Issue 26, March 2005
Prelude, the Latest in Self-Etching Primers
Dear Fellow Bondodontists,
Fifth Quarter Seminars experienced a great surge of attendance in 2004. Thanks for your strong support. I attribute this surge to the inclusion of ozone in the seminars. Ozone will be the next revolution in restorative dentistry. Quintessence Publishing just published the book: "Ozone: The Revolution in Dentistry" edited by Prof. Edward Lynch. The book covers all research and clinical applications of KaVo's Healozone. For ozone info, you might also wish to see www.the-o-zone.cc
We plan to reduce my USA speaking for the remainder of the year, instead sponsoring speakers who I personally wish to hear. In September we will proudly present Dr. Geoff Knight from Australia, one of my favorite discussion partners. The seminars are at Ko Olina, Oahu, Hawaii on September 15 and North Lake Tahoe, California on September 24. Geoff may well have invented a clinical technique that obsoletes ozone!! If you wish to look at the background, search Saforide on the Internet. Saforide turns teeth black in the process of arresting caries. Geoff has found a way to overcome the color problem but maintain the effectiveness. Geoff does not speak much in the USA so don't miss this opportunity. To further entice you, we have arranged some super low room rates at the JW Marroitt Ko Olina Hotel and Spa, a world-class property. This is on Oahu, easy to reach from Honolulu airport but seemingly worlds away from Honolulu. At Tahoe, we will be at Northshore, near the California-Nevada state line in Kings Beach. A favorite hotel nearby is the Cal-Neva Lodge. Tahoe is at its best in September.
In November, we will be in Yosemite. We feature guest speaker Dr. Van Thompson, one of the top materials experts in the world. Van is very adept at transferring research to clinical practice. Last November we had an absolutely spectacular Yosemite seminar. Yosemite was at its very best with the first fall rain the day before. Weather is a bit hit and miss at this time of year but we seem to hit a lot more than we miss. Again we have negotiated great room rates for both the Ahwahnee Hotel and the Lodge.
There is a terrific program being planned for South Africa on August 11-13. It is being organized by Dr. Julian Holmes in a location very near Capetown. This is a great time of year for game parks (no water, no malaria) and the whales are along shore at Hermanus (so close you can hear them breathing). I will be a speaker at this one. For further info, please e-mail Julian: [email protected]
On October 21-22, Dr. Dan Laizure and I are doing an over-the-shoulder/hands-on course in his superb CARE facility in Walla Walla, Washington. This program will feature application of the "Kois deprogrammer" for establishing new occlusion. For further info, please see www.center4excellence.org. At this time we are planning some very "civilized" social events in the local wine country as part of the event.
Have a great 2005.
Sincerely,
Ray Bertolotti
Fifth Quarter Seminars experienced a great surge of attendance in 2004. Thanks for your strong support. I attribute this surge to the inclusion of ozone in the seminars. Ozone will be the next revolution in restorative dentistry. Quintessence Publishing just published the book: "Ozone: The Revolution in Dentistry" edited by Prof. Edward Lynch. The book covers all research and clinical applications of KaVo's Healozone. For ozone info, you might also wish to see www.the-o-zone.cc
We plan to reduce my USA speaking for the remainder of the year, instead sponsoring speakers who I personally wish to hear. In September we will proudly present Dr. Geoff Knight from Australia, one of my favorite discussion partners. The seminars are at Ko Olina, Oahu, Hawaii on September 15 and North Lake Tahoe, California on September 24. Geoff may well have invented a clinical technique that obsoletes ozone!! If you wish to look at the background, search Saforide on the Internet. Saforide turns teeth black in the process of arresting caries. Geoff has found a way to overcome the color problem but maintain the effectiveness. Geoff does not speak much in the USA so don't miss this opportunity. To further entice you, we have arranged some super low room rates at the JW Marroitt Ko Olina Hotel and Spa, a world-class property. This is on Oahu, easy to reach from Honolulu airport but seemingly worlds away from Honolulu. At Tahoe, we will be at Northshore, near the California-Nevada state line in Kings Beach. A favorite hotel nearby is the Cal-Neva Lodge. Tahoe is at its best in September.
