Bonding: An Everyday Practice in Dentistry

Authored By: Lesley Ranft

Reviewed By: Brian Quesnell, DDS

In dentistry, “bonding” describes the linking of dental material to a natural tooth. Today, virtually every dental procedure involves some form of bonding. In particular, many of today’s dentists have an affinity for using the bonding process to correct a defect and make a tooth glimmer.

Bonding can be painless and non-invasive. It is accomplished in one visit to the dentist — no mold-taking, no “temporary,” no lab-fabrication. Bonding can also serve as a solution for chips, gaps between the teeth, staining, splotches from wearing braces, crookedness or even misshapen teeth. Plus, it’s relatively inexpensive.

Bonding Types

Bonding for Linking One Surface to Another: The bonding process may be used to attach a “white colored” composite filling or silver amalgam filling to a natural tooth. Bonding can also be used to secure crowns as an alternative to the traditional cementing process.

Direct Bonding: Bonding has recently grown in popularity as a solution for the repair of a cracked, decayed, chipped or otherwise cosmetically unattractive tooth. With the direct bonding technique, the bonding resin material is painted on the natural tooth to fill, cover and protect the flawed area.

Bonding Options

Cracked, decayed, chipped or otherwise unattractive teeth can be repaired through several types of procedures, including direct bonding, dental veneers or dental crowns. Your dentist will evaluate the extent of your cosmetic and/or functional defect in order to determine the appropriate treatment plan for your tooth.

Direct Bonding for Minimal Flaws: Direct bonding may be the right choice for a minimally damaged tooth, particularly for a front tooth. While certain adults may be candidates for direct bonding, the process is the optimal restorative option for children under the age of 18. Also, your dentist may recommend a direct bonded veneer if you are including a smile makeover in your treatment plan.

Bonding for Significant Damage: Veneers may be recommended as part of a treatment for more significant adult imperfections and may be included as part of a smile makeover or cosmetic dentistry treatment plan. A porcelain veneer may serve as the material choice for bonding in a smile makeover case.

Bonding for Large Imperfections: In cases where a defect cannot be repaired adequately with a veneer or through direct bonding, your dentist may recommend a dental crown. A crown can be attached to the tooth through the bonding or cementing process.

The Bonding Process

During the bonding process, the damaged tooth is isolated. Tooth isolation is critical to the success of bonding techniques because it prevents moisture from interfering with the process.

Following tooth isolation, a gentle phosphoric acid (this does not produce discomfort) is applied to the natural tooth surface. This "acid etching" of the tooth surface enhances the bonding strength of the resin. After 15 seconds, the phosphoric acid is removed and a liquid bonding resin is applied. A putty-like composite resin is placed in stages on the natural surface of the tooth, where it is shaped and cured into place with a blue light. The process is repeated in layers until the resin has achieved its final shape and form.

The bonding process is sensitive to each dentist’s technique, so your dentist must follow the steps diligently and produce an appropriate finish to ensure that the bonded resin does not fall off or cause tooth sensitivity. It is not uncommon for a bonded tooth to feel sensitive after treatment. This minor sensitivity is often short-lived; however, if sensitivity persists, it is recommended that you schedule a follow-up appointment with your dentist. Usually, the bonding process is not associated with complications.

Selecting the Right Dentist for Bonding

For the best results, it is important that you locate a dentist who is adept at performing the restoration. Not all dentists are skilled in the bonding process. Those considering bonding as a restorative treatment must factor into their decision the dentist’s level of skill. Post-graduate education is a critical factor for all dentists who wish to refine their bonding skills.

If a tooth is inadequately bonded, bacteria or debris can invade the restoration and further damage the tooth. If you experience tooth sensitivity or leaking following a bonding procedure, it is important to see your dentist as soon as possible. A poorly bonded restoration can foster the development of a potentially deep or rapidly progressing, recurrent cavity — the kind that is difficult to treat.

Bonding Costs

The cost of bonding depends on a variety of factors, including:

• The dentist performing the procedure.
• The location where it is performed.
• The type of dental insurance you have.
• The type of restoration the bonding process is associated with. For example, dental insurance may pay for a portion of bonding associated with a dental filling but not for bonding associated with veneers.

Dentists with advanced bonding training may charge more for performing the procedure. For some people, the benefit of using a dentist with great technique justifies the extra costs associated with selecting a highly trained professional.

The supplementary costs associated with the bonding process may depend on whether additional equipment is used or additional time required (in some procedures, up to 50% more time is needed).

Additional Cost Considerations

In the treatment of larger defects, direct bonded veneers using composite resin are usually less expensive than direct bonded veneers using porcelain. Be aware, though, that it takes more time for the dentist to perform the procedure using direct bonding without porcelain.

Since tooth staining continues over time, the results of the direct bonding process are generally expected to last approximately five years. The porcelain approach carries an associated laboratory charge, leading some to conclude that it is a more costly process — but the porcelain approach usually lasts many more years. So, over time there may not be a considerable financial difference between a direct bonded veneer using porcelain and a direct bonded veneer without porcelain.

[Updated July 2008]

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