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The cost of one bond failure?

From Volume 42, Issue 5, June 2015 | Page 497

Authors

FJ Trevor Burke

DDS, MSc, MDS, MGDS, FDS (RCS Edin), FDS RCS (Eng), FCG Dent, FADM,

Articles by FJ Trevor Burke

Article

Resin-based bonding to dentine has improved substantially in the past two decades, and the new group of Universal (multi-mode) bonding agents, with Scotchbond Universal (3M ESPE, Seefeld, Germany) and Clearfil Universal (Kuraray) appearing to hold promise although, as with any new material, we all await the results of clinical trials. A common factor in this new group of materials is 10-MDP monomer, originally introduced to dentistry by Kuraray in 1981, which appears effective for bonding to enamel, dentine and metal alloys. Readers will remember this resin as a component of Panavia (Kuraray) luting materials. The 10-MDP resin appears to be important for the status of the bond interaction with hydroxyapatite.

Dentists use adhesion for non-retentive restorations such as Class V, resin-retained bridges, etc. So what is the cost of one adhesive restoration failure, for example, of the restoration shown in Figures 1 and 2? First, there is an emergency attendance (10 minutes, perhaps?), possibly with a disgruntled patient for whom you need to embark on a charm offensive, and then a further appointment (30 minutes perhaps – depending on the size and complexity of the restoration) to replace the lost restoration. Readers can work out the cost according to their hourly rate, but I would suggest that the minimum is £75–£150!

Figure 1. Class V abrasion/erosion cavities in UL1, UR1 in a patient with tooth wear whose central incisor teeth have already received extensive composite incisal build-ups.
Figure 2. Cavities in Figure 1 restored using Filtek Supreme XT Flow (A3), bonded with Scotchbond 1 (3M ESPE). Immediate post-op.

So, how does the clinician avoid such expense? The following tips may be of value for effective bonding:

  • Use a material from a reputable manufacturer, with an evidence base from clinical studies. In this regard, at a recent ‘Battle of the Bonds’ session, a group of Masters students (in Advanced General Dental Practice) at the University of Birmingham carried out their own hands-on bonding test. Three of the four specimens using an own-label bonding agent had fallen apart before they reached the testing machine! Clinicians using this material will have negated any saving in the cost of the material by having to replace a high proportion of adhesive restorations which will debond.
  • Follow the instructions (especially with regard to how wet or dry the surface should be)!
  • Light cure effectively (check your light's output regularly).
  • Use a material with optimized handling. Technique wise, a one bottle bond should provide a reduced risk of error.
  • Selectively etch the enamel margins.

    • The next two Technique Tips will feature ‘The cost of one post-op sensitivity’ and ‘The cost of one defective posterior composite contact point’.