Avoiding the pitfalls in composite bonding
Composite bonding can be a highly effective way to perform minor cosmetic adjustments such as repairing, reshaping or recolouring teeth. Thin layers of adhesive resin material are attached to the tooth and sculpted to achieve the desired shape and appearance.
The technique is popular with patients as it is a less invasive, more affordable alternative to veneers that can provide a natural-looking improvement to the appearance of their smile. The fact that the procedure can often be done in one appointment also makes it ideal for busy patients.
A major advantage of composite bonding is that repair is usually straightforward. This contrasts with ceramic veneers and crowns, which can be difficult or impossible to repair.
When used appropriately, cosmetic bonding can have excellent aesthetic outcomes, but it has some limitations and disadvantages, which could be the cause of complaints. Dentists should be aware of the following pitfalls and how to avoid them.
Inadequately informed patients
Careful patient assessment and honest discussion about the treatment options is essential to obtain valid patient consent before composite bonding. Complaints and litigation are more likely if the patient does not understand and accept the limitations and possible adverse effects prior to the procedure.
A dentist should assess the patient, carefully examining the teeth and gums to determine whether composite bonding is suitable. They should also explore whether the patient has psychological issues or unrealistic expectations about cosmetic dentistry. Such issues could make a subsequent complaint more likely, so extra care is warranted.
Patients should be fully informed of the pros and cons of different treatment options and advised on the most appropriate procedure to achieve the desired result. The cost of treatment should be explained, including the long-term costs of maintenance and replacement. They should be forewarned about the need to avoid chipping or staining the composite material to prolong its life.
Inappropriate treatment
Cosmetic bonding is not suitable for everyone. It is less durable and stain-resistant than porcelain veneers and crowns and may be inappropriate for some patients. For those with heavily-restored teeth, bruxism, extreme discolouration or extensive damage to teeth, other treatments may be preferable.
Patients with periodontal disease and caries will require treatment before composite bonding. Others may first need to undergo orthodontic procedures.
Patients should also be advised that tooth whitening is best done before composite bonding since it will only alter the colour of natural teeth and not the composite material. Following whitening, it is advisable to wait several weeks before applying composite bonding, to ensure a stable bond is achieved.
Failed composite bond
Being less durable than porcelain restorations, the composite material may occasionally fall off or become damaged. Dentists can help to create a robust bond and avoid premature failure by:
- Isolating the tooth with a rubber dam to prevent interference by moisture
- Preparing the tooth correctly before applying the composite
- Carefully choosing the composite
- Following the directions for use to achieve the required quality and depth of resin
- Using material systems with high-quality products from reputable manufacturers
- Polishing to create a smooth surface.
Patients should be advised about the need for ongoing maintenance and asked to return for a review of the bonding if they feel any sharp edges or a change in bite.
Suboptimal appearance
If the composite material does not match the patient’s natural teeth in shade or opacity, or if it is not shaped correctly, the aesthetic outcome may be poor. Training is necessary to help dentists develop skills in choosing, applying and sculpting the layers of composite bonding.
Sensitivity
Composite bonding is generally well-tolerated, and any sensitivity should be short-lived. However, patients should be advised to contact the dentist if any sensitivity continues.
Staining
Composite bonding is susceptible to staining by tobacco, foods and drinks, especially tea, coffee, and red wine. The patient should be informed about this risk prior to treatment and advised about the durability of the restoration based on their habits. They should also receive advice on good aftercare, including brushing, flossing, and avoiding foods and drinks that could stain. The dentist can also help to prevent staining by polishing the bonding to form a very smooth surface.
Inadequate documentation
As always, accurate records should be made of the assessment, planning and treatment processes. In the event of a subsequent claim, these may be useful as medico-legal evidence to support the dentist’s case. Keeping photographic records pre- and post-bonding is also important as objective evidence.
Diagnostic wax-ups may form a useful part of treatment planning and would also be valuable evidence if a claim was made. They can be used to plan and guide placement of the composite and to show the patient the expected outcome. Providing this additional clarity about the extent of treatment may help to achieve patient satisfaction and avoid complaints.
If you have received a complaint or experienced any incident related to composite bonding, please contact Dental Defence Society for expert advice as soon as possible.
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