Which Generation Bonding Agent is the Best? 2024 Adhesive Systems – PDP192
24/7/2024
0:00
55:51
What is the best bonding agent to use?
Does it actually matter? Spoiler: it does!
How do you get the best bond to dentine and enamel with the adhesive system you are using?
Dr Sam Sherif joins us in this episode, where he discusses bond strength in detail as well as sharing his top tips in achieving long lasting adhesion for our daily adhesive Dentistry. There's a lot to learn in this one so get ready those onions ready!
https://youtu.be/FICDBVljsGw
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Protrusive Dental Pearl: Always read the directions for use - ESPECIALLY for your adhesive systems!
Need to Read it? Check out the Full Episode Transcript below!
Did you know? Paid members on Protrusive Guidance can access the PDF summary notes as part of the Protrusive Vault. Oh and be sure to answer the quiz for 1 CE credit!
If you liked this episode, you will also like Immediate Dentine Sealing Part 2
Click below for full episode transcript:
Jaz's Introduction: Did you know that the strength in which enamel binds to dentine at the DEJ is approximately 50 megapascals? So when we're looking at the literature for which adhesive system or which bonding agent we should be using. Do we actually need more than 50 megapascals?
Jaz's Introduction: A lot of adhesive systems will easily give you 20 megapascals. Is that good enough? It probably is. We know that adhesive density in the right environment, done skillfully, can work, and sometimes all you're achieving is 10 to 20 megapascals. However, if there are a few things that you could do in your practice, in your protocols, to reach the higher ends, 50 and even beyond, then perhaps we should consider and learn these techniques.
For me, it depends on how complicated it makes your procedure. Like if it becomes really technique sensitive, so that only 10 percent of the time you're getting 70 megapascals and then 80 percent of the time you're getting like 10 megapascals, that's not predictable. That's not a predictable way of doing it. So how can we make our bonding protocols more predictable so we get a higher bond strengths more consistently.
That's what today's episode is about because I asked Dr. Sam Sharif, which is the best adhesive system, which is the best bonding agent, and to tell us which generation or generations on bonding agents should we be buying.
Hello Protruserati, I'm Jaz Gulati and welcome back to your favorite dental podcast. Today's a very geeky one we go into science behind the bonding and I love how Sam will break down the different generations which we've all come across a different generations of bonding systems and we fell asleep in that lecture and there's just far too many generations. But actually we make it clinically relevant and I love that he actually gives you sound advice on which generations to avoid and which generations to go for, and which bonding agents he believes in and what the literature is saying.
If you're a new listener, welcome to Protrusive. It's great to have you here. If you're a returning listener or watcher on YouTube or on the Protrusive Guidance app, it is so great to have you back. You've picked a good one to re engage back into. Very clinical relevant in our daily dentistry. And towards the end of the episode, we'll actually cover little nuances and how we can actually get the higher bond strength. This episode is eligible for CPD. There will also be premium notes which get released in the Protrusive Vault of Protrusive Guidance app. We should totally download an iOS or Android.
Dental PearlThe Protrusive Dental Pearl I have for you is to read the instructions for whichever adhesive system you're using. Now, I've said this before, but some cool things that I learned here is that in some adhesive systems and some bonding agents, if you air abrade the dentine in something I do routinely, you are actually hindering your bond strength.
Whereas with other systems, you really enhance the bond strength by using air particle abrasion. So if, like me, you're just blanketly air abrading everything, then we need to reconsider. It kind of depends. Is that compatible with your adhesive system? So I would just pause, even if you've done this before, but it's been a few years.
I would just pick up the literature again, find the literature, ideally independent if you can. And Sam does reference a really cool paper, this group that releases a paper every 10 years looking at how to optimize bond strength, so I will add that paper to the protrusive vault. But the main lesson is to really use whichever adhesive system you're using in the way that the manufacturer intended.
And only really deviating from that or enhancing that if some evidence base suggests that actually by tweaking this protocol you could get a better result. But essentially, don't make it up as you go along. Please don't just etch for a random number of time, and just using it in a way that the material was not designed to. Hope you enjoy this very geeky episode, and I'll catch you in the outro.
