowed for each adhesive system.
All patients received equal number of restorations
of both types. The distribution of restorations was
approximately equal between maxillary and man-
dibular arches, and about 70% of restorations were
placed in premolars. Fifteen percent were placed in
anterior teeth and the rest in molars.
The characteristics examined included both
evidence of occlusal stress and dentinal sclerosis.
S¸.L. Tu¨rku¨n528

3. The scale used for scoring dentin sclerosis is shown
in Table 1. The sizes of the lesions were similar and
varied from small to moderate. The scores of
dentinal sclerosis of the abrasions varied between
1 and 2 for the two restorative groups.
Restorative procedures
Operative procedures were performed without
local anesthesia. Vitality test scores of the teeth
were recorded before any preparation. Operating
sites were isolated with cotton rolls and retraction
cord. Tooth preparation did not include retentive
grooves or enamel bevels; rather, dentin and
enamel walls were lightly roughened with a coarse
diamond bur. Ninety-eight cavities were prepared,
restored and finished by one experienced (LST)
operator, who was familiar with adhesive dentistry
and who followed standard procedures and manu-
facturer’s recommendations.
The self-etching adhesive system tested was
Clearfil SE Bond (Kuraray Co. Ltd, Osaka, Japan,
Lot: 41168) and the one-bottle system was Prime&-
Bond NT (Dentsply/De Trey, Konstanz, Germany,
Lot: 103000296) whose properties are presented in
Table 2. The adhesives were applied randomly to
neighboring lesions if possible or in the left and
right part of the same dental arch.
For the Prime&Bond NT group, enamel and
dentin were etched for 15 s with a 34% phosphoric
acid gel (De Trey Conditioner 36, Dentsply/De Trey,
Konstanz, Germany, Lot: 101000213). The acid
was rinsed for 15 s and the excess of water was
removed with a cotton pellet. A thin layer of
adhesive system was applied over the entire
surface of the etched preparation for 20 s;
the solvent was removed with an air-syringe for
5 s and light cured for 10 s.
The Clearfil SE Bond primer was applied amply on
all surfaces of the cavities, leaved undisturbed for
20 s and evaporated with an air-syringe. The
bonding was applied with a brush, spread gently
with an air-syringe and light cured for 10 s. The light
source was the Luxor light-activating unit (ICI
Dental, Macclesfield, UK), which was tested prior
to each placement to ensure an output in excess of
450 W/mm2
.
The light curing composite resins used to restore
the teeth were Clearfil AP-X (Kuraray Co. Ltd,
Osaka, Japan, Lot: 0332) for Clearfil SE Bond, and
Spectrum TPH (Dentsply/De Trey, Konstanz,
Germany, Lot: 9804262) for Prime&Bond NT. The
properties of the resin composites were shown in
Table 2. The restorations were built up in vertical,
parallel to the long axis of the tooth using an
incremental technique of 2 mm or less. Each
Table 2 Compositions of the adhesive systems and resin
composites tested according to their manufacturers’ techni-
cal manuals.
Adhesives Compositions
Clearfil SE Bond
(Kuraray Co.,
Osaka, Japan)
Primer. 10-Methacryloyloxydecyl
dihydrogen phosphate (MDP), HEMA,
hydrophilic dimethacrylate,
DL-camphorquinone, N,N-diethanol
p-toluidine, water
Bonding. 10-Methacryloyloxydecyl
dihydrogen phosphate (MDP), Bis-GMA,
HEMA, hydrophobic dimethacrylate,
DL-Camphorquinone, N,N-diethanol
p-toluidine, photoinitiator, silanated
colloidal silica
Prime&Bond NT
(Dentsply/De Trey,
Konstanz, Germany)
PENTA, UDMA resin, resin R5-62-1,
T-resin, D-resin, nanofiller, Initiators,
stabilizer, cetylamine hydrofluoride,
acetone
Composites Properties
Clearfil AP-X
(Kuraray Co.,
Osaka, Japan)
Type of resin composite:
Universal Hybrid
Filler content: 86 wt%
Particle size: 0.04–3 mm
Polymerization shrinkage: 1.9 vol%
Modulus of elasticity: 16.6 GPa
Compressive strength: 449 MPa
Spectrum TPH
(Dentsply/De Trey,
Konstanz, Germany)
Type of resin composite:
Universal Hybrid
Filler content: 86 wt%
Particle size: 0.04–1,5 mm
Polymerization shrinkage: 2.5 vol%
Modulus of elasticity: 10.572 GPa
Compressive strength: 383 MPa
Table 1 Dentin sclerosis scoring scale.
