与巴特·范·米雷贝克教授探讨通用粘接与多步粘接

嘿，我想告诉你我为你准备了一些东西。

Hey I want to tell you about something I have put together for you.

我做了一个免费的PDF指南，一步一步教你注塑成型技术。

I created a free PDF guide that walks you step by step through the injection molding technique.

我喜欢这项技术，因为它是获得可预测、美观且高美学效果的前牙复合树脂修复的最佳方法之一。

I love this technique because it is one of the best ways to get predictable, beautiful and highly aesthetic anterior composites.

你实际上是使用一个透明的模板直接将复合树脂注入牙齿中，这使得操作更加一致和高效。

You're actually injecting the composite directly into the tooth using a clear template which makes it far more consistent and efficient.

如果你想要这份指南，我让它变得非常简单，只需访问elevatedgp.com/impdf，为了更简单，我也在节目笔记中为你附上了链接。

If you'd like this guide, I've made it super easy just head over to the elevatedgp.com/impdf and to make it even simpler, I've included the link for you right here in the show notes.

嘿，欢迎收听《牙科文摘》。

Hey, welcome to Dental Digest.

这是一个播客，旨在帮助你保持在循证牙科的前沿。

This is a podcast with a mission of enabling you to stay on the cutting edge of evidence based dentistry.

我是你的主持人，医生。

And I'm your host, Doctor.

梅丽莎·塞伯特。

Melissa Seibert.

今天的节目是两集系列的第一部分，邀请的是博士。

Today's episode is part one of a two part series featuring Doctor.

巴特·范·梅尔贝克。

Bart Van Meerbeek.

这场对话的重要性怎么强调都不为过。

And it's hard to overstate just how significant this conversation is.

范·梅尔贝克教授确实是全球粘接牙科领域最权威的专家之一。

Professor Van Meerbeek is truly one of the preeminent authorities in adhesive dentistry worldwide.

他的研究从根本上塑造了我们对粘接的理解，从牙本质渗透性和混合层稳定性开始。

His work has shaped how we understand bonding at a fundamental level from dentin permeability and hybrid layer stability.

某些简化在粘接牙科中确实会带来生物学和力学上的代价。

Twice certain simplifications and adhesive dentistry come at a biological and mechanical cost.

几十年来，他的研究为整个领域树立了科学标杆，我们都在以此为标准来衡量自己。

For decades, his research out of has set the scientific benchmark that the rest of our field measures itself against.

在第一部分，我们先退一步，看看粘接的核心原理。

In part one, we take a step back and examine the core principles of adhesion.

我们讨论现代粘接牙科真正处于什么位置，证据到底告诉我们通用系统和多步系统哪个更好，以及为什么操作简便往往是一种权衡，而不是免费的升级。

We discuss where modern adhesive dentistry truly stands today, what the evidence actually tells us about universal versus multi step systems, and why ease of use is often a trade off rather than a free upgrade.

巴特带我们了解疏水层、膜厚度、应力分布这些概念，以及为什么正确的技术仍然比单一产品更重要。

Bart walks us through concepts like hydrophobic layering, film thickness, stress distribution, and why proper technique still matters more than a single product.

这不是一场关于捷径的对话。

This is not a conversation about shortcuts.

这是一场关于理解生物学和材料科学，以便做出深思熟虑、站得住脚的临床决策的对话。

It's a conversation about understanding the biology and material science well enough to make deliberate, defensible clinical decisions.

在我们开始之前，我能请你帮个忙吗？

Before we get started, can I ask for your help with something?

如果你觉得这个播客有价值，能不能花一点时间在Apple Podcast应用、Spotify或者你常用的播客平台上给我们打个分、订阅一下？

If you found value in this podcast, would you mind taking just a moment to leave a rating and subscribe on the Apple Podcast app, Spotify, or ever get your podcast?

多年来，我一直在用心经营Dental Digest。

I've poured my heart into Dental Digest for years.

你的支持直接帮助我和我的家人继续为像你这样的牙医制作有深度、高质量、基于证据的教育内容。

Your support directly helps me and my family continue creating thoughtful, high quality evidence based education for dentists like you.

我真的很感激。

And I really appreciate it.

好的。

Okay.

让我们开始第一部分，有请Bart Van Meerbeek教授。

Let's get to part one with professor Bart Van Meerbeek.

我有个你一定会喜欢的东西。

I've got something that you are going to love.

如果你一直喜欢这个播客，想更深入地掌握种植牙学，这就是你的机会。

If you've been loving the podcast and want to dive deeper into mastering implant dentistry, this is your chance.

我正在免费赠送我的一门在线课程。

I'm giving away access to one of my on demand courses completely free.

这门课程涵盖了你需要知道的关于种植体咬合、平台转换，以及打造那个令人惊艳的美学穿龈轮廓的所有内容，这些都能让你的作品脱颖而出。

This course is packed with everything you need to know about implant occlusion, platform switching, and creating that stunning aesthetic emergence profile that's set your work apart.

那怎么领取呢？

Here's how to grab it.

给播客留个评分，截个图发给我就行。

Leave a rating for the podcast, take a quick screenshot, and send it my way.

你可以直接在Instagram上私信我。

You can either direct message me on Instagram.

我的Instagram账号是Doctor。

My Instagram handle is Doctor.

Melissa Seibert，或者发邮件到dr.

Melissa Seibert or send it to me an email at dr.

