The clinical performance of adhesives.

OBJECTIVES: Traditional mechanical methods of retaining restorative materials have been replaced to a large extent by tooth conserving adhesive restorative techniques. Because adhesives have been evolving so rapidly for the last few years, the timing is right for evaluating the clinical status of present day adhesives. DATA SOURCES: Current literature with regard to the clinical performance of adhesives has been reviewed. An overview of currently available adhesive systems is provided and a categorization of these adhesives according to their clinical application procedure and their intended mechanism of adhesion is proposed. Parameters of direct relevance to the clinical effectiveness of adhesives are discussed in relation to the clinical effectiveness of today's adhesives.
CONCLUSIONS: The clinical performance of present day adhesives has significantly improved, allowing adhesive restorations to be placed with a high predictable level of clinical success. Most modern adhesive systems are superior to their predecessors, especially in terms of retention that is no longer the main cause of premature clinical failure. Recent adhesives also appear less sensitive to substrate and other clinical co-variables. As the remaining major shortcoming of modern adhesives, none of these modern systems however appears yet to be able to guarantee hermetically sealed restorations with margins free of discoloration for a long time.