ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Treatment of Sclerotic Dentin for Maximum Bond Strength
Clinical Question In a patient with severe acid erosion of the maxillary central incisors, would increasing the etch time of the sclerotic dentin result in a comparable composite bond strength to removing the sclerotic dentin and bonding to normal dentin?
Clinical Bottom Line Although increasing etch time of sclerotic dentin does improve its composite bond strength, the maximum bond strength is achieved by removal of sclerotic dentin and bonding to the underlying normal dentin. (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) 12877429Lopes / 2003Prepared dentin samples from extracted teethIn Vitro Lab Study
Key resultsNormal dentin etched for the recommended 15 seconds had the highest mean microtensile bond strength, while sclerotic dentin etched for 15 seconds had the lowest mean microtensile bond strength. Neither were significantly different from normal and sclerotic dentin each etched for double the recommended time (30 seconds). Statistical significance existed for the type of dentin (p=0.03), but not for etch time (p=0.45) nor the interaction of two main factors (p=0.20). The bond to normal dentin etched for 15 seconds was 23% stronger than the bond to sclerotic dentin etched for 15 seconds, and 9% stronger than the bond to sclerotic dentin etched for 30 seconds.
Evidence Search Mesh terms: (1) “tooth erosion”, (2) “dentin”, (3) “dentin bonding agents”, and (4) “acid etching, dentin”All mesh terms combined yielded 0 resultsMesh terms 2-4 combined yielded 827 results (no meta-analyses; systematic reviews not applicable)Most recent, pertinent article selected as best evidence
Comments on
The Evidence
This in-vitro lab study addressed my clinical question. It was determined to be valid, and the results applicable to actual patients. A meta-analysis or systematic review would have provided a higher level of evidence, but was unavailable through my search.
Applicability If sclerotic dentin is not removed prior to bonding, the etch time should be increased to improve bond strength. Removal of sclerotic dentin may not be indicated if sufficient enamel exists to bond to, if the remaining dentin is thin over the pulp, or in non-load bearing areas.
Specialty/Discipline (Restorative Dentistry)
Keywords acid erosion, sclerotic dentin, etch time
ID# 899
Date of submission: 05/25/2011spacer
E-mail MorganS4@livemail.uthscsa.edu
Author Starr Morgan Mayen
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Gary F. Guest, DMD
Faculty mentor/Co-author e-mail GUESTG@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
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Catherine Tatum, Nikhil Reddy (San Antonio, Texas) on 10/03/2014
A PubMed search conducted in October 2014 found a limited amount of related evidence. There are still no studies that include a direct comparison of the etching time required for bonding to sclerotic dentin versus normal dentin. Mesh terms used: sclerotic dentin, acid etching time, tooth erosion.
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