Japanese Dental Science Review 58 (2022) 59–66

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Japanese Dental Science Review

journal homepage: www.elsevier.com/locate/jdsr

Review Article

Role of the smear layer in adhesive dentistry and the clinical

applications to improve bonding performance
Pipop Saikaew a,∗ , Vanthana Sattabanasuk a , Choltacha Harnirattisai a ,
Abu Faem Mohammad Almas Chowdhury b , Ricardo Carvalho c , Hidehiko Sano d
a
Department of Operative Dentistry and Endodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi, Bangkok 10400, Thailand
b
Department of Conservative Dentistry and Endodontics, Sapporo Dental College and Hospital, Plot 24, Sector 8, Dhaka 1230, Bangladesh
c
Department of Oral Biological and Medical Sciences, Division of Biomaterials, Faculty of Dentistry, University of British Columbia, 2199 Wesbrook Mall,
Vancouver, BC V6T 1Z3, Canada
d
Department of Restorative Dentistry, Faculty of Dentistry, Hokkaido University Graduate School of Dental Medicine, Japan

a r t i c l e i n f o a b s t r a c t

Article history: Currently, dental adhesives can be divided into two systems; a smear layer-removal approach with etch-
Received 29 June 2021 and-rinse adhesives or a smear layer-modified approach with self-etching adhesives. After phosphoric
Received in revised form 8 December 2021 acid etching, the smear layer is completely removed. More attention is, however, required when using
Accepted 12 December 2021
self-etching adhesives. The smear layer is partially demineralized by the weak acidic monomer and
subsequently incorporated into the hybrid layer. Therefore, the characteristics of the smear layer play an
Keywords:
important role on the bonding performance of self-etching adhesives. Such characteristics, for instance,
Dentin
smear layer thickness and smear layer density, are influenced by many factors, e.g., instruments used for
Self-etching adhesive
Smear layer
dentin surface preparation, cutting speed, and the abrasive particle size of the cutting instruments. This
Surface preparation review discusses the contributing factors that affect the smear layer characteristics, and the influence
TEM of the smear layer on the bonding performance of dental adhesives. Also, the application techniques
regarding how to improve the bonding performance of self-etching adhesives – the smear layer removal
by using chemical agents, or the modification of the adhesive application procedures – are provided.
© 2021 The Authors. Published by Elsevier Ltd on behalf of The Japanese Association for Dental
Science. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).

1. Introduction It has been reported that the bonding performance of self-

etching adhesives is affected by the smear layer, especially with
Adhesion to enamel and dentin can be divided into an etch-and- mild- and ultra-mild self-etching adhesives. This unfavorable effect
rinse approach and a self-etching approach. The etch-and-rinse of the smear layer also depends on the instruments used for surface
approach requires a separate step of applying phosphoric acid to preparation. However, in vitro studies have demonstrated that the
demineralize the smear layer and tooth structure. For dentin, after bond strength of self-etching adhesives can be improved with sev-
applying 30–40% phosphoric acid, the smear layer is completely eral bonding modification techniques. This review discusses the
removed, and the underlying dentin is demineralized, exposing smear layer characteristics and their effects on the bonding per-
dentin collagen [1]. The zone of exposed collagen is subsequently formance of dental adhesive, including application techniques to
infiltrated with resin monomer to form a so-called hybrid layer improve the clinical outcome.
[2,3]. In contrast, an acidic primer is used in the self-etching
approach to demineralize the tooth structure and simultaneously
2. Smear layer definition
penetrate the underlying dentin. Due to the mild pH of the acidic
primer, the smear layer is partially demineralized (Fig. 1a, b). Con-
Smear layer is a zone of tooth preparation debris found spread on
sequently, the residual smear layer is incorporated into the hybrid
the surface after tooth preparation. Some of this debris blocks the
layer (Fig. 1c). This structure is called the hybridized smear layer
orifices of the dentinal tubules, forming smear plugs that decrease
[4], or resin-smear complex [5] in some reports.
the dentin permeability by 86% [6]. However, the fluid from the
dentinal tubules can permeate through the smear layer due to its
micro-porous structure [7]. The smear layer is mainly composed
∗ Corresponding author. of hydroxyapatite and collagen that is denatured by the friction
E-mail addresses: [email protected], [email protected] (P. Saikaew). and heat during tooth preparation [8]. It has been suggested that

https://doi.org/10.1016/j.jdsr.2021.12.001
1882-7616/© 2021 The Authors. Published by Elsevier Ltd on behalf of The Japanese Association for Dental Science. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
P. Saikaew et al. Japanese Dental Science Review 58 (2022) 59–66

