Bonding with Your Dental Clientele
Solidifying your relationships with adhesion
Executive Editor Daniel Alter, MSc, MDT, CDT | dalter@aegiscomm.com
The world of the dental laboratory professional continues to evolve with regard to the level of knowledge and expertise, particularly as treatment protocols become further sophisticated—all in an effort to achieve the best possible outcomes for our patients. As restorative materials evolve and new indications are presented, it is the dental laboratory that is presented with the opportunity to engage its dentist clientele, new and existing, from a level of knowledge, experience, and know-how to truly consult them and together attain the most optimal clinical outcomes.
Never has it been more imperative to understand cement and resin bonding protocols, and the materials with which they function and perform best. Dental cement is "a type of material that can be used for different dental purposes," Dr. Paulo Pinho writes in a Dental Implants Professionals blog. "Some are temporary, while others are permanent."1Commonly used cements have indications and bonding characteristics that do the intended job of adhesion with specific restorative materials. Having a complete understanding will provide the laboratory with a unique competitive advantage, and a relationship- and loyalty-building function with the laboratory's clientele. Modern restorative laboratory procedures further demand the need to bond multiple dissimilar restorative materials in order to create a comprehensive solution, such as is the case for implant-supported prosthetics. Five types of cement are used for the dental purpose: zinc-oxide eugenol, polycarboxylate, zinc phosphate, glass ionomer, and composite resin,1 and a keen understanding is paramount.
Much emphasis, as of late, has been on glass ionomers and composite resins, for their characteristics when bonding to all-ceramic restorations, lithium (di)silicates, and zirconia. Glass ionomers are composed of maleic acid, itaconic acid, tartaric acid, and water, and are used for cementing metal restorations and to line or bond dentin in all-ceramic restorations.1 Composite resins are very flexible when used as a dental cement due to their low film thickness and insolubility in water, which is supported for permanent cementation. They can be used as permanent cement to fix dental restorations—particularly veneers, crowns, and bridges—into the mouth or implant fixtures.1
There are cements indicated for metal bonding, glass bonding, and zirconia bonding in a single- and dual-stage process. Some are self-adhesive, while others are light-cured or a combination of both. An article by Spear Faculty member Robert Winter, DDS, illustrates the use of a bonding technique that works well for cementing zirconia restoration with MDP or functional methacrylate containing primer/adhesive followed with resin cement—dual or auto-polymerizing.2 The article claims from their research that using a precise clinical technique is essential to establishing the best bond, and further shows that human error is the most common reason for clinical failures.2
There are multi-use bonding cements that can be used across multiple restorative materials, but the better informed a laboratory owner or manager can be as to the specifics and workability of each, the more valuable the laboratory is positioned in the ecosystem within the restorative dental team.
It is my great honor and pleasure to elevate and inspire with knowledge.
References
1. Pinho P. Dental Cement - Types, Functions, Features & Benefits. Dental Implants Professionals website. https://www.dentalimplantscost.com.au/blog/dental-cement-types-functions-features-benefits. Published April 17, 2017. Accessed May 5, 2021.
2. Winter R. Bonding to Zirconia: Is It Possible? Spear Review. https://www.speareducation.com/spear-review/2018/11/bonding-to-zirconia-is-it-possible. Published November 18, 2018. Accessed May 5, 2021.