In November, we will be in Yosemite. We feature guest speaker Dr. Van Thompson, one of the top materials experts in the world. Van is very adept at transferring research to clinical practice. Last November we had an absolutely spectacular Yosemite seminar. Yosemite was at its very best with the first fall rain the day before. Weather is a bit hit and miss at this time of year but we seem to hit a lot more than we miss. Again we have negotiated great room rates for both the Ahwahnee Hotel and the Lodge.
There is a terrific program being planned for South Africa on August 11-13. It is being organized by Dr. Julian Holmes in a location very near Capetown. This is a great time of year for game parks (no water, no malaria) and the whales are along shore at Hermanus (so close you can hear them breathing). I will be a speaker at this one. For further info, please e-mail Julian: [email protected]
On October 21-22, Dr. Dan Laizure and I are doing an over-the-shoulder/hands-on course in his superb CARE facility in Walla Walla, Washington. This program will feature application of the "Kois deprogrammer" for establishing new occlusion. For further info, please see www.center4excellence.org. At this time we are planning some very "civilized" social events in the local wine country as part of the event.
Have a great 2005.
Sincerely,
Ray Bertolotti
The Latest Self-Etching Primer
Danville has just introduced Prelude, a unique self-etching primer. It bonds well to both cut and non-cut enamel, a feature which elevates it above many competitors. Of course it bonds very well to dentin. Prelude was independently tested by Larry Watanabe at UCSF. Larry found it to have bond strength among the best and perhaps more important, the lowest standard deviation of any bond he has tested. This result suggests technique sensitivity is low.
When used in light cure applications, Prelude is used very much like Kuraray SE Bond. Unlike SE Bond's incompatibility with self-curing composites, the compatibility issue has been solved by addition of a self-cure bonding Link that is supplied with Prelude. Time will tell if Prelude takes a share of SE Bond's market.
"Free is good", right? Well Prelude is essentially free for the first kit but there is a catch. Danville gives a voucher in the amount of the Prelude cost that can be used toward purchase of any other Danville product. Danville direct (800-827-7940) or presumably any Danville dealer will make this offer, which is valid to the end of March. There is a double whammy here. Prelude costs a lot less than SE Bond.
When used in light cure applications, Prelude is used very much like Kuraray SE Bond. Unlike SE Bond's incompatibility with self-curing composites, the compatibility issue has been solved by addition of a self-cure bonding Link that is supplied with Prelude. Time will tell if Prelude takes a share of SE Bond's market.
"Free is good", right? Well Prelude is essentially free for the first kit but there is a catch. Danville gives a voucher in the amount of the Prelude cost that can be used toward purchase of any other Danville product. Danville direct (800-827-7940) or presumably any Danville dealer will make this offer, which is valid to the end of March. There is a double whammy here. Prelude costs a lot less than SE Bond.
Simplified Bonds - Is This "Progress"?
Many of you have heard my lectures where I mention the outstanding research of Dr. Franklin Tay in Hong Kong. Franklin has discovered what he terms "transudation", that is the permeation of dental fluids through the "sealed" tooth on vital dentin. Franklin's research has tremendous clinical implications, many of which I am covering in current seminars. It explains why a time delay after bonding and before curing composite leads to bonding problems when using the "all in one" (what I call "EPB": etch-prime-bond) adhesives. It also suggests why self-cured composites would be expected to have a compatibility problem with EPB adhesives. The water free, hydrophobic second layer of two-step bonds provides an effective water barrier to prevent the transudation from reaching the dentin surface. Based on this research, my bottom line recommendation is to stay with the two layer adhesives such as SE Bond or perhaps Prelude.
The above discussion is in harmony with a very extensive European study just published: A Clinical Review of the Durability of Adhesion to Tooth Tissue: Methods and Results, J. DeMunck et al., J Dent Res 84(2) 118-132, 2005. I quote: "Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits such as ease of manipulation and reduced technique-sensitivity." I further quote: " The strong one-step adhesive, Prompt-L-Pop, performed very poorly, with a retention rate of 65% after 1 year in contrast to the "mild" two-step self-etch adhesive, Clearfil SE Bond, that exhibited excellent results up to 2 years".
The above discussion is in harmony with a very extensive European study just published: A Clinical Review of the Durability of Adhesion to Tooth Tissue: Methods and Results, J. DeMunck et al., J Dent Res 84(2) 118-132, 2005. I quote: "Any kind of simplification in the clinical application procedure results in loss of bonding effectiveness. Only the two-step self-etch adhesives approach the gold standard and do have some additional clinical benefits such as ease of manipulation and reduced technique-sensitivity." I further quote: " The strong one-step adhesive, Prompt-L-Pop, performed very poorly, with a retention rate of 65% after 1 year in contrast to the "mild" two-step self-etch adhesive, Clearfil SE Bond, that exhibited excellent results up to 2 years".
