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Case Study
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Dentin Adhesion Bonding Methods

Learning Objectives:  

This case study describes various aesthetic adhesive modalities for application in selective, separate, and secure bonding. Upon reviewing this case study, the reader should:
  • Understand the indications of selective and separate bonding procedures
  • Be conscious of bonding techniques for various restorative materials

In recent years, adhesion has become fundamental to restorative dentistry. Minimally invasive restorations,amalgam alternatives, veneers, metal-free crowns, slot fixed partial dentures, and even posts rely on adhesion. Nevertheless, adhesion to the tooth surface is always in opposition to the polymerization shrinkage of the composite material. The negative effects of polymerization shrinkage (eg, marginal gaps or marginal enamel fractures) become particularly pronounced in restorative systems with a large volume of the shrinking composite and a small free surface area.  In such a situation, volume loss caused by polymerization shrinkage of the composite can hardly be compensated for by the flow of the material from the free surface during the gel phase of polymerization.

Free surfaces may be found in instances where the restorative material does not adhere to the tooth (ie, on the outer surface of the restoration), and inside the cavity if no adhesion between the restoration and tooth is present in this area. The ratio between the free and bonded restoration surface is called the configuration factor or the "C-factor." A high C-factor makes it difficult to establish optimal adhesion. Even if this objective can be established initially, a high C-factor leads in these instances to a preloaded restorative system that may be prone to gap formation during loading. It has been demonstrated that total bonding, creating the highest possible C-factor in a given cavity configuration, is not always the most appropriate bonding procedure.

The practitioner should be aware that total bonding is not the only way of working with an adhesive system. According to the clinical situation, the best bonding technique should be selected to achieve the best combination of sealing, marginal adaptation, retention, and handling.

*Professor and chairman, Department of Cariology, Endodontics, and Pediatric Dentistry, University of Geneva, Geneva, Switzerland
**Visiting Professor, Department of Cariology, Endodontics, and Pediatric Dentistry, University of Geneva, Geneva, Switzerland
Related Reading:


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  30. Lutz F, Besek M, Gohring TN, et al. Amalgamersatz - klinisches Potential. Acta Med Dent Helv 2000;5(3):21-30.
  31. Mjor IA, Toffenetti F. Secondary caries: A literature review with case reports. Quint Int 2000;31(3):165-179.
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