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Title Applying Adhesive Techniques Over Darkened Dentin Can Decrease Bond Strength
Clinical Question When replacing a defective alloy restoration with a resin composite bonded restoration, is it better to remove the residual corrosive elements on dentin and enamel or to leave the darkly discolored dentin?
Clinical Bottom Line Discolored dentin may be an indicator of demineralized dentin and caries affected dentin can decrease bond strength, therefore caution should be used in applying adhesive techniques over darkened dentin because this may have an implication on bonding. (See Comments on the CAT below)
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19231059Scholtanus/2009Patients with conventional amalgam restorations that are removed due to exposure to the physico-chemical challenges of intra-oral conditionsSystematic Review
Key resultsThis article reviews literature focused on the grayish discoloration remaining after amalgam removal. From that review it appears that discolored dentin is due to uptake of metals from amalgam and may be an indicator of demineralization. This may have an implication on bonding prior to amalgam replacement.
Evidence Search Systematic Reviews, Meta-Analysis Search corrosion amalgam penetration, dental amalgam
Comments on
The Evidence
This article is a systematic review of articles from comprehensive, detailed Medline and Pubmed search for relevant trials that have been assessed for validity.
Applicability This article is applicable to any patient with a defective conventional amalgam restoration that is wanting a bonded restoration.
Specialty/Discipline (General Dentistry) (Restorative Dentistry)
Keywords Corrosion, Dental Amalgam/adverse effects, Dental Amalgam/chemistry, Dental Bonding, Dentin/chemistry, Dentin Permeability, Diffusion, Humans, Ions, Metals/analysis, Tooth Discoloration/chemically induced
ID# 541
Date of submission: 03/30/2010spacer Revised: 08/30/2011
E-mail buimt@livemail.uthscsa.edu
Author My Hanh Bui
Co-author(s) e-mail
Faculty mentor/Co-author Rita Renee Parma, DDS
Faculty mentor/Co-author e-mail PARMA@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Chris Patterson (San Antonio, TX) on 04/16/2012
A PubMed search on this topic was complete April 2012. The publication listed in the CAT is the most recent and highest level of evidence for the clinical question.

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