Main Episode:Dr. Sam Sherif, someone who every time I see the word adhesive dentistry, biomimetic dentistry, you come to mind. My friend Niall always raves on about you and your knowledge and wisdom, and I've been following your stuff online for a while now. Welcome to the show. How are you?
[Sam]Thank you very much, Jaz. I'm glad to be here. I've been excited to get on your show. Something I listen to going to work each week. So, so thank you for having me on.
[Jaz]Amazing. Well, I think the kind of stuff we're covering tonight is absolutely, I think, fundamental because we're there at dental school learning about these adhesive systems, bonding agents, and the generation and stuff for an exam.
But I think what I'm really excited to pick from you is actually the real world application of it, as well as actually answering these niggling questions that which generation actually is the best and how long will this continue for? Will it go into like generation 50 and 60 and that kind of stuff.
And it'd be interesting to see how close you think we are to the pinnacle of bonding and the little nuances. So it's gonna be a very geeky episode, I feel. And I think that's going to be a fun one for all the Protruserati to listen to. For those people who haven't heard of you, haven't seen your stuff, please tell us about yourself, where you work, what kind of stuff you're into.
[Sam]Yeah, I'm a prosthodontist and I work in Harley Street. I came back from America about 12 years ago after I finished up with Guys. I went over there, I did pros and I did a PhD at Harvard med school. And then it was choice of either staying in Boston as faculty or going to LA. And I got a very nice offer in Beverly Hills.
So I went over there. And stayed out there for a few years. I ended up buying that chap's practice. But I think in the end, the lure of Europe for Europeans is too much with the easy travel. So came back.
[Jaz]I mean, what a location history, right? That's very impressive. In Beverly Hills, did you ever come across Lane Ochi?
[Sam]Yeah, another great prosthodontist. Yeah, came across Lane.
[Jaz]He's such a great guy. I'm a huge, huge, huge fan of Lane. So great. I didn't know you practiced in Beverly Hills. Amazing. And then now you're in the heart of London. Man, that is quite a career trajectory. How much do you think, this is completely like random, not like in my list of questions, but your PhD, I didn't know you did a PhD, so you're a proper doctor. When you were doing your PhD, how, was it like super academic or was it clinical?
[Sam]My PhD was on the academic side. So to graduate, you have to do your residency. So you choose your specialty and you have to pick a three year master's or a five year doctorate. The doctorate I did it in was a lot to do with implants and the bacteria around implants. You'd order the bacteria, you'd grow the bacteria, you'd run the DNA, DNA hybridizations. So that was fun. But overall, the program, you know, would be very clinical, but also very research because we do eight till six in the clinic, and then you'd have research time or classes at night. And then you do your lab work, like all good pros residents.
[Jaz]Do you have a life? Like when you're doing, when you're like, that sounds so intense. Do you have a life? I mean, people who do masters and MClinDent and that kind of stuff. They always tell me that you literally have no life, but did you experience that as well?
[Sam]So we were all jealous of the endo residents, because the endo residents would Wednesday afternoon, go off, moonlight, do some work. Some of the days they would do that. The pros residents would be doing their lab work, casting, designing. And then we'd have classes, and I think you take it for granted, but I spoke to a lot of people here, perio residents, and we'd have famous perio residents, Monday, Tuesday, night, from Ferrier faculty just come and give us tutorials to three pros residents, three perio residents in the first year.
So, I would say those were the best years in my life, even though there weren't much of a life that you were locked in there and you tend to get about a two minute walk from the dental school because that is going to be your life for five years.
[Jaz]Amazing. How did you get into, in terms of you could go but you do everything. You're a prosthodontist, your research and PhD and implant focus and the bacteria around that, but your true, I mean, what you teach on and what you put out there is a lot of the biomimetic adhesive dentistry. And they make sense now why I know some of the courses run and go very deep into literature as well. So it's starting to all make sense to me now. How did you get attracted to that particular part of dentistry?
[Sam]It was 2005 and Harvard had an exchange with Switzerland and Urs Belser, who was Magne's mentor,
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