3 0 th A n n i v e r s a r y

REALITY NOW

The information source for esthetic dentistry
2 0 1 7The Ratings BONDING AGENTS — UNIVERSAL

1

(4.6)

Clearﬁl Universal
Bond Quick
INTRODUCTION/MANUFACTURER’S CLAIMSRAVES & RANTS++-

3-second application timeWorks across-the-board
Need to etch enamel for
optimal performance
Cannot use unidose with dualcured/self-cured materials

MANUFACTURER

Kuraray
www.kuraraydental.com

PRICES

KITS
Bottle$160.00/5ml ($32.00/ml)
Unidose (50)$170.00/5ml ($34.00/ml or $3.40/dose)
REFILLS
Bottle$135.00/5ml ($27.00/ml)
DC Activator$86.52/4ml ($21.63/ml)

SHELF LIFE

3.5 years refrigerated

Just like its namesake, it is a universal, single-component bonding
agent that is stated to work with all direct and indirect procedures aswell as with all etching protocols and dentin hydration conditions, i.e.,dry, moist or wet. However, to make it universal so it can be used withdual-cured and self-cured composites and cements, you still need tomix it with the a la carte Clearfil DC Activator (unless you are using itwith other Kuraray Noritake products such as Panavia SA Cement Plusor Clearfil DC Core Plus).
But the real attraction with this adhesive is its application time. Hint: it
is fast! This leads us to several facts of life that occur in many (most?)
dental practices when it comes to applying bonding agents. The first
fact, which plagues virtually all products, equipment, and materials, isignoring the DFU/IFU, aka directions/instructions for use. You think you
know how to use a product because it seems to be similar to others you
have used in the past.
So you may glance at the chairside technique card that comes withmany products these days, but these cards are meant to supplement
the main directions, not replace them. This is due to the technique cards
omitting many of the details from the main instructions that can mean
the difference between success and failure.
However, those main directions, which are typically printed on thin, plain
paper (they are easily contaminated and virtually impossible to disin-Michael B. Miller, D.D.S. – President/Editor- in- Chief

Ingrid R. Castellanos, C.D. – Vice President/Publisher

Editorial Team: David L. Baird, D.D.S., Bellevue, WA; Robert W. Baker, Jr., D.M.D, Ithaca, NY; Nathan S. Birnbaum, D.D.S., Well esley, MA; Alan A. Boghosian, D.D.S., Chicago, IL; Matthew Brock, D.D.S., C.A.G.S.,
M.S.D., Chattanooga, TN; Mitch A. Conditt, D.D.S., Fort Worth, TX; Juliana da Costa, D.D.S., M.S., Portland, OR; Marvin A. Fier , D.D.S., Pomona, NY; Daniel Fortin, D.M.D., M.S., Montreal, Canada; George A.
Freedman, D.D.S., Toronto, Ont., Canada; Fay Goldstep, D.D.S.; Toronto, Ont., Canada; Gary Henkel, D.D.S., Horsham, PA; David S . Hornbrook, D.D.S., San Diego, CA; Mark E. Jensen, D.D.S., Ph.D., Slidell, LA;
Thomas P. Keogh, M.D., D.D.S., Navarra, Spain; Timothy F. Kosinski, M.S., D.D.S., Bingham Farms, MI; So Ran Kwon, D.D.S., M.S., Ph.D., Iowa City, IA; Hannu O. Laamanen, D.D.S., M.S., Turku, Finland; Paul
Landman, D.D.S., Chicago, IL; Clarence C. Lindquist, D.D.S., Washington, D.C.; Edward Lynch, M.A., B.D.Sc., Ph.D., Coventry, UK ; Hans Malmstrom, D.D.S., Rochester, NY; Sandesh Mayekar, M.D.S., Mumbai,
India; Steven McGowan, C.D.T., Seattle, WA; Michael K. McGuire, D.D.S., Houston, TX; Aikaterini Papathanasiou, D.D.S., Boston, MA; Christopher Pescatore, D.M.D., Danville, CA; Stephen D. Poss, D.D.S.,
Brentwood, TN; Robert G. Ritter, D.M.D., Juniper, FL; Andrew T. Shannon, D.D.S., Vancouver, BC, Canada; Liviu Steier, D.M.D., M ayen, Germany; Franklin Tay, B.D.Sc.(Hons), Ph.D., Augusta, GA; Marcos A. Vargas,
D.D.S., M.S., Iowa City, IA; Charles Wakefield, D.D.S., Dallas, TX; Thomas G. Wilson, Jr., D.D.S., Dallas, TX; David Winkler, D .D.S., Windsor Berks, England.
A publication member of theAmerican Association of Dental Editors1