Category Criteria
1 No evident sclerosis. Dentin is opaque, light
yellow or whitish with little discoloration and
little translucency is evident. These types of
lesions occur most frequently in younger
individuals
2 More sclerosis than in category 1, but less than
50% of way between categories 1 and 4
3 Less sclerosis than in category 4, but more than
50% of way between categories 1 and 4
4 Significant sclerosis present. Dentin is dark yellow
or even discolored and significant translucency is
evident. These types of lesions occur most freq-
uently in older individuals and are considered a
result of the aging process in dentin
Clinical evaluation of a self-etching and a one-bottle adhesive system at two years 529

4. increment was polymerized for 40 s using the Luxor
visible light-curing device. After polymerization,
finishing was accomplished under water spray
cooling with flame diamond burs (Komet, No: 859
EF.314.014) to remove gross excess followed by the
Sof-Lex polishing disc system (3M/ESPE St Paul, MN,
USA, Lot: P020403) to obtain a smooth reflective
surface.
Clinical evaluation criteria and procedures
The restorations were examined at the baseline
(one week later), 6 months, 1 and 2 years. All
restorations were evaluated using the modifi-
cation of the method developed by Ryge and
Cvar,17
commonly known as USPHS criteria’s.
Evaluation parameters included the following:
color-matching ability, marginal adaptation, loss
of anatomic form, marginal discoloration, recur-
rent caries, post-operative sensitivity and reten-
tion rate. For each of the criteria, Alfa was used
to indicate the highest degree of clinical accept-
ability; Bravo and Charlie were used to indicate
progressively lessening degrees of clinical accept-
ability (Table 3).
Two clinicians trained in the technique and not
involved with the treatment procedures evaluated
each restoration. When there was disagreement
during an evaluation, the ultimate decision was
made by consensus of the examiners, who were
calibrated before the study by a joint examination
of 20 composite restorations each. Vitality tests
were recorded and color photographs were taken
(Agfa Chrome RSX 50, AGFA, Leverkusen, Germany;
Nikon F4 for medical Niccor 120 mm) at the baseline
and at every recall.
Restoration retention rates were calculated
using the following equation:
Cumulative failure % ¼ ½ðPF þ NFÞ=ðPF þ RRÞŠ £ 100%
PF is the number of previous failures before the
current recall; NF the number of new failures during
the current recall; and RR the number of restor-
ations recalled for the current recall.
Statistical analyses
In the study design, no more than three restorations
with the same adhesive system were placed in one
patient. For each patient, the number of teeth
restored with the different adhesive systems was
equal so every restorations of the same patient
could be compared with his own control. At the end
of two years, there was no more than one problem
for each restoration. The data were analyzed on
a restoration-basis rather than a patient-basis. The
criteria evaluated have mostly three possible
categories of scoring (A, B and C). However, in
none of the criteria we have restorations scored in
Table 3 Modified Cvar/Ryge direct evaluation criteria’s.
Category Inspection
type
Rating scale
Color-
match
Visual inspection
with mirror at
18 in.
(A) No shade mismatch
in room light in 3–4 s
(B) Perceptible mismatch
but clinically acceptable
(C) Aesthetically
unacceptable (clinically
unacceptable)
Marginal
discoloration
Visual inspection
with mirror at
18 in.
(A) No discoloration
anywhere along
the margin.