Fig. 1. Schematic diagram of smear layer treated with self-etching adhesive. (a) Smear layer covering dentin surface after tooth preparation. (b) After being treated with self-
etching adhesive, the smear layer was partially demineralized and superficial collagen was exposed. (c) After resin polymerization, the residual smear layer was incorporated
into hybridized smear layer between the adhesive layer and the hybrid layer.

the smear layer should be removed prior to the application of the [19]. Additional studies are warranted to further evaluate the
bonding agent. Complete removal and partial removal of the smear effects of these new etchants on different smear layer preparations.
layer are observed when phosphoric acid is used in etch-and-rinse
adhesives and self-etching adhesives, respectively [9,10]. 3.1.3. Reduced phosphoric acid etching time
Another approach to minimize the dentin collagen degrada-
3. Role of the smear layer in dentin bonding tion caused by phosphoric acid etching is to reduce the etching
time. Though it has been proposed that the depth of dentin dem-
Prior to the use of phosphoric acid, dental adhesives in the early ineralization was related to the etching time [20,21], no adverse
generations bonded directly to the smear-covered surface [8,11]. effect on dentin bond strength was observed when the etching time
The in vitro bond strengths of these adhesives have been reported was reduced to 5 s [22]. On the other hand, the bond strength of
to be less than 5 MPa, which could easily result in clinical debond- primary dentin was significantly improved when phosphoric acid
ing [8,11]. The debonded specimens were also mainly classified as etching time was reduced by 50% [23]. Recently, it has been demon-
cohesive failure within the smear layer because the adhesive resin strated that etching with phosphoric acid to dentin for 3 s improved
was hydrophobic and, therefore, failed to penetrate through such the bond strength and bond durability of universal adhesives [24].
a zone of debris [12]. Similar smear layer demineralization pattern after etching with
phosphoric acid for 3 s and 15 s has also been observed. It has
3.1. Etch-and-rinse approach been stated that shortening the etching time can reduce the adverse
effect of phosphoric acid on bond degradation. However, further
3.1.1. Removing the smear layer with phosphoric acid investigation of the effect of reduced etching time on MMPs activity
It is well accepted that the smear layer can be removed by apply- is needed.
ing phosphoric acid. However, the appropriate concentration of the
acid needs to be carefully considered. Lower concentrations, such 3.2. Self-etching approach
as 0.13% and 20%, demonstrated a less aggressive etching effect,
and the smear layer has been shown not to be totally removed [9]. 3.2.1. Smear layer modified with self-etching system
Similarly, the high concentration, such as 65% in Super-Bond C&B When using self-etching adhesive systems, the smear layer
Red Activator (Sun Medical Co., Ltd., Moriyama, Japan), also demon- characteristics and the etching ability of the adhesives are the
strated the inferior demineralization effect [13] and lower bond two main factors that influence the bonding outcome [10,25–27].
strength [14]. Clinically, the optimum concentration of phospho- It has been previously mentioned that the smear layer charac-
ric that is routinely used is 30-40%. With phosphoric acid etching, teristics are critical for dentin adhesion [10]. Many investigations
the smear layer does not affect etch-and-rinse adhesive systems have evaluated the effects of the smear layer produced by different
because it is completely demineralized and rinsed away [15]. How- preparation instruments. However, a control group with a smear-
ever, the long-term degradation of dentin collagen has been shown free surface was not included for comparison in most studies.
to be more pronounced with etch-and-rinse adhesive compared Therefore, the effects of the smear layer on dentin adhesion might
to that of self-etching adhesive [16]. This phenomenon is possi- be underrated. In 2000, a fractured dentin technique was intro-
bly due to the aggressive demineralization of phosphoric acid that duced by Tay et al. to compare the bond strength of the self-etching
expose more dentin collagen fibrils. Consequently, matrix metal- adhesive to smear-free and smear-covered dentin [28]. The results
loproteinases (MMPs), the endogenous enzyme responsible for the demonstrated that the bond strength of a 2-step self-etching adhe-
collagenolytic activity, are activated and degrade denuded exposed sive, Clearfil SE Bond, was not affected by the smear layer created by
collagen overtime [17]. silicon carbide (SiC) paper [28]. A study by Suyama et al. compared
the bond strength on fractured dentin with that on diamond bur-
3.1.2. Alternative etchants cut dentin [29]. They found that the diamond bur-cut smear layer
Due to the drawbacks of phosphoric acid, new alternative interfered with the interaction of the self-etching adhesive with the
etchants have become available, e.g., Multi Etchant (Yamakin, underlying dentin [29]. These studies imply that the smear layers
Osaka, Japan), Shofu Enamel Conditioner (Shofu, Kyoto, Japan), created from different instruments differentially impact the bond-
and an experimental zirconium oxynitrate conditioner (Ivoclar ing with self-etching adhesives. More details regarding smear layer
Vivadent, Schaan, Liechtenstein) The compositions and the chem- characteristics are discussed in the next section.
ical formula of the active component of each alternative etchant
are provided in Table 1. These alternative etchants demonstrated 3.2.2. Classification of self-etching adhesives by pH
higher dentin bond strength compared with phosphoric acid The etching ability of the self-etching adhesives is related to
[18,19]. Moreover, the inhibitory effect of the experimental zirco- their pH, which can be classified into strong self-etching adhesives
nium oxynitrate conditioner on MMPs has also been demonstrated (pH ≤ 1), intermediately strong self-etching adhesives (pH 1–2),

