Ever Seen a Stained Composite Restoration?

I think the answer is yes, for just about all of us? Keep that picture in mind. Think of the adjacent enamel, good condition. Recall the appearance of the bulk of the composite, generally, also in good condition. So what's the problem? The image I am trying to have you conjure up is the problem that I would like to address, that of marginal staining and leakage of a composite restoration. The problem starts at the margin. The interface between the tooth, in this case, primarily etched enamel, and the composite. Ooops, I almost forgot my point

The material that is in between the tooth and the composite that brought all this upon us was the bonding agent. Yes, bonding agents leak! We are all now familiar with water trees, the fluid transfer between the layers of: dentin, bonding agent and the composite within a restoration. Where does this also occur, but in this case, ultimately causes us to replace the restoration, at the exposed margins! See our studies on bonding agent leakage vs. self adhesive materials, posted on our website, and shown below.

It is amazing to me that some leading clinicians identify this as the number one leading cause of replacing existing composite restorations, while others deny that this even occurs.

So what's the point? Keep the bonding agents, if at all possible, away from the margins and avoid pooling of the bonding agent. And the suggestion, where possible use a self adhesive material, such as Aura Veneer Cement or Aura VLC Cement either with or with out a bonding agent, but please keep the bonding agent away from the margins, they leak, like crazy!!

What do you think? Thanks for your input. Let's keep it going. All the best, Jan

The above study compared the leakage of different materials such as bonding agent with composite, glass ionomers, and self adhesive materials without bonding agents. Four groups of seven teeth each were evaluated. Shown above is a synopsis of the results. Call for further details of the study design and results.