Dental Ozone
Clinical experience continues to prove the ozone-initiated caries reversal concept.Quintessence Publishing just released the book: "Ozone: The Revolution in Dentistry" edited by Prof. Edward Lynch. The book covers all research and clinical applications of Healozone. For the latest ozone updates, see www.the-o-zone.cc
Introduction of Healozone in the USA is expected early next year. In anticipation of its release, I am continuing to cover the latest findings on ozone in the seminars. Here is the abstract of what may be the most significant clinical application paper to date, dealing with ozone effects on primary root carious lesions (PRCL's). The author, Julian Holmes, was our speaker for the sold-out Yosemite seminar last November. Note that 100% success with caries reversal was achieved at the end of the 18 month period.
Clinical reversal of root caries using ozone, double-blind, randomized, controlled 18-month trial. Holmes, J. Gerodontology 2003;20(2):106-14. A total of 89 subjects, each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. RESULTS: There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed.
Introduction of Healozone in the USA is expected early next year. In anticipation of its release, I am continuing to cover the latest findings on ozone in the seminars. Here is the abstract of what may be the most significant clinical application paper to date, dealing with ozone effects on primary root carious lesions (PRCL's). The author, Julian Holmes, was our speaker for the sold-out Yosemite seminar last November. Note that 100% success with caries reversal was achieved at the end of the 18 month period.
Clinical reversal of root caries using ozone, double-blind, randomized, controlled 18-month trial. Holmes, J. Gerodontology 2003;20(2):106-14. A total of 89 subjects, each with two leathery PRCL's, were recruited. The two lesions in each subject were randomly assigned for treatment with ozone or air, in a double-blind design, in a general dental practice. Subjects were recalled at three, six, 12 and 18 months. Lesions were clinically recorded at each visit as soft, leathery or hard, scored with a validated root caries severity index. RESULTS: There were no observed adverse events. After three months, in the ozone-treated group, 61 PRCL's (69%) had become hard and none had deteriorated, whilst in the control group, four PRCL's (4%) had become worse (p<0.01). At the six-month recall, in the ozone group, seven PRCL's (8%) remained leathery, the remaining 82 (92%) PRCL's had become hard, whilst in the control group, 10 PRCL's had become worse (11%) and one had become hard (p<0.01). At 12 and 18 months, 87 Subjects attended. In the ozone group at 12 months, two PRCL's remained leathery, compared to 85 (98%) that had hardened, whilst in the control group 21 (24%) of the PRCL's had progressed from leathery to soft, i.e. became worse, 65 PRCL's (75%) were still leathery, and one remained hard (p<0.01). At 18 months, 87 (100%) of ozone-treated PRCL's had arrested, whilst in the control group, 32 lesions (37%) of the PRCL's had worsened from leathery to soft (p<0.01), 54 (62%) PRCL's remained leathery and only one of the control PRCL's had reversed.
Microprime
Remember Danville's original Microprime, the formula based on HEMA and glutaraldehyde? It is now being reintroduced as Microprime G. The comparable product is Gluma Desensitizer (Heraeus Kulzer) which costs more than twice as much for a bottle half the size!
The newer Microprime formula that has been used very successfully for years is now called Microprime B. (It is designated B type because it is covered by my patent.) It contains HEMA and a proprietary disinfectant.
Both products seem to work well. Since there is good evidence that the active ingredient in preventing sensitivity is the HEMA, the B formula seemed more desirable since it does not contain tissue-burning glutaraldehyde. However some opinion leaders believe that inclusion of glutaraldehyde is preferable. So now there is a choice. Same low cost.
The newer Microprime formula that has been used very successfully for years is now called Microprime B. (It is designated B type because it is covered by my patent.) It contains HEMA and a proprietary disinfectant.
Both products seem to work well. Since there is good evidence that the active ingredient in preventing sensitivity is the HEMA, the B formula seemed more desirable since it does not contain tissue-burning glutaraldehyde. However some opinion leaders believe that inclusion of glutaraldehyde is preferable. So now there is a choice. Same low cost.