(B) Superficial staining
(removable, usually
localized)
(C) Deep staining
Marginal
adaptation
Visual inspection
with explorer and
mirror, if needed
(A) Undetectable crevice
along the margin
(B) Detectable V-shaped
defect in enamel only
(C) Detectable V-shaped
defect in DEJ
Recurrent
caries
Visual inspection
with explorer,
mirror,
radiographs
(A) No evidence
of caries
(B) Evidence of
caries along the
margin of the
restoration
Anatomic
form
Visual inspection
with explorer and
mirror, if needed
(A) The restoration
is continuous with
existing anatomic form
(B) Generalized wear but
clinically acceptable (50%
of margins are detach-
able, catches explorer
going from material
to tooth)
(C) Wear beyond the DEJ
(clinically unacceptable)
Postoperative
sensitivity
Asked to
the patients
(A) No post-operative
sensitivity at any time of
the restorative process -
and during the study
period
(B) Experience of
sensitivity at any time of
the restorative process -
and during the study
period
Retention Visual inspection
with explorer and
mirror
(A) Retained
(B) Partially retained
(C) Missing
S¸.L. Tu¨rku¨n530

5. every category. According to the dichotomous of
the results, Cochran Q test was preferred.18
SPSS
software program was used to run Cochran Q test
analysis was used to examine the changes across the
four time points, for each of the criteria listed in
Table 3. The two adhesive systems were compared
in the same recall period for each of the criteria
using McNemar’s test. In Cochran Q test, the
asymptotic significance value and in McNemar, the
exact significance was used. a was set at 0.05.
Results
At the two-year follow-up examination, 88 of the 98
restorations were evaluated (90% recall rate) in 28
patients. Four patients were not able to reach for
various times of the control period. Those patients
were considered to have missing restorations and
were scored ‘C’ (Charlie) for the retention rate.
The Cvar/Ryge scores for the evaluated restor-
ations were listed in Table 4. Using the ADA
guidelines formula,19
we calculated the two-year
retention rates to be 93% for the self-etching group
and 91% for the one-bottle group. The percentage
of the retention rates of both adhesive systems
were not found to be different when comparing the
failure rates at the end of the two-year study
period.
Caries recurrence, anatomic form, aesthetics,
gingival response, tooth vitality and postoperative
sensitivity were all rated satisfactory for the two
adhesive systems investigated ðp $ 0:05Þ: The poss-
ible effect of clinical co-variables, such as dentinal
sclerosis, lesion size and shape, tooth type and
location in the arch, occlusal function, and the age
of the patient, on the clinical effectiveness could
not be demonstrated due to the limited number of
variances.
At the two-year recall; in five different patient,
there were three Bravos for marginal adaptation
and two Bravos for marginal discolorations for the
one-bottle adhesive system (Prime&Bond NT) eval-
uated while in three other patients, two Bravos
were scored for marginal discoloration and one for
marginal adaptation on the self-etching group
(Clearfil SE Bond). One restoration of each adhesive
system of the same patient had bulk color change
after two years due to eating habits. As Bravo
scored restorations are not considered to be
Table 4 Cvar/Ryge criteria obtained at each recall.
Baseline 6 Months 12 Months 24 Months
SE BONDa
P&B NTb
SE BOND P&B NT SE BOND P&B NT SE BOND P&B NT
Color match A 49 49 49 48 47 47 43 43
B 0 0 0 0 0 0 1 1
C 0 0 0 0 0 0 0 0
Marginal discoloration A 49 49 49 48 46 46 42 42
B 0 0 0 0 1 1 2 2
C 0 0 0 0 0 0 0 0
Recurrent caries A 49 49 49 48 47 47 44 44
B 0 0 0 0 0 0 0 0
Anatomic form A 49 49 49 48 47 47 44 44
B 0 0 0 0 0 0 0 0
C 0 0 0 0 0 0 0 0
Marginal adaptation A 49 49 49 48 47 47 43 41
B 0 0 0 0 0 0 1 3
C 0 0 0 0 0 0 0 0
Postoperative sensitivity A 49 49 49 48 47 47 44 44
B 0 0 0 0 0 0 0 0
Retention A 49 49 49 48 47 47 44 44
B 0 0 0 0 0 0 0 0
C 0 0 0 1 2 2 5 5
Alfa was used to indicate excellent restorations, while Bravo and Charlie were used to indicate progressively lessening degrees of
clinical acceptability.
a
Clearfil SE Bond.
b
Prime&Bond NT.