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Table 1
Compositions and chemical formula of the active component of each alternative etchant.

Product Manufacturer Compositions Chemical formula of the active component

Multi Etchant Yamakin, Osaka, Japan Methacryloyl oxytetra ethylene glycol

dihydrogen phosphate (M-TEG-P),
thickener, colorant

Enamel conditioner Shofu, Kyoto, Japan Three carboxylic acid-based organic

compounds (Polyacrylic acid and other 2
smaller molecular weight organic acids),
thickener, colorant

Zirconium oxynitrate conditioner Ivoclar Vivadent, Schaan, ZrO(NO3 )2 , water, glycerol, fumed silica,
(experimental) Liechtenstein polyethylene oxide

mild self-etching adhesives (pH ∼2), and ultra-mild self-etching Surface preparation using erbium-doped:yttrium-aluminium
adhesives (pH > 2.5) [25]. Typically, an adhesive with a lower pH garnet (Er:YAG) laser has been reported to be more advantageous
tends to demonstrate better etching ability. However, it has been than preparation using burs [39]. Though the process is time-
suggested to avoid using strong self-etching adhesives [25]. The consuming, Er:YAG laser causes water micro-explosions, together
etching pattern of the strong self-etching adhesives is similar to with the vaporization and melting of organic and inorganic compo-
that of phosphoric acid; however, the difference is that the dis- nents. The prepared surface is then free of smear layer where the
solved mineral content is not rinsed away. Therefore, the dentin improved bond strength should be expected [40]. However, sub-
bond can be weakened by the remnants of the dissolved minerals. In surface dentin fissuring [41] and the inferior bonding performance
contrast, the mild self-etching adhesives superficially demineralize after laser ablation has been noted [42].
the dentin surface. The hydroxyapatite remnants are still available Airborne-particle abrasion is also used for caries removal
for chemical bonding, especially with 10-MDP monomer to form [43,44], tooth preparation [45], and surface roughening [46]. The
10-MDP calcium salts [25,30]. This structure is responsible for the aluminum oxide particle is commonly used to prepare the surface.
long-term durability of the resin-dentin interface [30]. Therefore, The rough surface is beneficial to the bonding performance of adhe-
using mild self-etching adhesives is preferable. However, with their sive by increasing surface area for resin adhesion [47]. On the other
weak acidity, the buffering effect of the smear layer should be taken hand, Ouchi et al. [48] reported that the dentin bond strength of
into account [26,31,32]. universal adhesives in self-etching mode significantly decreased
after the surface was grit-blasted with alumina particle. They sug-
3.2.3. Universal adhesives gested that such adverse effect was caused by the compaction of
Universal adhesives can be applied either with the etch-and- the smear layer after alumina grit-blasting, which might inhibit
rinse approach, self-etching approach, or selective enamel etching. the adhesive resin penetration. However, according to the recent
The compositions of the universal adhesives are basically simi- systematic review and meta-analysis, it has been concluded that
lar to the previous generation all-in-one adhesives with several the airborne-particle abrasion with alumina presented no adverse
improvements. The functional monomer in the universal adhesives effect on the dentin bond strength [49]. They recommended using