Palfique Estelite
Many of you know my favorite anterior composite, Palfique Estelite. This is a spherically filled composite with the strength of a hybrid, the polish of a microfill and terrific handling. It is the most chameleon composite known so only few shades are necessary. While Palfique has for years received my very highest recommendation, many have asked why Reality has not rated it highly? (I am a Reality evaluator.) I think it's because many Reality evaluators tend to be influenced by availability of a wide range of shades, never mind if they are necessary or not.
Well, Palfique just got even better. If is now sufficiently radiopaque for posterior use. Low radiopacity was a limitation in the older material. There are a lot of new shades, Reality might even take notice! The new version is known as Estelite Sigma. This is truly a universal composite. I think Estelite Sigma is all you need besides a flowable composite. (I use Starflow and Sigma for posterior composites.) Once you try it, you are likely to clean out your refrigerator.
I should note that the translucency of Sigma tends to result in a "grayout" for large class III and Class IV fillings. That is why they also offer "opaque" shades such as OA2, that is opaque A2. It is not really very opaque, just enough to block out the gray translucency problem. I like the opaque shades OA1 and OA2, used by themselves, for direct resin veneers. Tin Man can tell you the shades their regular customers prefer (800-554-6394 or www.tinmandental.com). That would be a good starting point for your initial order.
Well, Palfique just got even better. If is now sufficiently radiopaque for posterior use. Low radiopacity was a limitation in the older material. There are a lot of new shades, Reality might even take notice! The new version is known as Estelite Sigma. This is truly a universal composite. I think Estelite Sigma is all you need besides a flowable composite. (I use Starflow and Sigma for posterior composites.) Once you try it, you are likely to clean out your refrigerator.
I should note that the translucency of Sigma tends to result in a "grayout" for large class III and Class IV fillings. That is why they also offer "opaque" shades such as OA2, that is opaque A2. It is not really very opaque, just enough to block out the gray translucency problem. I like the opaque shades OA1 and OA2, used by themselves, for direct resin veneers. Tin Man can tell you the shades their regular customers prefer (800-554-6394 or www.tinmandental.com). That would be a good starting point for your initial order.
Black Momba?
Yes, it's a deadly African snake and also my nickname for a new impression material that is deadly accurate and will wrap your margins. Think about margin reading. Is light or dark best for readability? I vote for dark. What is the darkest color? Black. So how about a black colored, thixotropic, fast setting "wash" viscosity? It's Danville First Half Light, designed to compete with the set time of Discus Half Time, a fine product but not black. First Half is about 30 seconds slower than the First Quarter series. Both work well in the Hoos/Morita H&H technique. They also work well in a more conventional dual-viscosity technique. The First Quarter series are the world's fastest VPS materials available in a complete range of viscosities. I think Danville's "regular set" Star VPS materials should be called Overtime. I am constantly amazed that these relatively slow setting, industry-standard materials sell at all. Once you get used to the fast set, there is no going back, not even to Star VPS.
Flexible Posts
I just heard a great lecture from Gordon Christensen at the Atlanta AGD meeting. It sure is good to see Gordon back lecturing after a two year absence (for church service). In his lecture he presented the results of a CRA study on strength of composite buildups retained by various posts. Gordon said he changed his mind about posts after seeing the results. What CRA found was that composite/fiber posts such as Luscent Anchor, Snowpost, and FiberKor post made core buildups about as strong as a traditional stainless steel post. (Gordon showed Snowpost to be the most radiopaque of the these three fiber posts.) Amazingly, these fiber posts produced cores even stronger than those made with titanium posts. However Gordon's deciding factor was not strength, rather it was the mode of failure: root fracture for the metal posts and crown dislodgement for the fiber posts. Gordon says that metal is obsolete, not just for fracture mode reasons but also for reasons of root darkening from the metal. I fully agree. The CRA Newsletter has a nice write up on posts in the May 2004 issue. Customer service at Danville has extra copies (800-827-7940). Snowlight, the light transmitting version of Snowpost, got the highest overall grade in the CRA study.
For AACD Members Only
One of my favorite lab technicians, Laura Kelly Brown, is now running for Vice President of AACD. I have known Laura for a long time. She is a world-class technician, AACD Accredited. I can't imagine a more dedicated and hard working candidate for this job. She has served on 19 committees and 6 years of AACD Board work. Please join me in supporting Laura Kelly Brown for VP.
