# Exploring Dentists' Preferences in Selecting Adhesive Systems: A Survey Analysis
## 4 Discussion  
The field of adhesive dentistry is experiencing rapid growth. It is therefore crucial to understand and analyze the attitudes and practices of dental practitioners in order to implement necessary changes. The study aimed to assess Romanian dentists' views towards selecting adhesive agents for various clinical procedures. Stratifying by graduation years provides a deeper insight into how variations in education, technology, experience, and practices influence the application of adhesive techniques in restorative dentistry. This approach effectively captures the impact of time-dependent factors on clinical practice, which may be overlooked when stratifying by other characteristics such as geographic region or age alone. In total, 71.35% of the respondents chose etch-and-rinse, whereas 28.65% selected the self-etch approach. In the context of ER adhesive systems, phosphoric acid is employed to etch both enamel and dentin. This process of etching enhances the surface energy of the enamel and demineralizes the inorganic hydroxyapatite [16]. The formation of micropores is a consequence of the etching process, whereby the resin tag extensions of the adhesive agent interlock mechanically with the demineralized surface. When applied to dentin, the acid eliminates the smear layer and opens dentin tubules, thereby increasing dentin permeability and demineralizing the outermost 1-5 um of dentin. Consequently, an acid rinse results in a structure of collagen fibers that is saturated with water [17; 18]. It is crucial to avoid over-drying dentin after etching. Excessive drying can collapse the demineralized collagen network and reduce the spaces between fibers, making it harder for adhesive monomers to penetrate the etched dentin. This may lead to suboptimal hybridization and reduced bond strength [19]. The sensitivity of the dentin bonding technique lies in determining the optimal moisture level for dentin. Furthermore, achieving the optimal moisture level in dentin is challenging due to the necessity of drying the enamel for bonding while avoiding excessive drying of the dentin [14; 20]. It is therefore crucial to recognize that applying the same bonding technique across various adhesive systems with different solvents, volatilities, and water displacement capabilities may result in unsatisfactory outcomes [21]. Consequently, etch-and-rinse bonding systems are typically the optimal choice for indirect restorations when there is still a substantial amount of enamel present. In this study, only 10.32% of participating dentists selected an ER system as their preferred choice. The following ER systems were included in the study: EE-Bond (Tokuyama\({}^{\circledR}\), Osaka, Japan), Optibond\({}^{\circledR}\) FL (Kerr Dental, Orange, CA, USA), and Optibond\({}^{\circledR}\) Solo Plus (Kerr Dental, Orange, CA, USA). The low rate of use is likely due to the potential for unsatisfactory outcomes resulting from the specific degree of dentin moisture. However, with regard to the ER approach to adhesive techniques, numerous studies in the literature have concluded that ER techniques are more effective than SE techniques. This is the conclusion of the study by [PERSON] et al. regarding failure rates in posterior composite restorations [22]. Self-etch adhesives offer excellent and reliable bond strength with respect to dentin, rendering them an optimal choice for direct composite resin restorations, particularly when dentin serves as the primary support [23]. SE adhesives contain acidic functional monomers with a carboxyl or phosphate group that simultaneously etches and primes the tooth substrate. Unlike ER adhesives, in the case of SE adhesives, the smear layer is integrated into the hybrid complex [13]. The acidic functional monomers present in self-etch adhesives penetrate and alter the smear layer while demineralizing the underlying tooth substrate. Consequently, the dissolved smear layer and demineralization by-products become incorporated into a more uniform hybrid layer, in contrast to ER adhesives [17; 23].