Verhandelingen - Koninklijke Academie voor Geneeskunde van België vol:60 issue:2 pages:75-107; discussion 107-9
During the last twenty years adhesive restorative dentistry has significantly changed routine dental care. This kind of therapy is not only easier to perform, but it also saves more tooth structure and offers additional forms of treatment. Adhesion to enamel was first achieved but adhesion to dentine was realized only many years later. Many solutions were proposed but most of these systems were unsatisfactory either in the lab or in the clinic. The in vitro investigation, cited in the text, provides a classification of the different systems and explains their mechanism of action. The corresponding clinical investigation confirms the in vitro data. Only those systems that produce a micro-mechanical retention of the adhesive resin in the intertubulair dentine combined with formation of resin tags in the dental tubules are able to assure a reliable bond to dentine. In addition, a stress relief mechanism is essential between the adhesive resin and the filling material to absorb the contraction stress occurring during polymerization of the filling material. Finally, while adhesion to tooth structure has become a reality, complete sealing of the restoration still cannot be guaranteed in all circumstances.