The December JADA study, "Total-Etch Versus Self-Etch Adhesive: Effect On Postoperative Sensitivity," by Dr. Jorge Perdigão and colleagues, contains contradictory information that may render the study worthless.
For a peer-reviewed journal as prestigious as JADA, it is surprising that this article survived even a cursory reading by reviewers without finding the problems. It’s possible that the problem is in the writing, rather than the actual study, but it should be clarified.
Compare the following statements for contrast:
- In the Abstract under Methods on page 1621: "Prime & Bond NT, ... which uses 34 percent phosphoric acid to etch enamel and dentin simultaneously."
- Body of article, page 1623: "Application of primer and adhesive. The operators treated the enamel and dentin walls of the preparation by applying an SE dentin/enamel primer ... for 20 seconds or by etching with 34 percent phosphoric acid ... for 15 seconds."
The first statement does not indicate that the operators actually used etching on dentin and enamel, called total etch, but states the manufacturer’s instruction for its use by the word "uses." The second statement implies, but does not state clearly, that etchant was used on enamel and dentin.
Two other statements and a photo suggest that dentin may not have been etched by the operators.
- The "Instructions for Use" column in Table 1 on page 1625 states, "Etch enamel with Caulk 34% Tooth Conditioner Gel for 15 seconds."
- The Figure F photo on page 1624 shows only enamel etched, not dentin. And the Figure F legend states, "etching with 34 percent phosphoric acid ... for 15 seconds, followed by rinsing and application of TE adhesive . . . on moist dentin."
Nowhere in the study is there a clear statement that total etching was used on the dentin before Prime & Bond NT. If this is the case, the comparison between "total-etch" adhesives and self-etching adhesives is rendered useless.
Compare this study of 30 restorations with Clinical Research Associates’ survey1 that arrived the same day as the December JADA. The survey was of 4,446 respondent dentists and the results indicated that "no post-op sensitivity is 2 times higher for SEP adhesives (24%) compared to total-etch adhesives (12%)." This is a huge contradiction in results from the study in JADA.
Reliance on one study or survey to determine which category of materials is best is foolish, of course. However, considering the flaws in the JADA article, be they procedural or written, if I was betting, I’d put my money on 4,446 colleagues and the personal peace I have from so few complaints of sensitivity from composite restorations bonded with a self-etching primer.
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