Clinical evaluation of a self-etching and a one-bottle adhesive system at two years 531

6. clinically unacceptable, we can affirm that both
adhesive systems did fulfill the ADA acceptance
criteria for restorative materials that is 90%
acceptable restorations rates at the 18-month
recall.19
Discussion
At the end of two years, the recall rate was 90%.
The clinical evaluation of the 88 available restor-
ations revealed over 90% retention rate for both
adhesive system. According to the ‘revised accep-
tance program guidelines for dentin and enamel
adhesive materials’ of the American Dental Associ-
ation Council on Dental Materials,19
success criter-
ia’s are defined by the maximum number of
restorations lost and microleakage failures at
baseline, 6 and 18 months. A dentin and enamel
adhesive material must have a retention and
marginal failure inferior to 10% Charlie at the 18-
month recalls. In our study, at the end of two years,
the percentage of Charlie scores for Clearfil SE Bond
and Prime&Bond NT was nearly 10%, revealing less
failure rates than the defined border rates.
The efficacy of enamel–dentin bonding systems
can be demonstrated in non-carious cervical lesions
located mainly in dentin, in which there is no cavity
preparation or macro-mechanical retention form. It
has been suggested that bonding to sclerotic dentin
is less reliable than to young dentin.20
Yoshiyama
et al.21
reported that the microtensile strength of
the dentin adhesive to the cervical sclerotic dentin
was significantly decreased compared to that of
normal dentin. Sclerotic dentin differs from unaf-
fected dentin by an increased apposition of peri-
tubular dentin, precipitation of mineral crystals in
the tubulus and decreased permeability. A thinner
hybrid layer has been described for sclerotic dentin
than in young dentin.22,23
The more inhomo-
geneous, thinner and void-rich hybrid layer in old
sclerotic dentin was explained by the inability of
the acid conditioners to uniformly demineralize the
sclerotic dentin.23
The mode of adhesion to
sclerotic dentin is like to etched enamel, based on
the creation of a highly energetic surface together
with an increased bonding area and surface rough-
ness, and not on resin-impregnation of the inter-
tubular dentin. The removal of the outer surface of
the sclerotic dentin by roughening with a diamond
bur has been recommended in order to create a
better and homogeneous hybrid layer.24
In our
study, as the degrees of dentin sclerosis of the
abrasions was different and in order to create
a better hybrid layer, the abrasions were lightly
roughened prior to adhesive application.
A bonding system which bonds to tooth suffi-
ciently strong to withstand the internal and
external stresses has been desired for long time.
Bonding of resin based composite to dentin is
mainly based on micro-mechanical retention, i.e.
(1) on the formation of intratubular resin tags with
anastomoses between the tubules, and (2) on the
formation of a hybrid layer or ‘resin-dentin inter-
diffusion zone’ which is an admixture of deminer-
alised collagen with the monomers of the primer
and the adhesive.25,26
The adhesives tested in this study have different
application techniques, solvents and compositions.
Current dental adhesives are commonly based on a
solvent. The most common solvents employed are
water, ethanol, acetone, or mixtures there of.