Melissa Seibertgmail点com。

Melissa Seibertgmail dot com.

收到截图后，我会把课程权限发给你，这样你就能马上开始学习了。

Once you get the screenshot, I will send you access to the the course so you can start learning right away.

这是我感谢你支持播客、成为这个优秀社区一员的方式。

It's my way of saying thank you for supporting the podcast and being part of this amazing community.

我迫不及待想听听你的想法。

And I can't wait to hear what you think.

你知道，在你关于粘接退化悖论的研究中，你展示了同样的亲水性，既能促进牙本质渗透，也会加速水解降解。

You know, in your work on the adhesion degradation paradox, you've shown that the same hydrophilicity that enables dentin infiltration also accelerates hydrolytic breakdown.

到2025年，你觉得有没有什么现实的途径能走出这个悖论？

In 2025, do you see any realistic pathway out of this paradox?

还是说，耐久性本质上仍然是一种妥协？

Or is durability still fundamentally a compromise?

对，我觉得这就是一种妥协，因为经常有人说新一代通用粘接剂是未来的方向。

Yeah, I think it is a compromise because quite often it is said that these new generation of universal adhesives are the way to go.

我觉得从使用方便的角度来说，确实是这样。

And I think so in respect of ease of use.

但另一方面，我们还是要认识到，这些粘接剂，我甚至称它们为权衡型粘接剂，你追求使用方便，但为此付出了代价。

But on the other hand, we should still realize that these are, I call them even trade off type of adhesives, where you go for ease of use, but you pay a price for it.

这不是我随便说的，我们有证据，我们测试了很多次，而且这些通用易用粘接剂的即时粘接强度确实更高，当你采用两步法时，强度显著更高。

And I'm not saying this, we have evidence, we have tested so many times and that also the immediate bond strength with these universal easy to use adhesives is higher, it is significantly higher when you go for a two step procedure.

所以这就是为什么我们确实认为你需要这个。

And that's why we indeed claim that you need this.

首先，你需要这两个步骤，你需要先涂一层底漆，也就是我所说的粘接促进剂，然后还需要涂一层粘接树脂，这层树脂要特别容易聚合。

Well, first of all, you need these two phases, you need a primer to be applied, which is the adhesion promoter like I call it, and this needs to be followed by an adhesive resin that especially polymerizes very well.

这还和疏水性有关，这样它就不会吸收太多的水分。

And that has to do with also the hydrophobicity that it will not absorb too much of the water.

而且，它还需要有一定的厚度。

And on top of that should have a certain thickness.

我觉得这个厚度也很重要，因为我们觉得它可以起到一种应力缓冲器的作用，在粘接界面之间，当然首先是与牙本质基质的界面，但也要考虑与复合树脂的界面，复合树脂会拉扯界面，立即产生收缩应力。

And I think that thickness is also very important, because we think it can function as a kind of stress reliever shock absorber in between the adhesive interface, of course, with the dentin substrate in the first place, but otherwise also with the composite, the composite is going to pull on the interface, creating shrinkage stress immediately.

但之后它也能起到缓冲作用。

But later on as well, it can work as a kind of buffer.

如果太薄的话，就起不到这个作用了。

And if it is too thin, it will not do that.

甚至有些产品上市时还宣称它们的薄膜厚度非常薄。

And some even products come on the market where they even claim it has a very thin film thickness.

所以这是个优势。

So it's an advantage.

嗯，我觉得基本上相反的情况就是劣势，因为如果太薄的话，它聚合得不好，稳定性也差，而且当你把粘接剂涂在上面的时候，脱粘的风险就更大，它可能会从牙本质表面被拉下来。

Well, I think basically the opposite is disadvantage, because if it is too thin, it will not polymerize very well, it will not be very stable and at the moment then you apply your adhesive on top of it, yeah, you have a bigger risk that it will be debonded, it will be pulled away from the dentin surface.

再说到疏水性，我们确实学到了很多，当然这也跟我们做的测试类型有关，我们现在做的是老化测试，通过简单的储水或者冷热循环来挑战我们的样本，但光是储水这一项。

Regarding more focusing on the hydrophobicity, we have clearly learned, and of course, this has to do also with the kind of testing we are really testing now we are ageing, we are challenging our specimens and by simple water storage or thermo cycle, whatever, but water storage on its own.

这当然是个很严苛的测试，跟临床实际情况有点差距，因为我们用的是非常小的试件，直接泡在水里，而患者口腔里当然不是这种情况，至少不是这样。

It's of course, a severe test, which is a little bit further away from what happens in the clinical situation, because we have these very tiny sticks that are exposed to water directly, which is not the case in the mouth of a patient, of course, not in that way.

但没关系，我们就是想做这些加速测试之类的。

But okay, we want to test these and accelerated tests and so on.

道理是一样的。

And that's the same thing.

它们吸水越多，强度、耐久性就会下降，界面会退化，性能会变差。

The more they absorb, the strength, the durability will, it will degrade the interface and it will go down.

正因为如此，我觉得有一层好的疏水层，不吸收太多水分，对耐久性也是有好处的。

And that's for that reason, I think to have a good hydrophobic layer there that doesn't absorb too much of the water is better for the durability as well.

这里有很多内容要讲。

There's a lot here to unpack.

所以，对于正在收听这个节目的牙医们，如果他们想知道，我用的通用粘接剂是不是这种？

So for dentists that are listening to this and they're wondering, am I using a universal adhesive?

