Modern dentistry is increasingly moving towards minimally invasive principles, where preserving natural tooth structure has become central to contemporary restorative care. Alongside growing patient expectations surrounding longevity and aesthetics, clinicians are frequently managing difficult restorative scenarios with limited enamel, deep margins and predominantly dentine bonding surfaces. Here, achieving durable adhesion becomes more technique sensitive and clinically demanding.
The substrate matters (why dentine is challenging)
Successful restorations in adhesive dentistry rely on achieving a clean, caries-free, stable bonding surface with effective moisture control and adequate isolation throughout. Under ideal conditions, enamel provides a highly predictable surface to bond to thanks to its high mineral content and relatively uniform structure. However, in practice these conditions are not always available.
Compared with enamel, dentine contains a significantly higher organic component and intrinsic moisture content, both of which influence adhesive behaviour.[i] The tubular structure of dentine and fluid movement within the dentinal tubules further affect adhesion and moisture control.
In deeper cavities, pulpal proximity may complicate adhesive procedures due to increased risk of post-operative sensitivity. Furthermore, the heterogeneous nature of dentine means bonding performance may vary depending on dentine depth, sclerosis and the presence of caries-affected tissue.[ii]
Caries-infected versus caries-affected
Unlike caries-infected dentine, which is typically removed during restorative treatment, caries-affected dentine is partially demineralised but potentially remineralisable and is therefore often preserved during minimally invasive restorative procedures.ii This may help preserve pulpal vitality whilst reducing the risk of unnecessary pulpal trauma. However, structural and chemical alterations within caries-affected dentine may reduce bonding predictability. Collagen disruption and thicker, less stable hybrid layers may also affect long-term adhesive durability.[iii]
When bonding conditions are less than ideal
Achieving predictable isolation in these situations is difficult, particularly where deep margins extend slightly subgingivally or moisture control is compromised. Small interruptions during adhesive procedures can have significant consequences for bonding predictability, especially in predominantly dentine-based restorations where clinicians are already working with a less-than-ideal substrate. Managing these clinical variables whilst balancing efficiency, patient comfort and aesthetic expectations places increasing pressure on clinicians to select effective adhesive systems used in everyday restorative dentistry.
Time pressures within general practice are stressful for everyone, particularly during longer appointments where maintaining consistent isolation becomes increasingly challenging for both dentist and patient. Even small amounts of contamination from saliva, gingival crevicular fluid or patient movement can influence bonding predictability, especially in deep posterior restorations where access and visibility are already compromised, despite careful isolation protocols. Clinicians are therefore required to balance technical precision with efficiency and patient comfort throughout treatment. In adhesive-dependent restorative procedures, many clinicians are seeking materials capable of supporting predictable outcomes without adding further complexity to already demanding clinical situations.
Reducing unnecessary complexity with modern adhesive systems
Versatility remains one of the most valuable qualities within any dentist’s restorative armamentarium. Clinicians are increasingly seeking adhesive systems capable of adapting to multiple restorative situations without introducing unnecessary complexity into everyday workflows. In many clinical situations, universal adhesive systems provide the flexibility to use self-etch, selective enamel etch or etch-and-rinse strategies according to the restorative substrate and clinical requirements.[iv],[v]
For example, a deep posterior composite restoration with limited enamel margins and caries-affected dentine within the cavity floor may benefit from a selective enamel etch approach. This helps clinicians balance strong enamel bonding with more conservative dentine management. Equally, smaller anterior restorations often have the advantage of greater enamel availability for bonding, but also demand highly aesthetic outcomes, where restoration failure may be particularly upsetting for patients. In these situations, an etch-and-rinse approach may be appropriate. Finally, deep dentine-heavy cavities where isolation is compromised can present additional clinical challenges, and self-etch strategies may help reduce technique sensitivity, post-operative sensitivity risk and simplify the bonding process. By avoiding aggressive phosphoric acid etching of dentine, self-etch approaches may also help preserve residual hydroxyapatite within the collagen matrix, potentially improving adhesion in deep dentine restorations.
Together the 3M™ RelyX™ Universal Resin Cement and 3M™ Scotchbond™ Universal Plus Adhesive, from Solventum, are designed to support a more versatile approach across different clinical indications, reducing the need for multiple bonding protocols and cementation systems. The pair produces an enhanced adhesive bond strength to all substrates, whilst enabling simple clean-up due to innovative syringe and bottle designs. 3M™ Scotchbond™ Universal Plus is also the first universal adhesive with dentine-like radiopacity, adding confidence to future treatment.
In practice, relying on the same adhesive approach throughout the day may help minimise material confusion chairside and support smoother coordination between dentist and dental nurse. Once effective isolation has been achieved, the focus should remain on the restorative procedure itself, not repeatedly pairing different bottles, materials and bonding approaches throughout the day.
Predictable adhesion may begin at the bonding interface, but its impact extends far beyond the restoration itself – influencing longevity, aesthetics and ultimately patient confidence in modern dentistry and the clinician providing it.
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About Solventum
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[i] Mohanty PR, Mishra L, Saczuk K, Lapinska B. Optimizing Adhesive Bonding to Caries affected dentin: a comprehensive systematic review and Meta-analysis of Dental Adhesive Strategies following chemo-mechanical caries removal. Applied Sciences. 2023 Jun 19;13(12):7295.
[ii] Nakajima M, Kunawarote S, Prasansuttiporn T, Tagami J. Bonding to caries-affected dentin. Japanese Dental Science Review. 2011 Aug 1;47(2):102-14.
[iii] Nicoloso GF, Antoniazzi BF, Lenzi TL, Soares FZ, Rocha RD. The bonding performance of a universal adhesive to artificially-created caries-affected dentin. J Adhes Dent. 2017 Jan 1;19(4):317-21.
[iv] Chen C, Niu LN, Xie H, Zhang ZY, Zhou LQ, Jiao K, Chen JH, Pashley DH, Tay FR. Bonding of universal adhesives to dentine–old wine in new bottles?. Journal of dentistry. 2015 May 1;43(5):525-36.
[v] Yamauchi K, Tsujimoto A, Jurado CA, Shimatani Y, Nagura Y, Takamizawa T, Barkmeier WW, Latta MA, Miyazaki M. Etch-and-rinse vs self-etch mode for dentin bonding effectiveness of universal adhesives. Journal of oral science. 2019;61(4):549-53.