Acetone-based primer-adhesives, like Prime&Bond
NT, have shown higher bond strengths and reduced
micro-leakage when a moist bonding protocol was
followed.27 –31
Clearfil SE Bond system is an aqueous
mixture of acidic functional monomers and polymer
components that demineralise the dentin and the
smear layer that remains after cavity preparation
and provides an infiltration of the underlying tooth
substance.32 – 36
Since the SE Bond primer contains
acidic functional monomers and the pH of these
solutions are low, the thickness of the deminer-
alised layer might be affected by the application
time. The hybrid layer formed by Clearfil SE Bond
was thinner (0.5–1 mm) and the resin tags were
shorter than that formed with one-bottle sys-
tems.37
Therefore, it has been concluded that the
quality, the homogeneity and the thickness of the
resin-infiltrated layer should receive attention in
future research.38
In our study, we preferred to use
each adhesive system with a resin composite of the
same company to restore the Class 5 abrasions
because we think that the systems could perform
better with their respective resin composites.
However, the modulus of elasticity of the resin
composites used was different (Table 2) and this
property may potentially affect the long-term
performance of the adhesive systems tested
because a material with low elastic modulus
deflects under stress.39
Treating the enamel and dentin with acidic self-
conditioning monomer solutions instead of employ-
ing a conventional total-etch procedure is a simple
method to prevent the collapse of collagen net-
work.36
When self-etching primers are used, there
is no need of etching, rinsing and drying so that the
risk of over-etching and over-drying of the dentin is
eliminated. Self-etching primers are extremely fast
and simple to apply in clinical situations, and
S¸.L. Tu¨rku¨n532

7. dramatically reduce the technique sensitivity of the
bonding procedure. Moreover, Gordon et al.40
stated that when using the Clearfil Liner Bond
system, the previous version of Clearfil SE Bond, the
marginal adaptation of resin composite restorations
to dentin was comparable or even superior to that
of total-etch three- and two-step systems.
According to Jacobsen and So¨derholm,41
the
water-based primers improved their bond strength
with increased priming time, but without reaching
the bond strength of the acetone based primers.
Perdiga˜o et al.42
stated that current one-bottle
dentin adhesives usually contain acetone and/or
ethanol, which can dislocate water from the dentin
surface and form the moist collagen network, thus
promoting the infiltration of resin monomers
through the nano-spaces of the dense collagen
web and enhancing bond strengths.
Postoperative sensitivity was the most frequent
complication of early posterior composite restor-
ations. With the introduction of adhesives, that are
able to completely penetrate into decalcified
dentin and/or to obdurate dentinal tubules, the
incidence of postoperative sensitivity has dropped
significantly.
Haller and Fritzenschaft27
had investigated
hypersensitivity in Class V restorations with Pri-
me&Bond NT/Spectrum TPH for a period of 18
months. At six months, cervical surfaces restored
with the phosphoric acid and Prime&Bond NT
reacted mildly hypersensitive to the dental air
syringe in 14.6% of the cases. However, we found no
sensitivity in any cases treated after two-year
period.
Since the adhesive restoration is technique
sensitive, the success of adhesive restoration is
mostly determined by the ability of the dentists,
beyond the performance of the material. Even with
the improved materials, the performance of the
material cannot be overestimated to exceed that of
a dentist. Therefore, it is still important for the
clinician to practice appropriately and meticulously
when using adhesive materials. Since the durability
of the adhesive restoration showed good results
clinically, we can conclude that the adhesive
restoration may be suggested as the ‘restoration
of choice’ that will be more and more preferred in
the near future.
Conclusion
Within the limits of this study, we can conclude that
for a period of two years, the clinical performance
of the self-etching and the one-bottle adhesive
systems were not different. The utilization of both
systems to restore Class V cavities is favorable for
two years.
Acknowledgements
The author would thank the companies of Kuraray
and Dentsply/De Trey for their generous material
support.
References
1. Buonocore MG. Simple method of increasing the adhesion of
acrylic filling materials to enamel surfaces. Journal of
Dental Research 1955;34:849—53.
2. Nakabayashi N, Kojima K, Masuhara E. The promoter of
adhesion by the infiltration of monomers into tooth
substrates. Journal of Biomedical Material Research 1982;
16:265—73.