你能列举一下，在全世界范围内，现在比较常用的通用粘接剂有哪些吗？

Can you name just around the world, what are some of the pretty popular universal adhesives that are used today?

在北美，比较常用的有像Scotchbond，你知道的，就是Solventum或者3M出的那种。

So here in North America, some of the pretty popular ones are things such as Scotchbond, you know, by solventum or three ms.

我觉得那真的是最常用的一种。

That's really, I think, the most popular one.

还有，Kuraray也生产通用粘接剂。

And even Curiari, they make a universal adhesive.

在欧洲。

In Europe.

你看到那边常用的通用粘接剂有哪些呢？

What are the popular universal adhesives that you see being used?

对，嗯，

Yeah, well,

作为大学出身的人，我确实不太方便直接点名或说哪些产品最受欢迎。

being from a university have a little bit difficulty with really naming or mentioning this product or what are the most popular.

而且我对市场数据也没有太多了解。

I also do not have really a view on market figures.

不过我可以想象，就像你提到的，在美国有Cosmos Universal，现在还有Universal Plus，这些都是比较受欢迎的。实际上，Universal也是第一个真正以“通用粘接剂”为名进入市场的产品，而且它非常稳定。

But I can imagine, like you mentioned that in The US that's Cosmos Universal and nowadays Universal Plus, that is one of the popular ones that actually Universal was also the first, let's say, as that really was branded as universal adhesive that came on the market, and it is a very stable product.

我们确实敢把某些产品称为“金标准”，但那些都是多步骤的粘接剂。

We dare to name certain products as a gold standard, but these are multi step adhesives.

我现在还不想说某个通用粘接剂就是金标准。

I do not yet want to say that this is a gold standard universal one particular product is a gold standard universal adhesive.

在我看来，现在说这个还为时过早，尤其是因为我们还缺乏长期的临床数据。

That is in my opinion, too early and especially because we lack really long term, clinical data.

虽然多步骤粘接剂有这样的数据，但长期来看，我是说超过十年或者差不多十年，我们正在接近这个目标。

While we have this for multi step adhesives and long term, I mean beyond ten years or around ten years, we are coming close.

但即便是今天，你看看这些五类临床试验，也能清楚地看到，确实，这些通用粘接剂的脱落率比多步粘接剂要高。

But still today, if you even look to these class five clinical trials, you can clearly see that, yeah, the loss rate certainly with these universal adhesives is larger than with this MultiStep.

但另一方面，在通用粘接剂这个类别里，确实也有差异。

But on the other hand, in that class of universal adhesives, yeah, there are differences.

这其实是个很有意思的问题，因为现在市面上有太多通用粘接剂了，而且我也觉得这是未来的趋势，就是同一种粘接剂，我们可以用在不同的粘接模式下，虽然我个人更倾向于两步法的通用粘接剂，就像我之前说的，但我也理解市场，理解牙医们喜欢用那些最简便的，不过要意识到这是一种妥协。

It's actually a very interesting issue, because today there are so many universal adhesives on the market, and I would also say this is the way to go that we have one and the same adhesive, we can use it in different bonding modes, although my preference would go to a two step universal adhesive that's like I said before, but, I of course understand also the market and where dentists would like to use these most easy to use, but still realizing that this is a kind of compromise that you make.

Scotswolds Universal 和它的 Plus 版本是最早进入市场的之一。

Scotswolds Universal and the plus version was one of the first on the market.

我觉得它在欧洲也很受欢迎，但还有其他几种我也认为是通用粘接剂，比如 G Premium Bond、Clearfield Universal Bond，现在还有两种。

I think it is also in Europe, very popular, but there are several others that I see are universal adhesives, G Premium Bond, Clearfield Universal Bond, two nowadays.

所以有好几种我确实认为属于同一类，我现在真的不想在它们之间做区分，但要说哪个最流行、市场怎么样，那我们就得看市场数据了，而我对这个没有了解。

So there are several ones that I certainly consider to be in the same kind of category, and I really do not want to make a distinction between them at this very moment, but regarding what is most popular, what is the market, yeah, then we have to look to market figures, and I have no view on that.

所以我没法告诉你，我只能说我所听到的之类的。

So I cannot tell that I can only say what I hear and so on.

但再说回来，我基本上对一步法通用粘接剂没什么意见，因为我们总是建议要么用两步法通用粘接剂，要么用一步法通用粘接剂，但一定要在上面涂一层流动树脂，这层流动树脂就起到一点粘接树脂或粘接剂的作用，就像我们喜欢这么叫的。

But saying this again, basically, have not that much against one step universal adhesives, because we always recommend either go for a two step universal adhesive or go for a one step universal adhesive, but always apply a flowable composite on top of it, which then serves a little bit as your bonding resin or your adhesive resin like we like to call it.

这样实际上就变成了一种两步系统。

And then you make it actually a kind of two step system in a way.

但这没什么问题，因为我们在鲁汶这里教后牙修复时，第一层总是用流动树脂。

But that is nothing wrong because also here we teach here in Leuven plus two restorations, the first layer in the box is always a flowable composite.

所以你也明白这一点。

So you're realizing that.

如果你把一步通用粘接剂和这个结合起来，但另一方面，我觉得大家还没充分意识到的是，通用粘接剂之间其实是有差别的。

And if you combine that with a bit of a one step universal design, But on the other hand, and this is not realised enough, I think, is that there are differences between Universal Adhesives.

