When it comes to dental adhesives, clinicians have plenty of options. Whether you’re looking for total-etch or self-etch systems, there’s no shortage of offerings from various manufacturers.

But before deciding what works best for each case, it’s important for clinicians to know the pros and cons of both self-etch and total-etch systems and when it’s best to use one versus the other.

It’s also important that dentists don’t buy a product simply because there’s a lot of hype surrounding it; just because a new product comes out doesn’t mean it has clinical research or proof behind it.

Know your options

There are basically four types of adhesives available: multi-bottle total-etch, one-bottle total-etch (all-in-ones), two-bottle self-etch and one-bottle self-etch.

Each system has its own strengths and weaknesses, but the multi-bottle three-step total-etch materials have been the “gold standards” for many years, and—based on clinical research—still exhibit the best clinical performance in dentin bonding. Total-etch systems work best with the wet bonding approach made popular by Dr. John Kanca; the down side is they are technique-sensitive, so if these systems aren’t used properly, patients can experience tooth sensitivity.

The self-etch benefits

Even though the tried-and-true total-etch systems are known as the “gold standards,” self-etch materials clearly are the market leaders as far as sales. They’re easy to use, the depth of etch is largely self-limiting and the acids used are less aggressive than phosphoric acid—so there’s little capacity for overetching the dentin. They also eliminate the variables associated with traditional total-etch/wet bonding procedures that, when used improperly, can more easily lead to post-op sensitivity.

Self-etching primers simultaneously condition (etch) and prime the dentin and to some degree, the enamel. They penetrate and saturate the smear layer, and they demineralize the underlying dentin and prime the dentin through hybrid layer formation. The two-step self-etch systems are similar to single-bottle total-etch products, but use a less aggressive resin-based etchant (primer) rather than a traditional phosphoric acid etchant.

The total-etch advantage

It’s important to note that when total-etch materials are used properly, according to clinical studies by Perdigao, et al, there is no difference in the incidence of sensitivity between self-etch and total- etch systems.^1,2 Sensitivity can be virtually eliminated when using total-etch adhesives if a glutaraldehyde-containing desensitizer is used as a re-wetting agent between the etching and priming steps. The desensitizer occludes the dentinal tubules by coagulating plasma proteins within the tubules.3

Total-etch systems offer better long-term durability for an improved clinical result because they are generally much less hydrophilic. The big concern is they’re more technique-sensitive; you must use them properly.

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