Chairside - Glidewell Dental Labs

me. I can’t blame the technique or the materials or myself. It
was some combination of all three — I’m willing the take the
blame. But when self-etching materials came out, it seemed like,
by lowering the postoperative sensitivity potential, that it was
going to be a step in the right direction, even if we didn’t have
the same high bond strengths. I interviewed Dr. Jose-Luis Ruiz a
few months ago, and he has gone fully self-etch for everything.
He does not use total-etch anymore. So that’s one far end of
the spectrum. I think over at the other far end of the spectrum
are the dentists who just love total-etch and still use it all the
time. Maybe they will use self-etch under a direct composite,
or something like that. What has your experience been with
self-etch adhesives, and where do you find yourself using
them most?
LB: I’m probably one of the folks in the middle. I was, for
years, a total-etch fourth generation. I used to teach it as
the gold standard. Technically, if you just want to look at
brass tacks research numbers for bond strength, it’s still the
gold standard. The challenge, for most people, is that it’s
so technique sensitive that whether you talk about post-op
sensitivity from the etching technique or marginal integrity
because of the film thickness those generations of dentists
use, the average general practitioner runs into trouble.
So now we have three other generations of self-etching
products and new total-etch products.
What I use right now is what we call a “selective etching
technique.” I actually use phosphoric acid and I etch only
the enamel, and then I let it go for 25 seconds and I rinse it
off and dry it. What do I avoid with that technique? I’m not
worried about over-etching, which is having the phosphoric
acid against the dentin for more than 15 seconds, or overdrying
the dentin; these are the two big reasons why
dentists have post-op sensitivity with phosphoric acid. Then
I switch to a self-etching dentin adhesive. I apply it over
all of the dentin surfaces — if I get it on the enamel, it’s
not going to hurt anybody, and I use a self-etcher to do the
dentin. Actually, I was recently reading up on some new
research, and what folks are finding in the newer research
with the newer generation of self-etchers, is that it actually
gets higher bond strength than the old, fourth generation
total-etch technique.
I can’t imagine practicing without
photography. For me, when I’m sending
stuff to the laboratory, I actually need
to go overboard and send too many
photographs. This has made such a
big difference for me as far as what
I get back in shade matching.
MD: Wow. Isn’t it ironic? When we graduated in 1988, I
remember Ultradent, in addition to the etch they made, also
made something to put on the dentin to identify it so we didn’t
accidentally etch it. So now you’re talking about a technique
that’s a great middle ground, with the ability to etch the enamel
like that with selective etching, and then go in and do a selfetch
on the dentin. It’s kind of the best of both worlds and really
represents a step forward in terms of common sense for what
we’ve been doing in adhesive dentistry.
LB: I think so, too. It takes the stress off of worrying about
the phosphoric acid, but it also takes the stress off of
Interview with Dr. Lee Ann Brady53