Variability of clinical dentin substrates.

Clinical trials remain the only conclusive research of dentin adhesive performance, but variables unique to the oral environment may influence the results. Dentin variability is one factor that may account for extreme variations in clinical evaluations. Despite the encouraging results of laboratory studies, clinical trials with adhesive systems have been disappointing. Current adhesives are reported to react with dentin surfaces by chemical and/or micro-mechanical mechanisms. Dentin surfaces, such as cervical abrasions, are subject to intraoral changes and dentin tubules commonly become obturated by the growth of peritubular dentin or by the precipitation of calcific deposits within the tubules. The resulting sclerotic dentin may be less receptive to current dentin adhesives. An examination of clinically aged dentin surfaces has revealed an inordinate variability in tubular morphology. The more sclerotic dentin present, the less effective was dentin conditioning and resin composite adaptation. Early correlations with current clinical trials appear to substantiate that the greatest failure of restorations occurred in sclerotic lesions.