# Exploring Dentists' Preferences in Selecting Adhesive Systems: A Survey Analysis
###### Abstract  
Dental adhesives play a crucial role in modern dentistry by enabling the bonding of diverse restorative materials to tooth surfaces. These systems have evolved through seven generations, each characterized by unique chemical compositions and application techniques. The advancements in dental adhesives have significantly impacted restorative dentistry by preserving tooth structure, enhancing aesthetics, and ultimately improving patient outcomes and treatment options. The choice of adhesive system depends on various factors, including the clinical scenario, material compatibility, and dentist preference. Ongoing advancements in adhesive technology continue to enhance treatment outcomes and streamline procedures for dental practitioners. The development of universal adhesives capable of functioning in both etch-and-rinse and self-etch modes has further simplified clinical protocols. This study is an observational cross-sectional study conducted among Romanian dentists. A questionnaire was distributed via email to Romanian dentists, encompassing seven questions that explored the predominant use of etch-and-rinse or self-etch adhesive systems, preferred adhesive types, and commonly encountered challenges in direct restorations. Statistical analyses were conducted using DATAtab version (2024). The study highlighted the varying preferences among Romanian dentists in selecting suitable adhesive agents. Etch-and-rinse (ER) techniques predominated in direct restorations, with universal adhesives being the most frequently used. Further investigation is warranted to delve into the preferences of Romanian dentists regarding the utilization of self-etch (SE), etch-and-rinse (ER), and universal adhesives (UAs). application techniques, progressing to the seventh generation. There is an ongoing concern about increasing the biocompatibility of this resin and reducing the influence of the factors responsible for the resin-bond interface degradation [2]. Furthermore, the effectiveness and lifespan of dental restorative materials are significantly influenced by their absorption of water. Various composites, for instance, absorb water at various rates, which could have an impact on the materials' longevity and mechanical qualities in the oral environment [3]. In the structure of Bis-GMA, the reactive methacrylate groups play a pivotal role in the crosslinking and polymerization processes during the curing of dental composites. When activated by an initiator, whether a photoinitiator or a chemical initiator, these methacrylate groups undergo polymerization, resulting in the formation of extensive polymer chains [4]. This polymerization reaction transforms the initially liquid or semi-liquid composite resin into a solid material that mechanically interlocks to the acid-conditioned tooth structure. The two main adhesive approaches are the etch-and-rinse technique (ER), which completely removes the smear layer, and the self-etching adhesive system (SE), which bonds to the smear layer [5]. Another technique frequently employed by dentists is selective enamel etching, which entails the use of self-etching adhesives on dentin and etch-and-rinse adhesives on enamel (commonly referred to as selective enamel etching) [6]. Dental adhesives have evolved from total demineralizing systems (fourth and fifth generation) to self-etching systems (sixth and seventh generation). The adhesion of dental substrates is based on different application strategies, either demineralization and rinsing or self-etching of tooth structures. The ER adhesion strategy necessitates the application of orthophosphoric acid and the subsequent removal of microcrystalline hydroxyapatite, organic particles, and the smear layer through the use of abundant washing with water. This process demineralizes the enamel and dentin surface layers. In the self-etch (SE) adhesion technique, the need for a prior conditioning step with orthophosphoric acid is eliminated because these adhesive systems include acidic primers.