当然，从树脂的角度来看，现在大多数通用粘接剂都含有10-MDP作为功能性单体。

Of course, composite wise, most of the universities today contain 10MDP as functional monomer.

但我们不知道的是，10-MDP的含量是多少，比例是多少。

But what we do not know is what is the content, what is the percentage of the 10MDP.

而且我可以向你保证，这些正是我们现在在研究的东西，差别真的很大。

And I can assure you, because these are things that we are studying now, that there are big differences.

有些粘接剂含的10-MDP比其他的多得多，差别非常明显。

There are big differences with adhesives that contain much more 10MDP than others.

有时候在我们的实验室里，也会看到粘接效果上的差异，这些差异我们并不总能解释清楚，因为我们并不完全了解这些成分，但可能与产品中10MDP的含量有关，尤其是在自酸蚀模式下使用时。

And sometimes also in our lab, see differences in bonding effectiveness that we not always can explain, because we do not know these compositions completely, but can be related, for instance, certainly when they are applied in self etch mode to the percentage of 10MDP inside the product.

这些信息不会公开，制造商也永远不会公开，这可以理解。

And this is not released, manufacturers will never release it, understandable.

但另一方面，这是一个重要的影响因素。

But on the other hand, it is an important factor that plays a role.

我可以告诉你，我们现在正在这方面进行研究，但现在公开还为时过早。

And we are now, I can tell you this, working in this light, and it's too early to make it public.

但我们确实看到了很多差异。

But certainly we see a lot of differences there.

所以，一种通用粘接剂和另一种在性能上可能完全不同。

And so one universal adhesive can be totally different in performance from another one.

这就是当前市场的现状。

And that is what the current market is.

但目前，人们认为这是一种通用粘接剂，可以使用，含有10MDP，但如果它只含有23%或10%，例如，这可能在性能上造成很大的差异。

But currently, one thinks this is a universal adhesive, I can apply it, contains 10MDP, but if it contains only 23%, or it contains 10%, by example, can mean a big difference in performance.

最后再补充一点，可能只有在自酸蚀模式下你才会注意到这些差异，因为那时10MDP的作用最大，因为你需要有酸蚀效果，也需要有化学粘接效果。

Adding to that as a final thing to add is maybe you will only notice this when you apply in the self etch mode, because then the 10MDP plays its biggest role, because you need to have the etching effect, you need to have the chemical bonding effect.

在酸蚀冲洗模式下，情况会不同，如果你想用酸蚀冲洗，要区分不同通用粘接剂会更难。

In an etch and rinse mode, it will be different, more difficult to differentiate between the universal adhesives if you go for an etch and ring.

所以全酸蚀模式，在美国通常这么叫。

So the total etch slag, it is usually called in The US this kind of mode.

差异没那么大，因为对10MDP含量的依赖较小。

And the differences are not that big because it depends less on the 10MDP contour.

我想问你一个问题。

Let me ask you something.

当你从牙科学校毕业时，你有没有想象过自己会处理高难度的病例，做那种让你在上班路上都感到兴奋的牙科工作？

When you graduate dental school, did you imagine yourself taking on advanced challenging cases and doing the kind of dentistry that excites you on your commute into work cases, etc.

还是你发现自己被困在重复、无聊、令人困惑甚至没有成就感的牙科工作中？

Or do you find yourself stuck in dentistry that feels repetitive, boring, confusing, and maybe even unfulfilling?

你是否因为不可预测的失败、牙冠脱落、患者不满意而沮丧，甚至不知道为什么会这样？

Are you frustrated by unpredictable failures, crowns debonding, patients unhappy, and not even sure why it's happening?

今天，你是你想成为的那种牙医吗？

Today are you the dentist that you want to be?

现在，想象一下成为你一直想成为的那种卓越的全科牙医。

Now imagine becoming the exceptional comprehensive dentist you always wanted to be.

那种思路清晰、自信且稳定，不局限于常规治疗的牙医。

The kind of dentist who practices with clarity, confidence and consistency who thinks beyond bread and butter procedures.

他们受人尊敬，被同行推荐，工作既有意义又有挑战，因此感到满足。

They're respected, referred to, and fulfilled because the work is both meaningful and challenging.

这就是我们在Elevated GP里培养的目标。

That's what we build inside of Elevated GP.

我们培养卓越的全科牙医，让他们成为自己一直想成为的临床角色。

We build exceptional, comprehensive dentists who step into the clinical version of themselves they've always wanted to become.

在我们的课程中，你每个月都会看到直播的继续教育讲座，涵盖社区最想了解的话题，从种植到咬合，从治疗计划到前牙复合树脂修复。

Inside our program, you will find live CE lectures every month that cover the topics our community wants most, from implants to occlusion to treatment planning to anterior composites.

我们还有每月直播的问答环节，一起处理你最棘手的病例，不仅教你该怎么做，还教你如何思考。

We also have monthly live Q and A sessions where we tackle your toughest cases together, teaching you not just what to do, but how to think.

我们还有一个专属社区，你可以在这里提出真实的临床难题，得到有依据的、深思熟虑的答案，而不是像在随便一个脸书群里那样被各种噪音淹没。

We also have an exclusive community where you can bring your real clinical challenges and get thoughtful evidence based answers without the noise of a random Facebook group.

我相信，铁磨铁，能磨出刃来。

I believe that iron sharpens iron.

你身边的人决定了你的水平。

You are the average of the people you surround yourself with.