3. Marshall Jr GW, Marshall SJ, Kinney JH, Baloch M. The dentin
substrate: structure and properties related to bonding.
Journal of Dentistry 1997;25:441—58.
4. Pashley DH, Carvalho RM. Dentine permeability and dentine
adhesion. Journal of Dentistry 1997;25:355—72.
5. Haller B. Recent developments in dentin bonding. American
Journal of Dentistry 2000;13:44—50.
6. Swift Jr EJ, Perdiga˜o J, Wilder Jr AD, Heymann HO,
Sturdevant JR, Bayne SC. Clinical evaluation of two one-
bottle dentin adhesives at three years. Journal of the
American Dental Association 2001;130:1117—123.
7. Fusayama T. New concepts in operative dentistry, 5th ed.
Berlin: Quintessence Publishing; 1980.
8. Tu¨rku¨n LS¸, Aktener BO. Twenty-four-month clinical evalu-
ation of different posterior composite resin materials.
Journal of the American Dental Association 2001;132:
196—203.
9. Ferrari M, Gorracci G, Garcia-Goday F. Bonding mechanism
of three ‘one-bottle’ systems to conditioned and uncondi-
tioned enamel and dentin. American Journal of Dentistry
1997;10:224—30.
10. Swift Jr EJ, Wilder Jr AD, May Jr KN, Wassell SL. Shear bond
strengths of one-bottle dentin adhesives using multiple
applications. Operative Dentistry 1997;22:194—99.
11. Frankenberger R, Kra¨mer N, Petschelt A. Technique sensi-
tivity of dentin bonding: effect of application mistakes on
bond strength and marginal adaptation. Operative Dentistry
2000;25:324—30.
12. Miyazaki M, Onose H, Moore K. Effect of operator variability
on dentin bond strength of two-step bonding systems.
American Journal of Dentistry 2000;13:101—04.
13. Bouillaguets S, Gysi P, Wataha JC, Ciucchi B, Cottani M,
Godin Ch, Meyer JM. Bond strength of composite to dentine
using conventional, one-step, and self-etching adhesive
systems. Journal of Dentistry 2001;29:55—61.
14. Frankenberger R, Perdiga˜o J, Rosa BT, Lopes M. ‘No-bottle’
vs ‘multi-bottle’ dentin adhesives—a microtensile bond
strength and morphological study. Dental Materials 2001;
17:373—80.
15. Van Meerbeek B, Peumans M, Verschueren M, Gladys S,
Braem M, Lambrechts P, Vanherle G. Clinical status of ten
Clinical evaluation of a self-etching and a one-bottle adhesive system at two years 533

8. dentin adhesive systems. Journal of Dental Research 1994;
73:1690—702.
16. Duke ES. Clinical studies of adhesive systems. Operative
Dentistry 1992;5(Suppl):103—10.
17. Ryge G, Cvar JF. Criteria for the clinical evaluation of
dental restorative materials. US Dental Health Center, San
Francisco: US Government Printing Office Publication; 1971.
Publication No. 7902244.
18. Conover WJ. Practical nonparametric statistics, 2nd ed.
New York: Wiley; 1971. p. 199.
19. Council on Dental Materials, Instruments and Equipment,
Revised American Dental Association acceptance program
guidelines for dentin and enamel adhesive materials.
Chicago: American Dental Association; 1994.
20. Duke ES, Lindemuth JS. Variability of clinical dentin
substrates. American Journal of Dentistry 1991;4:241—46.
21. Yoshiyama M, Sano H, Ebisu, Tagami J, Ciucchi B, Carvalho
RM, Johnson MH, Pashley DH. Regional strength of bonding
agents to cervical sclerotic dentine. Journal of Dental
Research 1996;75:1404—413.
22. Van Meerbeek B, Braem M, Lambrechts P, VanHerle G.
Morphological characterization of the interface between
resin and sclerotic dentine. Journal of Dentistry 1994;22:
141—46.
