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Laura Dorr is the executive editor of DPR's Modern Dental Network.
Implementing a new adhesive system can be daunting, but there are several steps that can minimize the struggle.
Change is scary. Switching jobs, moving to a different city—heck, even getting a new haircut can be majorly anxiety inducing. But what happens when it’s time to make a change in a clinical situation where even the smallest misstep can lead to a huge problem?
Many dentists shudder when they think about changing procedures or products and (perhaps rightfully) have a “go with what you know” or “if it ain’t broken, why fix it” mentality. But sometimes, change is necessary.
Whether you’re making a shift because of issues with your current products, or you want to try a new generation of a tried-and-true favorite, the process of switching materials can be understandably intimidating. But with so many fresh, innovative generations of products, including dental adhesives, hitting the market seemingly every day, the temptation to switch can outweigh trepidations about adopting something new. And, when implemented correctly, a new adhesive system could end up being the best choice in the long run.
First steps: Making the switch
There are many reasons to adopt a new adhesive. Maybe you’re looking for better longevity in your restorations, or you find your current product is causing an unacceptable amount of postop sensitivity. Perhaps you’re looking for a material that’s easier to work with and cuts down on procedure time. Possibly you want a product that is more versatile, and is compatible with different composite and cement materials. Conceivably, your colleague raved about a new product and you just want to take it for a spin.
Whatever your reason, it’s important to identify what you’re looking for and why you want to make a switch.
“Generally, if I’m switching something, it’s because I’m having a problem and am looking to solve that,” says Dr. Jennifer Sanders, a general dentist practicing in Frenchtown, Montana. “If there’s something I don’t like about the previous system, I’m looking to make sure the new one doesn’t have that issue. It takes some legwork, but finding the appropriate adhesive for your situation is an important step for successful adoption of the product.”
Once you pinpoint what you’re trying to gain with a new adhesive, you can narrow down which adhesive meet those needs. Then you’re ready to try them out.
It may seem obvious, but introducing a new product to your repertoire requires education. Each product comes with its own steps, benefits and quirks, so understanding how—and why—it works can be the difference between success and failure. Essentially, you’ll need to know the adhesive system inside and out, and understand the specific instructions you’ll have to follow.
“When dental materials experts get together to discuss the most important advice to give clinicians when using a new adhesive, the advice is simple: Read the directions,” says Dr. Nathanial Lawson, director of the division of biomaterials at the University of Alabama at Birmingham School of Dentistry. “Every adhesive has its unique instructions and the reality is most of us who practice, believe that all adhesive handle the same. This simply isn’t true.”
Other practitioners agree that Lawson’s recommendation can’t be stressed enough.
“Read the instructions,” concurs Dr. John Flucke, Dental Products Report’s technology editor who practices in Lee’s Summit, Missouri. “Read them before using the product and make sure you fully understand them. This very well might be the smartest things to do.”
Even if you’ve worked with similar adhesives—or even previous generations or other comparable products from the same manufacturer—it’s not safe to assume that the new adhesive will behave like the past one. Does this product require etching? Is it a one- or two-bottle system? What about curing time? Manufacturers often update products with features to help simplify procedures or eliminate steps, but if you aren’t aware of these time-saving developments, it can actually cost you valuable procedure time and increase the risk of errors.
“Making sure you understand the steps to the adhesive is critical, and it’s also really important to ensure that it will work with your current materials,” Sanders explains.
Once you’ve learned the steps and have identified any you think might be problem areas, it’s important to trial the product so you know how it handles and can perfect your technique.
“I always bench test something before I ‘go live’ with it,” Flucke says. “Understanding how the product feels is important. Is it runny, hard to mix, hard to get on a brush or instrument, or hard to spread evenly? These are all things you can discover by tinkering with it before you throw all the patient variables of saliva, movement, limited opening, etc. into the equation.”
Running these bench tests and taking a product for a test drive can make a big difference in the success of an actual procedure. Flucke emphasizes the importance of understanding how a product works, because uncertainty can affect procedure time. Since contamination is such a persistent problem with bonding, it’s critical that clinicians can implement a product efficiently and smoothly to minimize opportunities for contaminates to enter the field.
“If you approach a clinical situation and have to work slowly because you don’t understand how to use the product efficiently, you are going to run the risk of fighting contamination throughout the procedure,” he explains. “Ultimately, you’re going to end up with a less-than-stellar results.”
While problems can arise from numerous issues, uncertainty about a new product can add another element to the mix. Identifying where the problems arose—whether it be from a product or a procedural error—can help prevent complications in future cases.
“Sometimes we see the results at the next recare appointment, forget we struggled and blame the product,” Flucke says. “If you can move efficiently and keep contamination to a minimum, when you see the restoration at recare, you can then know for sure it wasn’t your product that caused the less-than-optimal result.”
Flucke further recommends making sure your other equipment is functioning properly, so you can focus on success with the new adhesive.
“I advise checking your curing lights on a regular basis,” he says. “If your lights do not have sufficient output, you cannot adequately cure materials. You want to remove as much blame from the product as possible—so that if there is an actual problem with the adhesive, it’s easy to identify.”
Ensuring you document the procedure will also give you a reference point to help narrow down the contributing factors if there are issues down the road.
“I make sure my procedure notes are accurate to reflect the system I’m using,” says Sanders. “That way if a problem arises, I can see what system I used and troubleshoot from there.”
In the end, the combination of education, attention to detail and practice make perfect. While adopting a new adhesive, or any other material or product, is a learning curve, it can make a big difference in how you practice—and for the end success of your restorations.