所以，加入一个牙医们互相激励、追求最高水平的社区吧。

So come join a community where dentists push each other to the highest level.

如果你对此有共鸣，我亲自邀请你访问 elevatedgp.com，成为我们中的一员。

If this resonates, I want to invite you personally to head over to the elevatedgp.com and become one of us.

那么，关于通用粘接剂，我不想替你把话说出来，但听起来你的意思是，通用粘接剂的优势可能在于使用方便，但使用它们可能意味着我们要接受一些妥协。

So just to recap on universal adhesives, I don't wanna put words in your mouth, but it sounds like what you're saying, the advantage with universal adhesives could be ease of use, but potentially with universal adhesives, we might be accepting some compromises.

这样说对吗？

Is that fair?

这个总结公平吗？

Is that a fair summary?

是的。

Yes.

也许我想补充一点。

Maybe I want to add something more to that.

对我来说，通用性也是一个非常重要的优势，意思是你可以说，作为牙医，你可以选择如何使用粘合剂，可能取决于个人偏好。

Versatility is for me also a very important advantage and meaning you can say, okay, you can choose as a dentist how to use the adhesive depending maybe on a personal preference.

对我来说，我一直说我们支持良好的化学粘接，然后你可能更倾向于在牙本质上使用自酸蚀技术，而不是在牙釉质上。

And for me, I always said we were in favour of having good chemical bonding and then you favour maybe more the self etch technique on the dentin, not on enamel.

牙釉质很明确，牙釉质需要磷酸。

Enamel is clear, enamel needs phosphoric acid.

你肯定需要酸蚀和冲洗。

You need etch and rinse definitely.

但在牙本质上，你可以说，是的，也许我个人更倾向于选择硫磺，因为我了解其背后的机制等等。

But on dentin, you could say, yeah, maybe I would like to have personally more I would like to go for the sulfur because I know the mechanism behind it and so on.

但另一方面，你也可以有不同的看法，这实际上是我现在想传达的信息。

But on the other hand, you can also see it different and that is actually the message that I now would like to bring.

你可以根据你要粘接的牙本质类型来决定，或者是你必须粘接的牙本质类型。

This you can let your choice depend on the type of dentin you want to bond to or you have to bond to.

如果是非常年轻的牙本质，比如年轻患者，或者比如患有饮食失调的患者，腭侧的所有牙釉质都完全溶解了，然后你面对的是非常年轻的牙本质，渗透性很强，而且常常非常敏感。

If this is very young dentin, for, a young patient, or for instance, a patient, suffering from, an eating disorder where all the enamel at the palatal side is completely dissolved, and you have then very young dentin, very permeable dentin, quite often very sensitive dentin.

有时候你甚至能看到牙髓透出一点粉色。

Sometimes you even see the pulp shining through a little bit pink.

对我来说，这种情况下我肯定会选择自酸蚀技术，选择温和的相互作用方式，因为我肯定不想进一步刺激牙髓，如果你那样做的话，但你在某种程度上总是会刺激到它。

That is for me, the way I'm going definitely for a self age technique, I go for the mild type of interaction, because I certainly do not want to further irritate that pulp if you would do that, but you will always do that up to a certain extent.

并不是说这真的是个问题。

Not that it is really a problem.

但在那种情况下，我觉得你不需要深层相互作用，不需要磷酸处理。

But at that moment, I think you don't need a deep interaction, you don't need a phosphoric acid treatment.

另一方面，当我需要修复一颗具有典型硬化性牙本质的牙齿时，这种牙本质长期暴露在口腔中，已经变色，呈棕色，像玻璃一样等等。

On the other hand, when I have to restore a tooth that with a typical sclerotic type of dentin, dentin that has been exposed for a long time to the mouth, which is also discolored, is brown, is glassy like and so on.

我知道这种情况下粘接会比较困难。

I know this is difficult then to bond to.

在这种情况下，我会选择酸蚀冲洗法，因为我想在牙本质上也达到更深的结合。

In that regard, I would say I go for an edge syringe approach because there I want to have really also on the dentin and I want to have a more deeper interaction.

同样的情况也适用于，比如你移除了一颗银汞合金修复体，在它下面有腐蚀的牙本质，带有色素沉着或腐蚀产物渗入的现象。

And the same would be true, for instance, you have removed an amalgam restoration underneath that amalgam restoration, you have this corroded dentin with tattooage effect, the pigments or corrosion products in there.

很多时候，即使不给患者打麻药，你也能操作，因为牙髓已经完全退缩了。

Quite often, even if you treat the patient without anaesthesia, you can do it because the pulp is completely retracted.

在这种情况下，我会说，好的，选择自然冲洗和更激进的处理方式。

In that case, I would say, okay, go for a natural rinse and more aggressive kind of treatment.

所以，这就是我认为现在比较合理的理念。

So and that is what I think now is a good philosophy.

这也是为什么我喜欢这种通用粘接剂，你可以选择，但并不是真的根据个人偏好，而是根据你面对的组织类型来决定如何粘接。

And that's why I like also this universal adhesive quite that you can choose, but not really, really based on the personal preference, but just depending on the kind of tissue you are confronted with and decide then how you want to bond to it.

让我总结一下，这是一个非常重要的考虑点，我想强调一下。

Just to recap as well, so this is a really important consideration I want to put some.