23. Prati C, Chersoni S, Mongiorgi G, Pashley DH. Thickness
and morphology of resin-infiltrated dentin layer in young,
old, and sclerotic dentin. Operative Dentistry 1999;24:
66—72.
24. Gwinnett AJ, Kanca III J. Interfacial morphology of resin
composite and shiny erosion lesions. American Journal of
Dentistry 1992;5:315—17.
25. Nakabayashi N, Nakamura M, Yasuda N. Hybrid layer as a
dentin-bonding mechanism. Journal of Esthetic Dentistry
1991;3:133—38.
26. Van Meerbeek B, Inokoshi S, Braem M, Lambrechts P,
Vanherle G. Morphological aspects of the resin-dentin
interdiffusion zone with different dentin adhesive systems.
Journal of Dental Research 1992;71:1530—540.
27. Haller B, Fritzenschaft A. Dentin haftung von ein-und
mehrkomponenten-haftvermittlern bei dry and moist
bonding in vitro. Deutsche Zahna¨rztl Zeitung 1999;54:
225—30.
28. Saunders WP, Saunders EM. Microleakage of bonding agents
with wet and dry bonding techniques. American Journal of
Dentistry 1996;9:34—6.
29. Tay FR, Gwinnett JA, Wei SHY. Micromorphological spectrum
from overdrying to overwetting acid-conditioned dentin in
water-free, acetone-based, single-bottle primer/adhesives.
American Journal of Dentistry 1996;12:236—44.
30. De Goes MF, Ferrari GCP, Garcia-Godoy F. Resin bond
strength with different methods to remove excess water
from the dentin. American Journal of Dentistry 1997;10:
298—301.
31. Kanca III J. One-step bonding strength to enamel and dentin.
American Journal of Dentistry 1997;10:5—8.
32. Chigira H, Yukitani W, Hasegawa T, Manabe A, Itoh K,
Hayakawa T, Debari K, Wakumoto S, Hismitsu H. Self-etching
dentin primers containing phenyl-P. Journal of Dental
Research 1994;73:1088—095.
33. Ikemura K, Kouro Y, Endo T. Effect of 4-acryloxyethyltri-
mellitic acid in a self-etching primer on bonding to ground
dentin. Dental Materials 1996;15:132—43.
34. Latta MA, Barkmeier WW. Dental adhesives in contemporary
restorative dentistry. Dental Clinics of North America 1998;
42:567—77.
35. Akimoto N. Study on adhesive cast inlay restoration with no
retention formed cavity: retentive force and marginal
leakage. Japanese Journal of Conservative Dentistry 1995;
38:130—51.
36. Watanabe I, Nakabayashi N, Pashley DH. Bonding to ground
dentin by a phenyl-P self-etching primer. Journal of Dental
Research 1994;73:1212—220.
37. Inoue S, van Meerbeek B, Vargas M, Yoshida Y, Lambrechts P,
Vanherle G. Adhesion mechanism of self-etching adhesives.
In: Tagami J, Toledano M, Prati C, editors. Advanced
adhesive dentistry third international Kuraray symposium,
Granada, 1999.
38. Gwinnett AJ, Tay FR, Pang KM, Wei SH. Quantitative
contribution of the collagen network in dentin hybridisation.
American Journal of Dentistry 1996;9:140—44.
39. O’Brien WJ. Dental materials and their selection, 2nd ed.
Berlin: Quintessence Publishing; 1997. p. 103.
40. Gordon VV, Vargas MA, Cobb DS, Denehy GE. Evaluation of
acidic primers in microleakage of class 5 composite resin
restorations. Operative Dentistry 1998;23:244—49.
41. Jacobsen T, So¨derholm K-J. Some effects of water on dentin
bonding. Dental Materials 1995;11:132—36.
42. Perdiga˜o J, Swift EJ, Heymann HO, Malek MA. Effect of a re-
wetting agent on the performance of acetone-based dentin
adhesives. American Journal of Dentistry 1998;11:207—13.
S¸.L. Tu¨rku¨n534