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Reprinted from To Your Health Magazine September/October 1990

During the last two or three years, more and more dentists are publicizing their use of "bonding." How many of you ever heard about bonding fifteen years ago when I started using it along with most dentists? That's right! This "new" technique has actually been around for that long a time.

Bonding is magic! Bonding is revolutionary! This is what we dentists thought, and this is what we were told in the early 1970's. One dental company came out with a product called "Restodent." For the first time I was able to remove a hopelessly loose front tooth; cut off the root; and, at that same visit bond the remaining natural crown to the adjacent teeth temporarily with Restodent. This generalized technique called "bonding" is truly remarkable and is, in fact, revolutionary as was claimed twenty years ago. The applications for this basic idea and technique have grown steadily over the years, and as I write this article, dentists are thinking of new uses for this adhesive technique.

Many people ask me if I do bonding. An equal number of people ask me what exactly is bonding. Many of you reading this have already had bonding procedures performed in you mouth; some of you without even being aware of it. If you had any recent white (tooth-colored) fillings placed in your mouth, they should have been bonded. If they were placed in your back teeth, they definitely had to be bonded.

Specifically speaking, dental bonding descibes a technique in which a solution is applied to the enamel that temporarily makes it more porous. Then the enamel is washed and dried throughly, at which time a liquid adhesive is painted on the prepared enamel. A visible light-curing machine is then usually used to harden or cure the liquid adhesive bonding material. Finally, a filling material or cement is used that chemically combines with the bonding layer, which is already physically fused to the enamel through the open pores. Before the "visible" fiber optic light-curing units were used, "U.V." (Ultra Violet) light machines were designed to catalyze or harden the bonding interface material to the enamel. I never bought or used these UV machines because of the potential health hazard of Ultra Violet rays.

Now that we are all knowledgeable about the basic technique for bonding teeth, I'm sure you are very anxious to learn about most of the conventional as well as innovative applications of bonding. Dramatically improved aesthetics of the front teeth is the first image that comes to mind for those who have previously heard about bonding teeth. An anterior composite (dental resin with a quartz particle filler) may be bonded to the front, sides, and/or back of a decayed, stained, broken, or misshapen front tooth using the basic technique described earlier. The results are excellent; however, color matching is sometimes difficult if only one front tooth is being restored. If aesthetics is more critical and matching must be exact, the porcelain laminate veneer is the treatment of choice. The porcelain laminate veener is a thin layer of porcelain bonded to the front and edge of an anterior tooth. An impression is sent to the laboratory, and at the second visit, the veneer is bonded onto the front of the tooth.

Another use of bonding is to seal all fillings for both front and back teeth at the junction between the fillings and the enamel. When non-mercury fillings like porcelain inlays, composite inlays or the usual posterior composites are used, the bonding layer will seal and fuse all these fillings. Certain synthetic porcelain crowns may also be bonded. This is in contradistinction to metal or metal based crowns requiring cement.

Returning to the first miracle use I mentioned with this bonding concept, replacing a missing tooth through the use of bonding was ans still is very impressive. Over the years new developments and refinements of the technique, as well as the availability of newer materials, resulted in the so-called "Maryland Bridge." A dental bridge usually denotes the permanent replacement of one or more missing teeth by cementing on a replacement prosthesis that will never be removed. After an impression is taken in the mouth, the dental laboratory fabricates a mental framework with specially prepared porous surfaces that will bond to the teeth adjacent to the missing one(s).

For many years general dentists and periodontists have been wiring loose teeth together in an effort to stablize them. Although acrylic was used to cover the wires, the asthetics left much to be desired. Now innovative dentists have created a technique utilizing clear monofilament fisihing lines, instead of wires, in combination with bonding material to splint loose teeth together.

Isn't it nice that fillings on the back teeth can be bonded to the enamel, and that if bonded fillings are in the back teeth already, dentists can add height to the back teeth on each side and balance the jaw in someone who has a collapsed bite or a jaw imbalance? Now, we dentists treating jaw malalignments or Temporomandibular Joint Dysfunctions can reversibly build-up and grind down the back teeth in patients with ever changing and demanding TMJoints. Now people who clench their teeth during the day and/or grind their teeth at night no longer have to be concerned that the tall new gold crowns on their back teeth used to build up their collapsed bite will intrude into the bony sockets in their jaws. Although some permanent crowns can be added to, there are certain limitation including crown height and dental arch alignment.

Now that we've delved into this whole "new" exciting world of bonding, we should begin to realize all the advantages of using this basic technique. First of all, we have an opportunity to conserve tooth structure, specifically enamel. Since bonding is adhesive, less tooth has to be drilled or undercut for mechanical retention. Because of this extra holding power, more teeth can be fixed without drilling off all the enamel. Because Maryland require a tiny fraction of the amount of tooth preparation as a conventional fixed (cemented-on) bridge, virtually all the enamel can be spared on the adjacent teeth.

By bonding posterior composite fillings, porcelain inlays or composite inlays, we are sealing these restorations to the cut portion of the enamel. This is in contradistinction to silver fillings which depend upon a secondary expansion about 24 hours after insertion to wedge the filling to the tooth. Wedging could considerably strain and stress the enamel rods. Since the silver filling expands at a greater rate than enamel, a ledge between the filling and the tooth may develop with time. We tried using plastic fillings almost twenty-five years ago, but these restorations expanded much more than even silver fillings. These composite resins with quartz particle reinforcements were truly a great advance over the old plastic fillings of the mid-'60's.

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