is mainly 10-MDP, which is relatively more hydrophobic com- the particle size larger than 30 ␮m with an air pressure of more
pared with other functional monomers [33,34]. Furthermore, the than 5 bar to improve the bond strength. For the clinical appli-
hydrophilic components are minimized, e.g., the concentration of cation, the splattering of the particles within the operating field
HEMA in Clearfil Tri-S Bond Plus and Clearfil Universal Bond Quick is inevitable. The use of rubber dam isolation with high-velocity
is 10–35% and 2.5–10%, respectively [35,36]. Finally, the pH of the evacuation devices is mandatory [50]. In addition, the patients and
universal adhesives ranges between 1.5–3.2; thus, most of them dental personnel must also be equipped with protective eyewear
are classified as mild and ultra-mild self-etching adhesives [37]. to prevent accidental eye irritation.
Therefore, the adverse effect of the smear layer should be carefully
concerned when the clinicians apply universal adhesives to dentin
in the self-etching approach.
4.2. Smear layer thickness
4. Smear layer characteristics
The smear layer thickness typically depends on the size of the
4.1. Instrument used for smear layer preparation abrasive particles used. The bigger the abrasive particle size is,
the thicker smear layer will be formed [9,26,51]. Tani and Fin-
The smear characteristics depend on the armamentarium used. ger reported the thickness of the smear layer ranging from 0.9
The two most common instruments used for dentin surface prepa- to 2.6 ␮m for the SiC-ground smear layer and 1.0 to 2.8 ␮m for
ration in literature are SiC paper and burs. SiC paper is used only diamond bur-cut smear layer [51]. Oliveira et al. demonstrated
in laboratory research to standardize the smear layer and roughen that the thickness of the carbide bur-prepared smear layer was
the tooth substrate before performing the bond strength test. It has 1.8 ␮m, which was similar to those prepared by SiC papers and
been recommended to use wet sanding to polish the surface with a diamond burs, except for the 240-grit SiC paper where the 3.0-
circular motion [38]. In some studies, dental burs, such as a diamond ␮m-thick smear layer was observed [9]. It might be difficult to
bur or carbide bur, were used to produce a clinically relevant smear compare the thickness of the smear layer from different instru-
layer. Special equipment, e.g., a CNC specimen former, was used to ments between literatures. However, when comparing between
stabilize the handpiece during surface preparation [27]. However, the most commonly used instruments (SiC paper and diamond
free hand preparation of the smear layer using burs would be more burs) with corresponding abrasive particle sizes, the SiC-ground
clinically relevant. Fig. 2 demonstrates the smear layers resulting smear layers have been shown to be significantly thicker than those
from different surface preparations. prepared by diamond burs [9,26].

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Fig. 2. Representative TEM images of dentin surfaces with different surface preparations. (a) No smear layer was detected in the fractured dentin specimen. (b) The smear layer
prepared by a carbide bur was loosely bound to the dentin surface with approximately 300 nm-in-thickness. (c) The smear layer prepared by SiC paper was non-homogenous.
(d) The smear layer prepared by a regular diamond bur was the most compact.