3 0 th A n n i v e r s a r y

Clearﬁl Universal Bond Quickfect) in a font that requires loupes to read, are manytimes long-winded, cryptic, and incomplete. So it is
no wonder you may ignore them and only follow the
aforementioned technique card.
The second fact about applying bonding agents is thetendency to be impatient and not allow them to dwellon the walls of your prep for enough time to perfuse
into the tooth structure. This application brevity can
result in less than expected performance from theadhesive and can manifest itself in post-op sensitivity, restoration dislodgement, and later down the road,brown lines at the margins that can signify leakage.
The third fact relates to isolation of the operativesite. Since dental dams (remember: no rubber anymore) are seemingly only used by a small percentage of clinicians for procedures other than endo, therisk of contamination is always present. So you wantto move forthrightly through your procedure before
the patient inundates the operative site with saliva.
And finally and certainly no less important, you haveoffice overhead always bearing down on everything
you do today in practice, which means you need tobe time-efficient to earn enough to pay those bills
and maybe even realize a slight profit for fun andentertainment.
With all this in mind, Kuraray Noritake, the manufacturer of the 5 Star, #1 rated, gold standards in selfetch adhesives and resin cements, namely Clearfil SE
Bond 2 and Panavia V5 respectively, now brings us
still another bonding agent called Clearfil Universal
Bond Quick. From its name, you can already see thatthe clever folks at Kuraray Noritake realized thateven though they had created some terrific products,
these same products still required several steps andmore time than many dentists were willing to spend
when applying a bonding agent.
So how is Quick different than the conventional
Clearfil Universal Bond? According to Kuraray
Noritake, Quick has a new amide monomer that“rapidly permeates dentin and enamel” and presumably only requires three seconds of application witha rubbing motion. This new monomer combined withtried and true MDP is stated to “provide a very highcuring property” resulting in “higher bonding
strengths, less fluid absorption, and no waitingtime.” It also releases fluoride, but we wonder
whether its quantity has clinical efficacy.

USES
All types of restorations. Requires mixing with
Clearfil DC Activator for dual-cured and self-cured
composites and cements.
The evaluators were almost evenly split on how theychose to use it with 31% primarily using it in the etch
& rinse mode, another 31% in the selective etch protocol and still another 31% moved between protocols
to fit the clinical situation, while the remaining 7%
most often used it as a self-etch. One evaluator
noted self-etch was used when time was an issue.

COMPOSITION
Adhesive HEMA, bisphenol A diglycidylmethacrylate(BIS-GMA), 10-methacryloyloxydecyl dihydrogen
phosphate (MDP), hydrophilic amide monomers, colloidal silica, silane, sodium fluoride, and CQ inethanol and water. Other Kuraray adhesives are filled
10% by weight, but the manufacturer will not disclose the filler content of this version. Film thickness
is stated to be 5-10 microns.
DC Activator Ethanol, initiators, and accelerators.

pH
Adhesive 2.3
Adhesive/DC Activator 3.2

VISCOSITY
Adhesive All evaluators except one thought it wasfine, with the lone holdout feeling it was too thick.
Adhesive/DC Activator All evaluators except one
thought it was fine, with the lone holdout feeling it
was too runny.

ODOR
Adhesive Most evaluators (69%) thought it was similar to other adhesives, while 23% felt it was lessoffensive and 8% worse than other adhesives.
Adhesive/DC Activator Most evaluators (75%)
thought it was similar to other adhesives, while theother 25% were evenly split between better andworse than other adhesives.