你提到，如果使用通用粘接剂，为了优化它的效果，你需要额外加一层流动树脂。

So you were talking about if using universal adhesive in order to optimize the universal adhesive, you need to include that extra layer of flowable.

你提到这有可能改善物理性能，也许还有机械性能。

You talked about how this can potentially improve physical properties, mechanical properties perhaps.

你能再多花点时间讲讲这个吗？就稍微多讲一点。

Can you just spend a little bit more time talking about that just a little bit more?

因为对很多牙医来说，这可能会让他们有点意外，至少在北美是这样，在欧洲可能还好。

Because for many dentists, this might come as a little bit of a surprise, at least in North America, and maybe not as much in Europe.

你现在说的其实是在上面加一层流动树脂，对，当然，就像我说的，对我来说，一步法通用粘接剂最大的缺点就是那层膜太薄了。

You're now really referring of the use of a flowable composite on top of, yeah, well, certainly, like I said, to me, biggest disadvantage disadvantage of one step universal adhesives is actually that thin film thickness.

而且有时候，在我看来，这在市场上甚至被误解了，因为经常有人说这是个优点。

And this is sometimes, in my opinion, even market wise, wrongly interpreted, because it is often said this is an advantage.

大多数这种一步法通用粘接剂，轻轻吹干后，厚度大概在10微米左右，当然吹干的方式也会影响厚度。

Most of these one step universal adhesives, they have a thickness, we gently air blowing, of course, that is also going to determine the thickness of about, let's say 10 micrometer.

但10微米很薄，非常薄。

But 10 micrometer is thin, is very thin.

你可以光固化它，但它永远不会固化得那么好，因为存在氧抑制层之类的问题。

And you can light cure it, but it will never cure that well, because you have this oxygen inhibition and so on.

然后问题在于，你实际上并没有真正稳定住混合层等等，实际的相互作用，实际的粘接力在那个时刻并不是很稳定。

And then the problem is that you have actually have not really stabilized the hybrid layer and so on, the actual interaction, the actual bond is not very stable at that very moment.

然后你把复合树脂放在上面，复合树脂会收缩，会在那个界面产生拉伸应力，当然可能导致脱粘，而且这又是C因素在起作用，尤其是在那些窄小的窝洞里，聚合收缩应力很大。

And then you're going to put that composite on top of it, the composite is going to shrink, it's going to produce tensile stress on that interface and it can result in debalming, of course, and that is an again, the C factor that plays a role in these narrow type of cavities where there is a lot of polymerization shrinkage stress.

如果你在上面用流动树脂，就相当于做了一个缓冲层。

Well, if you have a flowable composite on top of that, you make a kind of buffer layer there.

这样首先能更好地稳定粘接剂。

And that has this kind, well, first of all, it will better stabilize the adhesive.

流动树脂也会收缩，它也会收缩。

It also shrinks, flowable composite shrinks also.

但作为一层，它还有很大的自由表面可以收缩。

But in a layer, it still has a big free surface where it can shrink.

即使复合树脂会收缩，也不是问题，因为这样不会在界面上产生太大的拉伸力。

And even composites can shrink, it's not a problem because then it will not produce too much tensile forces on the interface.

所以，这就是第一点，要有一层能更好地保护下面混合层的缓冲层。

So and that is the first thing to have a layer that better protects actually the hybrid layer underneath on that.

而且在这之上，你做的这个流动树脂比较疏水，里面有一些填料，性能更强。

And on top of that, you make it, it's quite hydrophobic, a flowable composite has some filler, it has stronger properties.

所以在我看来，它也起到一种缓冲器的作用，一种应力缓解的作用。

So it works also as a kind of, as I see it, a kind of shock absorber, a kind of stress reliever in between.

但是如果是两步系统，有底漆和粘接树脂，形成一定的厚度，原则上你就不需要那个流动树脂了。

And but with a two step, system where you have a primer and an adhesive resin that creates, a certain thickness, you don't need in principle that flowable composite.

当然，在上面再加一层流动树脂也没什么坏处。

But of course, there is nothing against by adding also flowable composite on top of that.

但这背后的基本想法是，我们选择一步粘接剂，但总是在上面涂一层流动树脂。

But that is the basic idea behind saying, okay, we go for a one step adhesive, but always apply that flowable composite on top of that.

当表面比较开放，收缩效应不那么明显的时候，这个问题就不那么严重了。

This is going to be less, an issue, when you have, let's say, an open surface where there is less shrinkage effects.

还有一些其他类似的情况。

And there are some other cases and so on like that as well.

你提到这些材料是疏水的。

You talked about how these materials are hydrophobic.

当然，唾液污染对粘接和最终修复效果的影响是相当大的。

And of course, salivary contamination can be quite detrimental to the bond and the final restoration.

你能解释一下，如果出现唾液污染，临床医生应该怎么做吗？

Can you explain what clinicians should do if salivary contamination arises?

嗯，这其实是不久前的事。

Well, it's not that long ago.

我们做了一项有趣的研究，专门探讨了最佳的清洁方法。

Did an interesting study where we actually looked at what is the best way to decontaminate.

过去，大家总是说，好吧，这种情况发生了。

In the past, it was always Okay, this happened.

那就重新来过吧。

Okay, start all over again.

但问题是，真的应该这样做吗？

And the thing is, should you do that?

还是说，还有其他处理办法呢？

Or are there other ways to do that?

