To Bond or Not to Bond

Ever since enamel etching was introduced in the 1950's, the science of adhesive dentistry has been constantly evolving and revolutionizing the practice of dentistry. Adhesion has facilitated the development of countless functional and esthetic treatment options that were never possible with conventional cementation. Because adhesion doesn't require the retention and resistance forms necessitated by cementation, it enables dentists to conserve more tooth structure, prolonging the lives of their patients' teeth. Indeed, advances in adhesion have been significant forces behind the profession's shift to minimally invasive treatment. Unfortunately, with great advances comes great complexity, and delivering the strongest, most long-lasting bonds requires staying up to date on the latest research regarding materials and techniques. To help our readers improve their understanding, Inside Dentistry's March 2024 special issue on adhesion presents the insights of several experts on different elements of adhesive dentistry, a CE article on reliably bonding zirconia, information about the latest adhesives and cements, and more.

I use a variety of adhesives to place different types of restorations in my practice, but I think that it's important to note that as fantastic as adhesion is, there is still a place for cementation. In being conservative, we don't want to be overpreparing teeth to create retention, but in some situations where we can develop it with minimal preparation, it can be more conservative to conventionally cement when one considers what it takes to remove an adhesively placed restoration. For example, when I'm delivering a zirconia crown, if I have a short clinical crown, I'll bond it. But if I have the retention, I'll place it with a resin-modified glass ionomer cement. With that approach, if retreatment is ever required, I can remove the crown by sectioning it and popping it off instead of having to grind off every bit of it, which could result in further loss of tooth structure. In addition, the need for isolation and other requirements of adhesion increase technique sensitivity, and I want to simplify, so if I don't need the added strength of bonding, I cement. Believe me, if I was seeing failures, I'd change my approach. We want to be selecting the most appropriate tools for each procedure, not necessarily the most advanced!

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor
Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com