SIMPLIFIED APPLICATION TECHNIQUE
1 Manufacturer states that moisture status of prep
doesn’t matter. Our tests found in the self-etch
mode, 1-2 quick blasts of air should be acceptable,
but blotting is still safer in the etch & rinse mode. In
the etch & rinse mode, the manufacturer wants you
to etch enamel and dentin for 10 seconds, which we
found to be effective (one enamel specimen failed
within the enamel, not at the adhesive interface).
However, it was more effective on enamel when air
was used to dry it, while it worked better on dentinwith blotting. Therefore, in the etch & rinse mode,etch for 10 seconds, rinse, suction excess water, andblot dentin with gauze, leave it in place, air dry
enamel, and then remove the gauze. This should
prevent you from over drying the dentin. The prepshould still look dry after blotting. Obviously, if theprep is small, you may not be able to use the blotting
technique. In this case, use air, but don’t overdo it.
Blotting the prep is our MOIST technique. In the etch
& rinse mode, most (64%) evaluators used moist,
27% preferred dry, and 9% went with wet.
As noted above, in the self-etch mode, clean andleave preparation MOIST by using 1-2 quick air
blasts. In the self-etch mode, most (62%) evaluators
used moist, while the other 38% used dry.
2 For LIGHT-CURED restorations in the etch & rinsemode, apply the adhesive with GENTLE AGITATION
for 3s. Do not use the rubbing technique in the etch
& rinse mode. For LIGHT-CURED restorations in the
self-etch mode, apply the adhesive with RUBBING
for 3s. For DUAL-CURED/SELF-CURED restorations,mix equal drops of the adhesive with DC Activatorand then apply it as noted above.
The manufacturer's direction of rubbing for both theetch & rinse and self-etch modes can be counterproductive for the former since rubbing previously
etched dentin can affect the demineralized collagenmatrix and the etched enamel rods.
As far as the 3-second application time, slightly
more than half (54%) of the evaluators still chose to

apply it 10-20 seconds, while the other 46% stuckwith 3 seconds. Several evaluators noted that therecommended 3-second application just made them
uncomfortable, so they played it safe by applying it
longer. One study shows that 3-second application
should be acceptable, but bond strength does
increase with longer application times.
On the other hand, our tests using immediate shear
bond strength on dentin found no differences among
the following groups: one 3-second application, twosequential applications of 3 seconds, one 10-second
application, and one 20-second application.
Therefore, it appears that the single 3-second application of Quick should be clinically acceptable aspromoted by the manufacturer.
Most evaluators (77%) used gentle agitation, rubbing/scrubbing was used by 15%, and only 8% used
let sit. However, 3 seconds is not a lot of time forany type of manipulation . In our tests, we applied theadhesive totally covering the bonding site and thenwe started the timer. Before you can blink, the 3 seconds is over and you are picking up the air syringe toevaporate the solvents.
3 Apply GENTLE AIR to evaporate the solvents. Note:
Quick has the uncanny ability to produce a shiny
surface after the solvents are evaporated. In our
tests, none of our specimens needed a second coatto produce a shiny surface. This shiny surface is notalways achieved with other adhesives after a single
application.
4 Light-cure adhesive or the adhesive mixed with the
DC Activator for 10s.
Using this technique, the bond strengths (MPa) withlight-cured composite were:Substrate

Self-Etch

Etch w/PA

Enamel

24.3

29.3

Dentin24.0

26.7

These results show etching the enamel with PA isvery beneficial, while the advantage of etching thedentin is not as significant. These results seem tosupport the selective-etch protocol, where enamel isstill etched with phosphoric acid, but dentin is not.
Note that the enamel tests were done on prepared
enamel. Etching unprepared enamel is always a prudent procedure.
No debonds were reported using this adhesive withlight-cured materials.
Using this technique, the bond strength (MPa) with
self-cured composite using the self-etch protocol on
dentin was 22.6.
All evaluators except one who used it with dualcured or self-cured materials had no bond failures.
The lone outlier had one bond failure and that
occurred with dual-cured material.