而且我们也有点惊讶地发现，当你使用基于10MDP的溶液时——我就这么叫它吧——它确实是一种非常有效的去污剂。

And we learned a little bit also to our surprise that when you use a 10MDP based solution, I'm going to call it like that because that really is a very effective decontamination agent.

这还和10MDP的特定单体，也就是功能性单体有关。

And this has to do also with the specific monomer, the function monomer of 10MDP.

10MDP是一种很好的粘接剂，化学粘接剂，但同时它也是一种很好的酸蚀剂。

10MDP is a good bonder, chemically bonder, but at the same time, it's also a good etcher.

这种组合使得它还具有某种清洁功能。

And this combination makes that it has a kind of cleaning function as well.

所以这就是我们所知道的。我们做了那项研究，进行了尝试，然后我们说，好吧，我们有唾液污染的情况。

So that is what we know, And we did that study and we tried that out and we say, okay, we have saliva contamination.

在实验室里，你会得到大量的唾液，那是过量的唾液。

And in the laboratory, you have a lot of saliva, it's exaggerated saliva.

让我们惊讶的是，如果我们只使用一个两步系统，其中包含基于10MDP的底涂剂，而且我知道——这又是一个关键因素——底涂剂中10MDP的浓度，那么它作为表面去污剂效果非常好。

And to our surprise, if we just used a two step system with a 10MDP based primer, and I know that and this is again a critical factor that the concentration of 10MDP in the primaries eye that this works perfectly as a surface decontamination agent.

所以你不必再那么担心了。

So you don't have to worry that much anymore.

唯一要注意的就是，我自己也遇到过这种情况，你拿起 primer，用刷子开始涂，这样就能清洁表面，然后轻轻吹干，接着继续操作就行了。

It's just the only thing and that happens to me also is that you take your primer and you start priming in with your brush And in this way, you decontaminate the surface, gently air blow after that and you just continue.

这一点已经得到了证实。

And this is confirmed.

我们在这方面做过一些测试。

We did some testing in that.

有一篇论文专门讲 10MDP 的出色去污能力。

There is a paper about this of the excellent decontamination capacity of 10MDP.

这确实是个好消息，知道这点挺好的。

And that is something, yeah, nice to know.

但这就是为什么我说要用基于 10MDP 的溶液。

But and that's why I said a 10MDP based solution.

如果你现在用一步法通用粘接剂，当然它也含有 10MDP，但浓度通常更低，因为一步法通用粘接剂是各种成分的混合物，10MDP 只是其中之一。

If you take now a one step universal adhesive, of course, it contains 10MDP, but the concentration of 10MDP is always lower because a one step universal adhesive is a cocktail of different kinds of ingredients and one of it is then 10MDP.

但如果你用一款以 10MDP 为功能成分、其他成分不多的 primer，那它的效果会比那种除了 10MDP 还含其他东西的一步法通用粘接剂好得多。

But if you use a primer that contains 10MDP as functional agent and not too much other ingredients, that this is going to work much better than that one step universal adhesive that besides 10MDP also contains other things.

所以这就是为什么我没有测试那个。

So that's why I have not tested that.

嗯，虽然我们确实测试过。

Well, although we did test that.

而且我觉得，当然，如果你涂得越来越久，那就可以弥补这一点。

And I think, yeah, of course, if you apply it longer and longer, then you can compensate for that.

但在我看来，一个好的基于10MDP的底涂剂是清洁表面的最佳选择。

But in my opinion, a good 10MDP based primer is the best to decontaminate the surface.

我现在还不能把这一点推广到比如血液污染的情况。

I cannot right now extrapolate that for, blood, contamination, for instance.

我只能推测，因为我没有相关数据。

I can only speculate on that because I have no data on that.

但我认为它对血液污染也可能有类似的效果。

But I think it might have a similar effect also on blood contamination.

而且对我来说，这也是选择两步法通用粘接剂并搭配含大量10MDP底涂剂的另一个原因。

And that is this to me is another reason to go for actually a two step universal adhesive with a primer that contains a lot of 10MDP.

所以，一个常见的例子是不是就是Clearfil SE？

So perhaps like a popular example would be clear SE?

那当然，这也是我们所说的金标准。

That is of course, that is also what we called the gold standard.

自酸蚀粘接剂就是Clearfil SE Bond 2。

Self etch adhesive is clear fill SE bond two.

那是较新的版本，基本上和原版类似，但据称聚合能力更好，不过确实是这样。

That's a newer version, which basically is similar to the original version, but with claimed better polymerization capacity, but yeah, definitely.

所以那个底涂剂里含有相当多的10-MDP，但也有其他的，比如G2 Bond Universal，它上市时有时被宣传为新产品，是两步版本，但基于同样的技术。

So that primer, there is quite some 10MDP inside, But there are others, you have the G2 Bond Universal that came on the market sometimes taught us as being what is this product appearing on the market, while we have this, to have a new product that is a two step version, but that is based on the same kind of technology, let's say.

你也有一个单独的底涂剂和粘接树脂，底涂剂里10-MDP更多，其他干扰成分更少。

You also have a separate primer within adhesive resin, and the primer has more 10MDP, there are less other ingredients that are in the way.

这就是为什么一步法通用粘接剂是各种东西的混合物。

And that's why a one step universal adhesive is a cocktail of different things.

把东西放在一个混合物里是好事，但这就是你做出的妥协。

It's nice to put things in one cocktail, but that's why it is a compromise that you make.