4.3. Smear layer density The density of the smear layer is more critical than its thick-
ness, especially for mild- and ultra-mild self-etching adhesives
The smear layer density or denseness is the degree of the smear [5,10,26,29,31]. Acidic monomers are less effective in interacting
compaction which is also influenced by the preparation instru- with a dense smear layer for the dissolution. Therefore, resin pene-
ments [9,27]. A dense smear layer was observed when prepared tration is hindered, resulting in low bond strength. In contrast, it is
using diamond burs, whereas a loosely organized smear layer was easier for mild acidic monomers to remove the loosely-organized
detected when prepared using SiC paper [9,27,52]. Although both SiC-ground smear layer and penetrate into the underlying dentin,
instruments are used with a similar abrade motion, the higher forming a uniform hybrid layer and resin tags [50,57].
cutting speed of a diamond bur could compress the preparation
debris into a more compact smear layer [9,10,27]. Mine et al. 5. Application techniques to improve the bonding
demonstrated that the ultra-mild self-etching adhesive could not performance of self-etching adhesives
completely demineralize and infiltrate to the diamond bur-cut
smear layer [5]. In contrast, the smear layer produced by carbide As mentioned above, most of the universal adhesives currently
burs is thin and loosely bound. This might be due to the different available are mild and ultra-mild self-etching adhesives. The weak
cutting motion of the carbide bur because a new surface is produced acidity of these adhesives can be buffered by the smear layer, espe-
when the cutting blade scrapes the dentin surface [27]. cially one created using a diamond bur [5,26,31,32]. Therefore,
The cutting speed also has influence on the smear layer den- bonding modifications either with chemical agents or adhesive
sity and bonding performance of self-etching adhesives. The application techniques might be optional to improve the bonding
fissure steel bur with low-speed cutting (2000 rpm) demon- performance of these adhesives.
strated similar smear layer characteristics when compared to
those prepared by 600-grit SiC paper [53,54]. The etching pat- 5.1. Chemical agents
terns of self-etching primer on those surfaces were also similar.
On the contrary, the coarse diamond bur with high-speed cutting There are several chemical agents that can be used to mod-
(100,000–120,000 rpm) produced a thick smear layer, which was ify the smear layer. The mechanisms of these agents depend on
subsequently more difficult to be removed by self-etching primers the compositions of the smear layer targeted. The organic com-
[53,54]. ponents of the smear layer can be dissolved using deproteinizing
The smear layer density was indirectly evaluated by counting agents [58,59], while the inorganic component can be bound using
the number of occluded dentinal tubules [9] and the reaction of chelating agents [60,61].
the smear layer after applying acidic agents, e.g., phosphoric acid Sodium hypochlorite (NaOCl) and hypochlorous acid (HOCl) are
or self-etching adhesives, using a scanning electron microscope the recommended deproteinizing agents for modifying the smear
(SEM) [27,55]. A recent study demonstrated the characteristics of layer [62–64]. The collagen fibrils in the smear layer can form
the smear layer using transmission electron microscopy (TEM) in a hydrogen bonds with water. Consequently, the hydrated collagen
longitudinal direction [10]. With this technique, the density and the fibrils inhibit resin penetration and polymerization. Therefore, it
reaction of the smear layer to various acidic agents can be evaluated has been recommended to remove the collagen before applying the
directly, as presented in Fig. 3 [10,56]. adhesive [65,66]. However, residual oxygen species can be gener-

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Fig. 3. TEM observation of dentin surface prepared by superfine diamond bur in longitudinal view (a). The dentin surface was etched with 35% phosphoric acid solution (b)
and treated with Clearfil SE2 primer (Kuraray Noritake; Tokyo, Japan) (c).

Fig. 4. Representative TEM images of superfine diamond bur-prepared smear layers treated with Clearfil SE2 primer (Kuraray Noritake; Tokyo, Japan) with the inactive
application (a) or active application (b).