Reality - Highest Recommendation
Most of you have heard me mention Reality, the best and most complete source of clinical info on techniques and materials for esthetic dentistry. From its start in the 1980's, Reality has progressed to an annual book resembling a Sears and Sawbucks catalog in size. Much of the research reported is from the Reality Research Lab. In addition to the annual book, there is a monthly newsletter. I am proud to be on the editorial team, in the company of some the world's most astute and influential dentists. If you don't know Reality, consider becoming a member. See www.realityesthitics.com for more about Reality and for membership information.
Bonding and Color-Correcting Porcelain Veneers
One of the most popular e-mail questions lately has been about color correction and bonding of veneers. I think flowable composite is ideal for bonding of veneers. Flowable rather that thick composite allows me to feel the veneers seat completely and prevents cracking the veneers from excess seating pressure. Most veneer "kits" make shade selection far to complex. For veneers, flowable composite needs to be available in about 3 specific shades. One veneer kit offers over 20 shades, that's crazy! Some manufacturers make their shades all too opaque, thereby reducing the vital look of teeth. Tom Hughes and I helped Danville dial-in the 3 necessary veneer shades for the clinic; these are sold as standard shades in the Starflow PV and Accodade PV kits. Fortunately Tom and I both have the benefit of experience in placing thousands of porcelain veneers, "keeping it simple".
If the veneer is too thick to allow light curing, then the bonding resin color will not be a factor because it can't show through. In that case, Panavia F in the TC ("tooth colored") shade works well. If there is only enamel on the tooth side, you may omit use of the ED Primer and just etch the enamel with phosphoric acid. Panavia F bonds well to etched enamel. Use silane on the HF etched veneer. Panavia F bonds well to silane. If there is dentin, use of the self-etching ED Primer without separate etching is wise. Panavia F is dual curing so you need not worry about incomplete cures. (The new Panavia F 2.0 will cure with any type of light, a problem with Panavia F, which would not cure with a typical LED light.)
Now, let's say it's a typical thin feldspathic porcelain veneer, about 0.5 mm thick, that you want to bond. Clearly the bonding composite will influence the final shade by showing through the thin veneer. Panavia F does not have a sufficient shade selection for color correction. Here is how I proceed to try-in for color, using StarFlow PV or Accolade PV (Starflow is thinner, Accolade is thicker), both "flowable" composites:
I usually try-in with Translucent shade first; it is acceptable about 90% of the time. If the color needs to be modified, remove the veneer, wipe off the first composite with a clean brush and change to the new shade. I find that when the first try-in with Translucent composite does not produce an acceptable shade, slight white opaquing is the most often needed change (the tooth shows too much). You may blend in color modifiers such as Danville VP White Opaque, Bisco Tints and Belle de St Chair HP Opaker. However Starflow PV and Accolade PV kits have excellent pre-opaqued whitish "veneer shades", Light and Extra Light, which greatly simplify this procedure. They eliminate the need for a custom mix. One of these two shades nearly always produces an acceptable try-in when the Translucent does not. In the rare event that the veneer needs darkening, just use a dark shade of any flowable composite. (I often select A5 Starflow.) In addition to the three PV shades that Tom Hughes and I like, Danville also has a White Opaquer in both Starflow PV and Accolade PV that is intended only for custom blending. It is the intense white blending shade that Danville uses to mix with the Translucent shade to produce pre-mixed Light and Extra Light PV shades. These shades are definitely worthy of a try, very highly recommended.
If the veneer is too thick to allow light curing, then the bonding resin color will not be a factor because it can't show through. In that case, Panavia F in the TC ("tooth colored") shade works well. If there is only enamel on the tooth side, you may omit use of the ED Primer and just etch the enamel with phosphoric acid. Panavia F bonds well to etched enamel. Use silane on the HF etched veneer. Panavia F bonds well to silane. If there is dentin, use of the self-etching ED Primer without separate etching is wise. Panavia F is dual curing so you need not worry about incomplete cures. (The new Panavia F 2.0 will cure with any type of light, a problem with Panavia F, which would not cure with a typical LED light.)