如果你在通用粘接剂里有10MDP，你总是会尽量简化操作。

You will always have put it as simple as possible if you have 10MDP in a universal adhesive.

对，那个10MDP必须和其他成分竞争才能到达牙本质表面，就这么简单，因为其他单体挡在路上，10MDP不一定总能到达牙本质并与之相互作用。

Yeah, that 10MDP has to fight with other ingredients to reach the dentin surface as simple as that, because there are other monomers that are in the way and by which 10MDP not always gets to the dentin to interact with.

如果你有一种底涂剂，它含有的10MDP更多，或者几乎只有10MDP，不是几乎只有，而是比例上更多，那么它就能更容易地到达表面，并且能更好地相互作用。

If you have a primer that contains more or almost only 10, it's not almost only but more 10mdB proportionally, it will reach much more easier the surface and will be able to interact much more.

这只是简单的常识。

That is just simple common sense,

我会这么说。

I would call it.

如果复合树脂被污染了，同样的规则适用吗？

Do the same rules apply if the composite gets contaminated?

你也可以直接涂抹含有10MDP的底涂剂吗？

Can you also just scrub in a 10MDP containing primer?

是的，我认为效果是一样的。

Yes, I think it works in the same way.

当然，在修复治疗过程中，你涂上一层复合材料，然后发现有污染，我确实会做同样的事情。

And of course, during your restorative treatment, you apply the layer of composites and you see then there is some contamination, I would indeed do the same.

这是你刚涂上的新鲜复合材料。

This is very fresh composite that you applied.

有时甚至已经固化了，我们需要这个氧抑制层来确保下一层能很好地粘合到上一层。

Even sometimes is set, we need this oxygen inhibition layer to build or to make sure that the next layer bonds quite well to the previous one.

这其实也不完全对，因为即使是新鲜复合材料，即使没有氧抑制层，仍然有足够的双键可用。

That is also not really true, because even a fresh composite, even if that oxygen inhibition layer is not there, there are sufficient double bonds still available.

如果你先用10MDP进行去污，然后再继续涂下一层复合材料，那就没问题了。

And if you decontaminate first with 10MDP and then go on with your procedure with the next layer of composite, you're fine.

如果你是一个追求卓越、重视连接、并且知道与对的人在一起可以改变一切的人，这就是给你的邀请。

If you're the kind of person who's passionate about excellence, and who thrives on connection, and who knows that being in the room with the right people can change everything, this is your invitation.

Elevated GP 正在举办首次线下面对面会议。

Elevated GP is hosting its very first live in person meeting.

会议将于4月10日和11日在科罗拉多州丹佛市举行。

It's happening April tenth and eleventh in Denver, Colorado.

两天实操，高密度互动。

Two days hands on, high touch.

这不仅仅是又一场会议，这是一次专为你这样的牙医设计的大师课体验，你致力于精进技艺、提升专业水平。

This isn't just another conference, this is a master class experience designed for dentists like you, people who are committed to sharpening their skills and elevating their craft.

我会教一整天的课程，还有关于陶瓷嵌体、高嵌体和贴面的实操课。

I'm going to be teaching a whole day long course and hands on course on ceramic onlays, overlays, and veneer lays.

然后我们会请来最顶尖的专家。

And then we are bringing in the best of the best.

Bob Margis 会教一门实操课，他会用一种彻底改变你处理这些病例方式的方法来授课。

Bob Margis is going to be teaching a hands on class four course in a way that is going to transform your approach to these cases.

我的导师，博士。

My mentor, Doctor.

Marc Lotta，前克雷恩院长，会教一堂粘接大师课，绝对会让你大开眼界。

Marc Lotta, the former dean of crane, is going to be teaching a masterclass in adhesion that is going to blow your mind.

另外，我们还会深入探讨微创牙科，因为创新让我们与众不同。

And as a bonus, we're going to be diving into minimally invasive dentistry because innovation is what sets us apart.

关键是，这不只是关于技能，也关乎人。

Here's the thing, this isn't just about the skills, it's about the people too.

在后疫情时代，我们都意识到自己多么渴望真实的联系。

In a post COVID world, we're all realizing how much we crave real connection.

这是你建立人脉的机会，和那些同样热情、同样有动力、同样致力于成长的人同处一室。

This is your chance to build your network, to be in the room with peers are just as passionate, just as driven, and just as committed to growth as you are.

铁磨铁，磨出刃来，这里就是发生这一切的地方。

Iron sharpens iron, and this is where it all happens.

对于那些知道自己准备好了、不需要催促的人，现在有早鸟价，一直到圣诞节。

Now for those of you who know you're ready, who don't need commencing, there's early bird pricing available until Christmas.

这是我们庆祝行动派的方式，那些知道这就是为他们准备的人。

This is our way of celebrating action takers, the ones who know this is for them.

名额有限，很快就会满员。

Seats are limited, and this is going to fill up fast.

所以，如果你准备好参与真正具有变革性的事情，就去 elevatedgp.com 报名吧。

So if you're ready to be a part of something truly transformative, head over to the elevatedgp.com and grab your spot.

我也在节目说明里附上了链接。

I've also included a link to it in the show notes.

让我们把四月变成你诊所、事业和社区的转折点，我迫不及待想在那里见到你。

Let's make April a game changer for your practice, your career, and your community and I can't wait to see you there.

再次提醒，要注册的话，请访问 elevatedgp.com/elevationsummit。

And again to get registered go to the elevatedgp.com/elevationsummit.