# Exploring Dentists' Preferences in Selecting Adhesive Systems: A Survey Analysis
## 4 Discussion
Water, an inorganic and polar solvent, is a crucial component of SE adhesives, as it facilitates the ionization of the acidic monomers for dentin demineralization. SE adhesives are less susceptible to moisture on the dental surface than ER adhesives [13]. Consequently, the practitioner is no longer required to consider the potential for technique sensitivity related to the moisture level of the dentin [24]. While SE adhesives are relatively straightforwardto use, their ineffectiveness in etching enamel effectively due to the absence of phosphoric acid represents a significant drawback. This results in a superficial enamel-etching pattern that may lead to marginal discoloration and debonding at the margins. To address this issue, a solution is selective enamel etching, which involves the use of phosphoric acid to etch the enamel prior to the application of the SE adhesive [25; 26]. In the present study, 32.36% of the respondents favored self-etch (SE) adhesives, such as Clearfil(tm) Bond (Kuraray Noritake Dental, Tokyo, Japan), Evetric(r) Bond (Ivoclar Vivadem AG, Schaan, Liechtenstein), G-aerial Bond (GC Corp., Tokyo, Japan), and G-Bond(tm) (GC Corp., Tokyo, Japan). Due to issues with adhesion to enamel, 64.21% of these participants preferred an etch-and-rinse (ER) technique, involving selective enamel etching when using these adhesives. However, [PERSON] et al. [27] studied microleakage levels associated with SE, selective etching, and ER adhesive systems in class II cavities, finding that universal adhesive (UA) systems statistically showed more microleakage than the other systems [27]. Furthermore, a study by [PERSON] et al. emphasizes that the Optibond(tm) Solo Plus adhesive technology creates the thickest and most uniform hybrid layer, while the G-Bond(tm) adhesive produces a watertight interface [28]. The one step self-etching adhesive studied by [PERSON] et al. exhibits dehiscence at the interface between the composite material and the dental structures [29]. Universal adhesives, like Tetric(r) N-Bond VivaPen (Ivoclar, Schaan, Liechtenstein) are widely used due to their cost-effectiveness, efficiency, and versatility in bonding to various substrates, as demonstrated in the study by [PERSON] et al. [30], which compared them with Single Bond Universal Adhesive (3M(tm) ESPE, Dental Products, Saint Paul, MN, USA), OptiBond(tm) All-In-One (Kerr Dental, Orange, CA, USA), and G-Premio Bond (GC America, Alsip, IL, USA) [30; 31]. In the current study, the most frequently used universal adhesives included All Bond Universal(r) (BISCO, Schaumburg, IL, USA), Futura Bond (Voco, Cukhaven, Germany), Scotch Bond Universal Plus and Single Bond Universal (3M(tm) ESPE, St. Paul, MN, USA). UAs were preferred by 33.37% of all participants, with 36.05% of them using with the SE technique and the remaining 63.95% with an ER approach (total etch or selective enamel etching). However, the success of direct restorations is significantly influenced by the isolation techniques employed by the dentist, as no adhesive materials or methods can function effectively if isolation is not effectively managed [32]. In this study, 231 participants encountered challenges in achieving adequate isolation. The use of multiple increments during restoration introduces risks of contamination between increments, affecting cohesion and potentially leaving radiolucent artifacts in the restoration [32]. Studies indicate that the use of rubber dams can significantly improve the longevity of dental restorations [33]. Despite the growing demand for resin-based composite direct restorations, many clinicians struggle with reproducing the anatomical details of teeth during these procedures. Seventy participants in the study reported difficulties in anatomically shaping the composite.