With a career spanning over two decades and a profound interest in the use and possibilities of adhesives, dental surgeon Dr Fabrice Gambier is the perfect person to speak with when looking back at the evolution of adhesives and the techniques in applying them. Brenda van de Watering, Sales and Marketing Manager of Kuraray Europe France met Dr. Gambier in Paris at the 2017 Association Dentaire Française meeting to discuss these topics, as well as the advantages of Kuraray Noritake Dental’s latest CLEARFIL Universal Bond Quick adhesive.
1/ Brenda Van de Watering: Hello, Dr. Gambier. Perhaps you would like to introduce yourself and tell us a little about your career to date?
Dr. Gambier: Next year will mark 25 years since I joined a practice near Toulon, in Six-Fours-les-Plages, a fine surgery which has grown steadily. In January 2018, we will have 12 practitioners; when I arrived in ’93, there were just four of us. Gradually, with increased patient numbers and patient loyalty, plus our continuous attention to the quality of patient care, the practice has indeed expanded.
As far as Kuraray is concerned, I have been using your products for a long time. I have known Christophe Commaux for some years and he has always provided me with excellent information on your products. And then, there is your literature and the scientific studies.
2/ What has been your experience with “Universal” adhesives in general?
In my practice, I have always been a great devotee of adhesive techniques. Just quoting from memory, twenty years ago, I was even using bonding adhesives on amalgams when working on extensive reconstructions. I progressed to direct composite restorations, having abandoned silver amalgams at least fifteen years ago now, so I have certainly become familiar with various generations of adhesives. The first of your products which I used was the first PANAVIA. At that time, I was also using CLEARFIL SE BOND.
Over time, again from memory, I moved on to Scotchbond, a 3-step total-etching system from 3M, to Excite F and Scotchbond 1, 2-step total-etching systems, then a 2-step self-etching system AdheSE from Ivoclar Vivadent, and finally, a 1-step self-etching system from Kuraray, CLEARFIL S3 Bond, which I found effective for fast enamel etching.
For adhesive bonding in my indirect restorative work, I prefer to use your PANAVIA V5.
Recently, having finished my last bottle of CLEARFIL S3 Bond Plus, I finally moved on to CLEARFIL Universal Bond Quick, which is a very good product. The universal adhesives are attractive and efficient and that is why I use them with a carefully applied, specific technique.
3/ In your experience, what are the most frequent mistakes found in the use of adhesives?
It’s just where directions for usage are not properly followed. I think this is really important and, from time to time, even if I am very familiar with a product, I will re-read the directions for use. It is easy to make a change to one of the stages, believing it to be for the best, only to reduce the effectiveness of the product. Although, I must admit that it is difficult to skip any of the stages now, as the method has been simplified.
As far as I am concerned, the simplified technique is an advantage and certainly, there is always the question of whether or not to use etching, depending on the surface. With CLEARFIL S3 Bond Plus, I used to etch for about two seconds on unprepared enamel. I have even adapted the application of the adhesive; instead of leaving it to act for 10 seconds, I massaged for 10 seconds and then I left it to act for 10 seconds. In my opinion, this optimised the bonding. With Universal, I have retained the etching application time, but for the adhesive, I massage for 5 seconds and then leave it to act for 5 seconds.
4/ Do you think that universal adhesives represent the way forward for modern restorative dentistry?
Yes, of course, since current modern dentistry favours adhesive dentistry and whether it is direct or indirect, it is far preferable and less disfiguring orally.
5/ CLEARFIL Universal Bond Quick is the latest version of adhesives from Kuraray Noritake. What do you see as the main advantages of this product?
There are many advantages. Firstly, with regard to ergonomics, the simplified technique and the fact that it can be universally applied means you need fewer products, fewer bottles in our basins or in the fridge; speed of application with scientifically proven effective adhesion; the simplified technique avoids any mistakes in handling. Then, compared to your product, the MDP together with a hybrid monomer, this enables better dental impregnation and some tolerance to humidity. Having said that, some care must be taken; attention must be paid to eliminate any saliva. There is also the extended durability period. Finally, it is compatible with the dual-cure products from Kuraray, without the need for a dual-cure activator. There are really many advantages.
6/ What kinds of restorative work do you use this adhesive for?
At the moment, mainly for direct restorations; I have not yet tried it for indirect work. I know that the CLEARFIL DC Core Plus is very good, but I have an indirect bonding technique with PANAVIA V5 and I am still working with carbon fibre posts, because for the last 10 or 15 years, I have had no problem with them. When I have direct access for photo-polymerisation, I use CLEARFIL PHOTO CORE, which enables polymerisation beyond 5 mm and, if not, I use LuxaCore.
When I need an adhesive bond for zirconia, I use the PANAVIA procedure. For some time, I used PANAVIA SA Cement Plus, even for inlays. Veneers are sintered and in such cases, my laboratory follows the Vivadent procedure.
I use CLEARFIL Universal Bond Quick for all classes of restoration and even for dentinal hybridisations. One of its advantages is also faster impregnation of the dentine and, therefore, the reduced application time.
7/ CLEARFIL Universal Bond Quick combines the MDP monomer patented by Kuraray with hydrophilic amide monomers, enabling it to penetrate the dentine faster whatever the level of humidity. How does this fast bonding technology benefit the dentist?
The benefits lie in its speed and the improved bonding result, plus the tolerance to humidity which we have just mentioned.
8/ What are the advantages to patients on whom you have used CLEARFIL Universal Bond Quick?
Patients are not really aware of the procedure. I could say the durability of restorations and a reduction in post-operative sensitivity, but this is something we have enjoyed for some time, thanks to the development of adhesives. I don’t think this is something that “Universal” adhesives can add to.
9/ Given the progress achieved in restoration materials and technologies, is post-operative sensitivity still something which dentists need to take into account? What has been your experience in this regard with CLEARFIL Universal Bond Quick?
Yes. I do pay special attention to this, aside from the quality of treatment, durability and the comfort of our patients. The satisfaction of our practitioners is dependent on our patients’ satisfaction!
10/ Do you think that there is more post-operative sensitivity when etching is carried out separately?
Personally, I have never felt this, but I do follow the instructions for use scrupulously. It is really a question of technique, whether rinsing the etching, applying the adhesive, intensive drying or not.
11/ You have still not tried CLEARFIL DC Core Plus. Do you think you will start using it?
That’s true, I have not used it yet, but I am very interested in the product and I shall review this.
