Light-Cured – Self-Adhesive

When it comes to resin-based materials, cements were the first to wear the self-adhesive label. So it's not surprising that flowables followed on their footsteps, since in many respects, cements and flowables can be used interchangeably.

From a clinical standpoint, a self-adhesive flowable has great appeal since it eliminates the need for a bonding agent. But while the application procedure is not difficult, it is quite specific. This means you can't just syringe these materials into preparations like you would with a conventional flowable. To complicate matters, the technique with each product has important differences. Instead of leaving the preparation dry after cleaning, one product may bond better to a glistening wet tooth surface. And a rubbing technique for the initial layer may be used instead of the agitation method. These technique variances point out that the application protocol for these products are material-specific, which means that there is a learning curve if you switch from one product to another.

Other differences between products in this category are their indications. At least one is being recommended for definitive small Class I, Class III, and Class V restorations. On the other hand, another is being restricted at this time to small Class I restorations, pit and fissure sealants and liners/bases under larger restorations. In other words, using it for other types of definitive restorations such as Class V or core buildups is not yet part of its bag of tricks.

So can you achieve as good a level of adhesion to tooth structure with these new products as you can if a bonding agent were used in combination with a more conventional flowable? The simple answer is not according to tests performed in the RRL, where the bond strengths, especially immediately after light curing, were substantially lower with the self-adhesive products compared to the more conventional approach. Interestingly, at least with one product, bond strengths to feldspathic porcelain, zirconia (Lava), and three different types of metal were quite high especially after 24 hours.

However, simple answers may not always be correct. For example, RRL bond strength tests of self-adhesive resin cements are significantly lower than when a more conventional bonding agent/cement combo is utilized. On the other hand, anecdotal reports show these cements don't seem to be suffering mass debondings. Therefore, the jury is still out on the bond stability of these self-adhesive flowables.

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