INSIDE SURFACE OF INDIRECTRESTORATION
Composite Quick, evaporate the solvent aggressively, and light cure for 10s. If you are using a low
viscosity resin cement, applying Quick as a wetting
agent may not be necessary.
Porcelain/Lithium Disilicate/Zirconia Clearfil Ceramic
Primer Plus, which is not included in the kit.
Precious Metal Alloy Primer, which is not included in
the kit.

POST-OPERATIVE SENSITIVITY
Direct restorations No evaluators except one reported any postoperative sensitivity, with the lone holdout having only one case after using the etch & rinse
protocol. In this case, the application time was
longer than 3 seconds.
Indirect restorations No evaluators except one
reported any postoperative sensitivity, with the loneholdout having only one case.

but the light gray printing is difficult to read,
although it resists removal during disinfection procedures. One evaluator questioned why the kit did
not include DC Activator, which is an a la carte item.
Unidose Kit is in an easy to stack box with productidentification on three sides and top. Plastic shrinkwrapped for security. Expiration date is on a label on
one side. Unidoses inside are in a Ziploc bag.
The actual unidose has two sections, with the top
one being the twist-off cap and the bottom holding
the contents. The cap has the product identificationand expiration date. The bottom section also has aflat floor so the unidose can stand upright on its
own. Most (85%) evaluators liked the unidose but
didn’t think it was any better than competing products, while the other 15% considered it to be better
than other products. One evaluator liked the fact thatit stands on its own. On the other hand, you can’t
use the unidose for dual-cured/self-cured procedures and several evaluators still preferred bottles.
DC Activator Our trial came in a non-resealable plastic pouch. Expiration date is on a label on the front of
the pouch. The material is in a conventional, semitranslucent plastic squeeze bottle with the expiration
date imprinted in white against the light pink background, which again makes it difficult to read.

DIRECTIONS
Multi-language, plain paper annoying foldout plus in
the bottle kit, plastic-laminated treatment roomcards with a hole punched in one corner so they canbe used in a flip-card style by attaching them withthe supplied plastic ring. In the unidose kit, there is acoated paper sheet instead of the cards.

Bottle Kit is in an easy to stack box with product identification on three sides and top. Plastic shrink-wrappedfor security. Expiration date is on a label on one side.
Most evaluators thought the contents were nicelyorganized with adequate space for all the components.

The paper instructions are long and tedious to wadethrough, but reasonably easy to follow. Beveling
porcelain in the marginal area is recommended when
performing a repair, but beveling can result in the
repair material being overly thin and more likely to
flake off or fracture under occlusal load. “Adherend
surface” is used, but its meaning can be nebulous.

The standard squeeze-type bottle has moistureresistant printing that includes the expiration date,

The laminated, treatment room cards feature color
illustrations and easy-to-follow, step-by-step appli-

PACKAGING

CLEARFIL UNIVERSAL BOND QUICK 2017

3 0 th A n n i v e r s a r y

Clearﬁl Universal Bond Quick

cation procedures. Overall, the cards are well done,
but still omit how to treat the tooth prior to applying
the adhesive in the self-etch mode. Most evaluators
preferred the cards over the paper version.

The coated paper sheet in the unidose box basically
mimics the plastic cards.

CLEARFIL UNIVERSAL BOND QUICK 2017

REALITY
STRENGTHS Faster than most other adhesives.

WEAKNESSES Still prudent to etch enamel with

Clinically acceptable bond strengths even with selfcured composites. Works for all procedures. Nice viscosity. Virtually no sensitivity was reported. Easy touse. Creates shiny prep surface virtually all the time.
Available in bottles and unidose. Laminated directions are easy to follow.

PA. Need to light cure before seating indirect restorations. Some parts of the conventional directions mayneed revisions to be clearer. Unidose cannot be usedwith DC Activator.

BOTTOM LINEThe 3-second application time is a big attraction, especially when time and isolation can be major issues
such as in pediatric and geriatric patients, but if adding a few extra application seconds gives you peaceof mind, then go for it: your results will still be really good.

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CLEARFIL UNIVERSAL BOND QUICK 2017