Now, let's say it's a typical thin feldspathic porcelain veneer, about 0.5 mm thick, that you want to bond. Clearly the bonding composite will influence the final shade by showing through the thin veneer. Panavia F does not have a sufficient shade selection for color correction. Here is how I proceed to try-in for color, using StarFlow PV or Accolade PV (Starflow is thinner, Accolade is thicker), both "flowable" composites:
I usually try-in with Translucent shade first; it is acceptable about 90% of the time. If the color needs to be modified, remove the veneer, wipe off the first composite with a clean brush and change to the new shade. I find that when the first try-in with Translucent composite does not produce an acceptable shade, slight white opaquing is the most often needed change (the tooth shows too much). You may blend in color modifiers such as Danville VP White Opaque, Bisco Tints and Belle de St Chair HP Opaker. However Starflow PV and Accolade PV kits have excellent pre-opaqued whitish "veneer shades", Light and Extra Light, which greatly simplify this procedure. They eliminate the need for a custom mix. One of these two shades nearly always produces an acceptable try-in when the Translucent does not. In the rare event that the veneer needs darkening, just use a dark shade of any flowable composite. (I often select A5 Starflow.) In addition to the three PV shades that Tom Hughes and I like, Danville also has a White Opaquer in both Starflow PV and Accolade PV that is intended only for custom blending. It is the intense white blending shade that Danville uses to mix with the Translucent shade to produce pre-mixed Light and Extra Light PV shades. These shades are definitely worthy of a try, very highly recommended.
Porcelain Bonding Without HF Etching - Apparently a Well Kept Secret.
My seminar topic of porcelain crown try-in has emerged as one of the most popular seminar short topics. The concept is to put a protective layer of Clearfil Photo Bond mixed with Clearfil Porcelain Bond Activator (a specialized silane) on the crown prior to try-in. This 3 drop mixture of A and B Photo Bond plus Activator bonds well to porcelain and to metal while protecting the internal porcelain and metal from contamination. After try-in, the crown is just washed with tap water and dried. The Photo Bond mix is hydrophobic and not displaced. Then the bonding resin such as Panavia F is placed in the crown and bonded to the tooth as usual. Photo Bond and Panavia F are both dual curing so there is no concern about lack of sufficient light cure.
Regardless of its being available for nearly 20 years, the Clearfil Porcelain Bond Activator system is a well kept secret for porcelain bonding. It does not depend on the use of hydrofluoric acid to etch the porcelain. There is a nice paper by Llobel et al. that found the Clearfil system equaled the best silane bond on hydrofluoric etched porcelain (Fatigue span of porcelain repair systems, Int J Pros 1992;5:205-213.). Clearfil is the ideal material for intraoral porcelain repairs, no HF needed!
I just read yet another porcelain repair paper that neglected Clearfil while discussing how difficult it is to repair porcelain adjacent to enamel (Bonding to Enamel/Dentin Etched with Phosphoric and Hydrofluoric Acids, PPAD 2004;16(9):653-659). With Clearfil, it is simple to bond adjacent porcelain and enamel. Just sandblast, etch all with phosphoric acid (etches enamel, cleans porcelain), wash, dry, apply the Clearfil 3 drop mix. You just bonded both surfaces (and also any metal and dentin, should they be there too.) Now you may place any brand of composite. It is worth noting that Reality gave only the Clearfil porcelain repair kit a 5 star rating, definitely deserved.
Regardless of its being available for nearly 20 years, the Clearfil Porcelain Bond Activator system is a well kept secret for porcelain bonding. It does not depend on the use of hydrofluoric acid to etch the porcelain. There is a nice paper by Llobel et al. that found the Clearfil system equaled the best silane bond on hydrofluoric etched porcelain (Fatigue span of porcelain repair systems, Int J Pros 1992;5:205-213.). Clearfil is the ideal material for intraoral porcelain repairs, no HF needed!
I just read yet another porcelain repair paper that neglected Clearfil while discussing how difficult it is to repair porcelain adjacent to enamel (Bonding to Enamel/Dentin Etched with Phosphoric and Hydrofluoric Acids, PPAD 2004;16(9):653-659). With Clearfil, it is simple to bond adjacent porcelain and enamel. Just sandblast, etch all with phosphoric acid (etches enamel, cleans porcelain), wash, dry, apply the Clearfil 3 drop mix. You just bonded both surfaces (and also any metal and dentin, should they be there too.) Now you may place any brand of composite. It is worth noting that Reality gave only the Clearfil porcelain repair kit a 5 star rating, definitely deserved.