As we know, bonding has become increasingly prevalent in today's dentistry. While bonding is indeed here to stay it's undeniably technique sensitive. The following are three simple universal steps we can use to greatly improve our predictability with bonding.

  1. Read: Understand and follow the instructions for the particular system or systems you decide to implement. While most systems today come with very clear instructions, if something is not clear to you don't guess; instead contact the technical support department of the manufacturer.
  2. Isolation: When it comes to bonding, isolation is critically important. The better you isolate the better your results. The most predictable ways I've found to achieve excellent isolation are with a rubber dam, an Isolite or the Isodry system. While there are advantages to each of these, if you are not familiar with the Isolite or Isodry systems, I highly recommend them. In many cases these can be an excellent alternative to rubber dam isolation.
  3. Keep the chemistry right: Bonding agents typically have more than one component in each container. It's important to be sure to mix them up prior to use by inverting the container a few times. This will ensure a good mix and also minimize the formation of bubbles. In addition some of the components in our bonding agents are inherently prone to evaporation and this evaporation can alter their chemistry and thereby affect their performance.

To minimize this risk be sure to wait prior to dispensing them until you are ready to use them. Immediately put the caps back on after you dispense the needed amount. Another thing to consider for the best possible chemistry is to use a unidose version of your preferred system. Doing this ensures that you have fresh chemistry every time you open a new dose.

John R. Carson, DDS, PC, Spear Visiting Faculty. www.johnrcarsondds.com


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Comments

Commenter's Profile Image Andrew Arnouk
October 5th, 2013
John, Thank you for article, it is nice and informative
Commenter's Profile Image John Carson
October 5th, 2013
Thanks Andrew!
Commenter's Profile Image Jason R. Tubo, DMD
October 5th, 2013
Thanks John - I agree that unidose is the way to go with bonding. It adds some $ to the procedure, but the benefit and piece of mind of having fresh, calibrated chemistry at every procedure is hugely under-sold by their companies. I find the main marketed benefit has been to "reduce cross-contanimation" ...and for those of us who are very conscientious of aseptic technique, we may feel that we do not need unidose systems to keep things clean. Also, most unidose systems have container designs meant to block light and limit solvent evaporation throughout the bonding procedure as well. So not only are you getting fresh chemistry at every procedure, but you are also finishing the procedure with close to the same chemistry/properties that you started with. As a side-note on cost: For those of you who are dispensing a fresh drop every time you go back, you might find that a unidose system works out to be less expensive than dispensing 3-5 drops in a visit.
Commenter's Profile Image Gerald Benjamin
October 5th, 2013
The key to fine adhesive dentistry is CARING to do it right. It is extremely challenging to do adhesive dentistry in an insurance dependent dental practice. Bonding takes time to do and requires a high fee structure. I removed 8 zirconia crowns yesterday placed with RelyX Unicem and there was leakage under every crown which were recently placed. Nothing could have been easier technique wise and yet the previous dentist didn't care enough or have the time to do it right. Manufacturers are trying to make their products idiot proof and yet the idiots are far more ingenious in creating new ways to fail. Study more, care more, slow down and raise your fees. Adhesion can be fail proof.