Examples of Direct Bonding
Direct Bonding
The two images to the
left above are an example of "direct" dental
bonding done at our office. These restorations are
known as veneers. In order to accomplish this form
of "instant orthodontics", tooth colored
composite filling material was "bonded"
to the front surfaces of the natural teeth and then
carved using a handpiece (high speed drill), and slow
speed polishing instruments to sculpt more esthetic
(pleasant appearing) teeth in a better position.
Direct veneers are very
thin coats of filling material placed on teeth, which
are sometimes altered (prepared) beforehand, and sometimes
not. The above teeth were not prepared, and the veneers
were placed without giving shots. The image on the
right is the completed case finished with a "Flipper"
which is the least expensive way to replace missing
teeth. If the patient had chosen a more expensive
flexible partial denture instead, the clasp would
not have been so visible. This is a fairly inexpensive
way to take a bad situation and turn it around.
Below are before and
after images of 2 less complex cases of "instant
orthodontics" through direct bonding. In these
cases composite filling material was applied to three
teeth (the two central incisors and the lateral incisor
to the right in both cases). The top case was done
about eight years ago and looks essentially the same
today as when the veneers were first applied. The
bottom case was done in the summer of 2001. The lower
case demonstrates the difficulty in placing wide veneers
on short teeth since the finished result shows teeth
which are a bit wide and somewhat blocky. In spite
of this, the patient was pleased to be rid of her
spaces.
The term "bonding"
is a misnomer. It applies to a process, and
not the product. Bonding is the process of
applying a dilute acid to the enamel of a tooth to
produce a frosted surface which looks microscopically
like a series of mountains and valleys. This microscopic
roughness is then filled with a liquid plastic which,
when hardened, mechanically adheres onto the surface
of the tooth and allows the further bonding of a glass
filled composite filling material. (See my page on
dental materials for more than you probably want to
know about the technical aspects of bonding fillings
to teeth.) This composite can be shaped into the form
of a tooth, as I have done in the example above. Direct
bonding is an artistic endeavor on the part of the
dentist. No laboratory is involved in the
production of the final product. The two images to
the right show the replacement of old composite fillings
with new ones. Even though this type of work is bonded,
they still are billed as simple fillings and are paid
for by most dental insurance companies while the bonded
veneers shown above are considered cosmetic and are
generally not covered by insurance.
The images below show
how a filling may be bonded inside a tooth. Bonding
a filling (even a silver filling can be bonded) tends
to make it waterproof. It also prevents the filling
from being dislodged in cases where an unbonded filling
might not stay in place. Once again, this is an example
of direct dental bonding. To see the complex history
of this tooth, click on the image on the right below.
Composite filling materials
are actually quite complex, and there are quite a
few different kinds. For a better understanding of
the chemical and physical makeup of composites, as
well as a technical explanation of the different types.
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