Which self-etch bonding systems are suitable for which clinical indications?

Self-etch bonding systems are promoted as a time-saving and user-friendly alternative to etch-and-rinse bonding systems. Self-etch adhesives are characterized by a relatively mild etching effect, resulting in a relatively low incidence of postoperative hypersensitivity. On the other hand, their mild etching effect causes a reduction in bond strength to enamel compared to that achieved with phosphoric acid etching. All-in-one adhesives still suffer from less-than-optimal initial bond strengths and from inadequate durability of the bond. Future developments need to focus on the elimination of water deposits along the adhesive interface of all-in-one adhesives. While self-etch adhesives may yield acceptable results when applied in combination with light-cured composite resin, their acidic monomers inhibit the polymerization of auto-cured and dual-cured composite resins. Unfortunately, most "self-cure" or "dual-cure" activators do not overcome this problem. This incompatibility has to be taken into consideration when using self-etch adhesives for adhesive cementation and for core build-up restorations. When assessing self-etch bonding systems, it should be noted that they do not represent a homogenous category of materials but rather comprise a great variety of different types of products, each with specific strengths and weaknesses.