I have an observation on December JADA’s "Total-Etch Versus Self-Etch Adhesive: Effect on Postoperative Sensitivity," by Dr. Jorge Perdigão and colleagues.
The article clearly defines the two techniques. However, many practitioners have found that the self-etch technique resulted in significantly less postoperative sensitivity. The same practitioners also question, though, whether this self-etch does indeed etch the enamel margins as well as the total-etch technique does.
For these two reasons, many practitioners, including myself, use a combination of the two methods. The combined technique is as follows: first, the enamel only is etched with the 34 percent phosphoric acid and rinsed. It is important here to use an etching acid gel rather than a runny almost-liquid. This way, the etch will not run down and touch the dentin at all. Also, in this case, it is not necessary to use the etch for only 15 seconds, since the dentin is not involved.
Second, the self-etch is used on the dentin of the preparation. One tries to use the self-etch on the dentin only, but if some touches the etched enamel margins, it is of no consequence.
I firmly believe that the combined technique uses the strong component of each system, and the result is therefore better than either of the techniques by itself.
