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Self-etching Adhesive Systems in Operative Dentistry: A Literature Review

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The development of a reliable bonding to enamel and dentin substrates along with different bonding agents is an example of a paradigm shift in the way dentistry is practised. The ability to bond in a reasonably predicable way to both enamel and dentin substrates enables dentists to routinely place direct and indirect restorations. In fact, the longevity and predictability of restorative procedures rely on the dentist’s ability to bond successfully to tooth structure. Adhesive systems have progressed tremendously since they were first discovered and continuously evolved over the past 30 years. In spite this significant improvements, the adhesive interface remains the weakest area of the restorations and if exposed to oral cavity, marginal discolouration, poor marginal sealing and loss of retentions as well as microleakage and recurrent caries are among the clinical consequences. Moreover, the differences between enamel and dentin substrates with regard to morphology, histology and composition make bonding to tooth structure one of the major challenges in adhesive dentistry. Current adhesive systems employ two major means to achieve a reliable bonding to the tooth structure. The first method is known as etch and rinse technique. In this technique, the smear layer is removed completely and the subsurface is demineralized via etching with acids. The second method uses the smear layer as bonding substrate and is known as self-etching adhesive system. These adhesives are attractive as, theoretically, they have the ability to significantly simplify adhesive protocols, eliminate the sensitive step of etch and rinse and may represent the next evolution in adhesive dentistry. However, whether their effectiveness is truly comparable to etchand- rinse system is still an issue of investigation. This review aims to explore existing literature and provide information about different adhesive systems, and their protocols, and techniques that have been used to improve the quality of the tooth structure/adhesive interface when self-etching adhesive systems were used. It is useful as it helps dental practitioners with clinical decision during direct restorative procedures. Different types, mechanisms, advantages, disadvantage, morphological evaluation, marginal adaptation leakage and bond strength as well as clinical performance were all reviewed in this paper.