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Why making strong bonds efficiently makes a big difference


How using a 5th-generation technique in bonded restorations can cut down on unnecessary chair time and provide numerous benefits to patients and doctors alike.

Dentistry is a great profession. Few career choices offer opportunities or possibilities almost from the moment in time the practitioner breaks into the real world after graduation. Of course, with that freedom comes responsibility. And, unfortunately, that responsibility is frequently one that requires incredible attention to detail as well as the mindset that you may have to troubleshoot as you wade into it.

This month I’m going to wade into a situation that can be, depending on a variety of factors, either incredibly satisfying or incredibly frustrating. For this month’s article, I’m going to be dealing with one particular piece of the bonding restorative puzzle. We’ll come back to this subject in future articles, although we won’t be doing this in a monthly type of series.

This month, let’s discuss why, as a practicing dentist, I choose to use a 5th-generation bonding technique.


First of all, we are inundated with “techniques” in our profession. A 4th-generation technique means the following:  in a 4th-generation technique, there is a total etch with phosphoric acid, followed by a dentin primer application, followed by the application of a separate bonding agent. This works well and provides very good bond strengths of the material to the tooth. The only drawback is the extra step of primer.

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A 5th-generation technique utilizes a formula wherein the dentin primer and the bonding agent are both part of the same chemical. The result is a bonding formula in which a bonding agent and primer are applied in a single step. The bond strength is very close to that of a 4th generation, but it eliminates a step which speeds up the restorative process. This win-win situation means a faster experience for the patient while cutting down the amount of chair time utilized by the dental team.  

While, in this article, I’m not going to go into great detail on elimination of sensitivity (that’s a subject we’ll cover in a future edition of Technology Evangelist), I do want to take a little time here to discuss the subject of “cutting down the amount of chair time” that I mentioned in the previous paragraph.

If you’ve read my articles here in Dental Products Report or on my blog (http://blog.denticle.com), or have attended any of my lectures, you’ll hear me discuss the concept of efficiency. To me, the idea of efficiency is a pretty simple one. I love utilizing technology and other principles to make procedures go faster. For me, it isn’t about speeding things up to cram more patients into my schedule so that I can make more money; on the contrary, it’s about two other very important things. So, I’d like to explain why “efficiency” is so very important to me and why. Why, when it comes to dentistry, efficiency matters-and matters big time.

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1. No one likes having dental work done.  By being more efficient, the dental team can provide treatment in ess time. This means that the stress of dentistry for the patient happens in a shorter window of time. If you ask a patient, “Would you like this filling to take one hour or would you prefer 30 minutes?” I’d be very surprised if anyone asked for a longer appointment. Patients do not like receiving dental treatment and they’d rather have shorter appointments.

2. The actual physical aspect of performing dental treatment is hard on the dental team. Many dentists suffer from debilitating repetitive stress injuries because they are in positions and postures that, over the course of a career, cause the human body to break down. Simply put, if you can decrease the amount of time your body is in these positions and postures, the better it is for the doctor and staff physically. Thus, by working more efficiently, you can prolong your career and reduce the chance and severity of these injuries. I graduated from dental school in the late ’80s and I can tell you from first hand experience that the practice of dentistry has taken a physical toll on my body.

Related reading: Bonding 101: Everything you need to know to have satisfied patients

So, when it comes to a bonded restoration, I am looking at saving a step and still providing the best bond strengths to my patients. Currently products such as VOCO’s Futurabond U, Ultradent’s Peak Universal Bond, and DENTSPLY Caulk’s Prime & Bond NT (although that list is NOT exclusive) provide me the ability to utilize the 5th-generation technique with the bond strengths I expect and my patients deserve.

At this point, though, many of you are probably asking yourselves (or me), “Why don’t you just go for a 7th- or 8th-generation technique and be done with it?”

The answer is simple. I could do that, but I will sacrifice bond strength, and my patients deserve better.  The problem of moving away from 5th-generation is that I give up bond strength, pure and simple. The higher generations were created because many clinicians could not perform 5th-generation procedures without post-operative sensitivity. In my clinical opinion, there is no need to move to a different technique or procedure unless one is warranted. Change for the sake of change is confusing and serves no purpose unless one can articulate to all involved why the change is justified (and by all, I mean the patient, the doctor and the staff).

Here is the important lesson in all of this. The 5th-generation technique is, for all intents and purposes, the best technique currently available to perform adhesive procedures. If performed properly while following all recommended manufacturer instructions, the incidence of postoperative sensitivity is relatively low. Unfortunately, the cutting of corners or improper techniques or poor isolation can quickly lead to post-operative problems.

As I stated earlier, we’ll cover these problems and their related solutions in future editions of Technology Evangelist. 

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