Wednesday, April 4, 2012

Adhesives: The Game

Hey all,

Sorry about Friday. My editor told me in advance to send the blog to a different email, and I didn't. So I sent this blog into cyberspace only for it not to be seen until after the weekend. My fault.

The sting of last weekend’s loss is still dull, but it is going away. I think watching the games being played is going to make it worse again. We should be there. I told my friend that watching basketball this weekend is like seeing your old girlfriend with some other guy at a dance. BUT I did get Masters tickets (just Monday's practice round). I am so excited. Hopefully the azaleas in full bloom will make me forget about the pain in my heart.

I will tell you about my Masters experience on Friday, but here is a tease.

I am not reading as fast lately. I am so busy wearing all my hats that I don't have that much time to read. But I did finish the book Samson and the Pirate Monks. It was okay. It is about this pastor of a church who was addicted to sex and pornography. He spent over $300,000 on prostitutes and porn. The book is more about his recovery than his addiction. I think it would have been better if he detailed his addiction. Society nowadays wants all the dirt.

I am now reading The Boy that Came Back from Heaven, a book is about a father and son. They were in a car accident and the boy was hurt badly (his head separated from his spinal cord). The doctors told the parents that no one has ever survived these injuries. I think the story is going to be that he survives and he talks about his time in Heaven. I have heard so many people talking about it and someone finally gave it to me, so I picked it up. I will let you know.

Okay, where were we? I have all this new knowledge of the science behind the new generations of adhesives. And like most things that are new to me, I usually bounce them off the experts. I usually go to two or three different places. I go to one of the top guys at the University of Florida College of Dentistry Biomaterials department. I go to REALITY and ask the question on their expert forum. And I go to Clinicians Report.

So Clearfil SE Protect? I went to CR and looked up the last adhesive study:

Fourth generation bond strength..................Dentin 39 and Enamel 34MPa
The best 6th generation (Peak)...................Dentin 50 and Enamel 46 (Wow!)
SE Bond..........................................Dentin 47 and Enamel 38
SE Protect.......................................Dentin 25 and Enamel 30 (Hmmm)

I wrote to the author of the article and I asked him how he felt about giving up half the bond strength just to add the bromide in the solution. He told me that he talked to Kuraray (manufacturer of Clearfil) and they said that they have a problem with the way CR did their study. So now who do you believe? Do you believe the manufacturer or do you believe the independent study?

I did call my contact at Kuraray (don't I sound so high society?) to get an idea of how Kuraray feels about the above. How does one company get one result and one company get another? He said he was going to call me about it.

Then I wrote my researcher in Gainesville and asked him what he knows about MMPs and how he feels about putting bromides or CHX in the solution. He said, “"Whether or not MMP means anything, I am not so sure. For example, in a recent study from Leuven, they could not detect any MMP when Clearfil SE was used, but found it after the use of Optibond FL. Personally, I am far from convinced that it plays any role at all. The reason is simply that Gwinnet did some studies where he had removed all collagen by use of collagenase, and the bond strength was as good as with collagen. I personally believe that one of the keys is to get an intimate contact between the primer and the hard dentin surface and then get rid of moisture before the resin is placed and cured. Under such conditions you form tons of van der Waal bonds. If water to any greater extent can reach that region, the van der Waal bonds may fail."

Oh man, now he is saying that collagen might not be the deal at all. So do we listen to the company, the independent study, or the researcher? Confused yet?

Listen, me and you are the same. We sit back and do our work. We are dentists. We want to do good work and do the best we can for our patients. There is no way we can get involved in all the research and all the back and forth that is obviously going on in the product manufacturing side. And if you do try to learn everything, you can see that your head will spin right off.

This is almost like a game. But who is the referee? Who is going to tell me THE TRUTH? I don't know, but I will keep working on the answer. And I am hoping it is not MONEY.

Have a great week.

No comments:


PLEASE NOTE: When commenting on this blog, you are affirming that any and all statements, and parts thereof, that you post on “The Daily Grind” (the blog) are your own.

The statements expressed on this blog to include the bloggers postings do not necessarily reflect the opinions of the Academy of General Dentistry (AGD), nor do they imply endorsement by the AGD.