ated after irrigating with deproteinizing solutions [67]. The residual bonding with self-etching adhesives [82]. On the contrary, the bond
oxygen species also inhibit resin polymerization and affect the strength of Clearfil SE Bond significantly increased after dentin con-
resin-dentin bond strength [67–69]. It is then suggested to reverse ditioning with 0.5 M EDTA at pH 7.2 for 30 s [83]. Another study
the bond strength of the deproteinized dentin by using antioxidants also demonstrated improved dentin bond strength with two self-
or reducing agents. Antioxidants scavenge the oxygen, and many of etching adhesives after applying 24% EDTA gel (pH 7.0) for 1 min
them can be used to reverse the bond strength of the deproteinized [84]. Nevertheless, these studies have evaluated the bond strength
dentin. The effectiveness of antioxidants depends on the number to SiC-ground dentin. Further investigations determining the effect
of hydroxyl (−OH) groups in each molecule [70]. A previous study of EDTA pretreatment on bur-cut dentin are needed.
reported that the dentin bond strength of NaOCl-treated dentin
could be reversed by irrigating with 10% ascorbic acid for 1 min 5.2. Modified techniques of the adhesive application
[71]. Another investigation also demonstrated a promising effect
of rosmarinic acid and p-toluenesulfinic acid sodium salt solution The adhesive application can be modified mechanically to
(Accel; Sun Medical, Kyoto, Japan) on deproteinized dentin by rins- improve the smear layer removal. The suggested modified tech-
ing for 5 s prior to the adhesive application [72]. The combination niques are the active application and the multiple application of
of a deproteinizing agent and an antioxidant is currently the best the adhesive.
option to dissolve the organic phase of the smear layer with no Active application is to rub the adhesive with force on the tooth
adverse effect on polymerization. substrate during application. Using this method, the smear layer
Ethylenediaminetetraacetic acid (EDTA) is used to selectively dissolution is enhanced by force applied and the stirring effect
remove the inorganic component from the smear layer due to its (Fig. 4) [85]. However, no significant difference in bond strength
ability to bind to hydroxyapatite [73]. The effect of EDTA depends was detected when various forces were used [86]. There are also
on the concentration used and time of application [73–75], where many benefits of active application technique in addition to the
the irrigation with 17% EDTA for 1 min has been recommended improvement of smear layer removal, such as promoting the chem-
[76]. Partial removal of the smear layer without altering the mor- ical interaction with the 10-MDP monomer [87], enhancing the
phology of the underlying dentin has been observed after using solvent evaporation [88], ameliorating the bond durability [89],
EDTA [77,78]. It has also been advised to pre-treat the dentin with increasing resin penetration and reducing nanoleakage [90].
EDTA instead of using phosphoric acid [73]. Although the chelating Ultrasonic treatment is also used to remove the smear layer.
effect produced by EDTA was milder than the etching potential of Nakabayashi and Saimi removed the smear layer by polishing the
phosphoric acid [79], the resistance to resin-dentin bond degrada- dentin surface with hydroxyapatite paste and immersing it in an
tion was improved with EDTA conditioning [80,81]. However, the ultrasonic cleaner [91]. The technique was modified by Saikaew
bond strengths of self-etching adhesives to EDTA-treated dentin et al. to remove the smear layer with an ultrasonic cleaner followed
are inconsistent. No benefit from EDTA has been observed when the by brushing with an ultra-soft toothbrush [26]. However, these
smear layer was treated with 0.5 M EDTA (pH 7) for 2 min before techniques are not clinically relevant. Many studies have inves-

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Fig. 5. Representative TEM images of superfine diamond bur-prepared dentin treated with Scotchbond Universal adhesive (3 M Oral Care; St. Paul, MN, USA) with single
application (a) or double application (b).

tigated the modification of using an ultrasonic device to clinically 6. Conclusion

remove the smear layer. One study attached a custom-made brush
to the tip of an ultrasonic scaler to remove the smear layer prior to The smear layer characteristics differently affect the bonding
applying the adhesive. With this technique, the smear layer thick- performances of self-etching adhesives. As most of the so-called
ness decreased, and a higher bonding performance was achieved universal adhesives can be classified as mild- and ultra-mild
after ultrasonic brushing for 30 s [92]. An ultrasonic device was also self-etching adhesives, the bonding performances can also be influ-
used in another study to agitate the adhesive during application. enced by the smear layer when applied in self-etching approach.
The benefit of this technique was, however, material-dependent Their adhesion potential can be improved by enhancing the smear
[93]. layer removal, both chemically and mechanically. Chemical agents
The adhesive application time has been indicated by the manu- such as NaOCl or EDTA, can be used prior to the adhesive application
facturer to warrant the optimal bond strength. Basically, applying to interact with the organic component and inorganic component
the adhesive at the time according to the manufacturer’s instruc- of the smear layer, respectively. Whereas, mechanical smear layer
tions is a minimum requirement to ensure the sufficient interaction removal can also be improved by modifying the adhesive appli-
between resin monomer and underlying dentin [94–96]. Notably, cation. From this review article, we recommend the clinicians to
some manufacturers claimed that their universal adhesives, i.e., use the adhesive according to the manufacturer’s recommended
G-Premio Bond and Clearfil Universal Bond Quick, can be applied application time with active application and/or double adhesive
using less time without compromising the bond strength [97,98]. application. We urge that future investigations should focus on the
It has been demonstrated that less application time resulted in long-term results when bonded to a clinically relevant smear layer.
inferior bonding performances [94–96,99]. However, in several
studies, applying the universal adhesives with less time demon- Role of the funding source
strated a stable bond after 1 year [95] and 2 years of water storage
[100]. None.
Increasing the adhesive application time is also recommended
to improve the bond strength. A significant effect was found after
extending the application time to 90 s and 150 s for acetone-based Conflict of interest
and ethanol-based adhesive, respectively [101]. The results from
another study, however, demonstrated no significant effect from The author confirms that there is no conflict of interest to be
doubling the application time [102]. A plausible explanation might declared.
be that the prolonged application time increases solvent evapora-
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