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Metal-resin Bonding
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Question #1: Which metal–bonding system is best for bonding conservative Type IV gold restorations?

Answer: A common concern with Type IV gold restorations is the ability to make internal adjustments. With tin plating and adhesive cements the dentist can replace the internal coating after all internal adjustments have been made. The most popular cement in our study groups is Panavia™ 21 TC (Kuraray) for partial gold units and Panavia Opaque for bonded bridges. Compolute and Cojet (ESPE) are new a easier to use. Cojet is a impact bonded coating used by sandblasting the restoration with it. The surface it them silinated. Compolute is a dual cured composite in a capsule which is mixed in a titurator. Espe makes a Rotomix tituator that centifuges the capsule after mixing it to reduce voids.

Question #2: I have had a number of failures "gluing" my bonded bridges with an adhesive cement. What am I doing wrong?

Answer: Regardless of which adhesive is used, resistance form, grooves and box forms are essential to limit stresses and adhesive peeling during normal occlusal function. The limits of composite resins make it unlikely that metal adhesives will be successful without mechanical resistance form.

Question #3: What are the most common clinical indications for metal–resin bonding compared to using conventional crown and bridge cements.

Answer: The primary indication for metal–resin bonding is the need for increased retention, as in conservative partial coverage restorations and teeth with short clinical crowns. It allows for more conservative tooth preparations.
Conventional cements (e.g. glass ionomers) are the luting agents of choice when retention is not the primary concern. They have the advantages of built–in adhesion (no bonding agents required), caries inhibition, pulpal kindness, ease of use, and long–term clinical success.

Question #4: Should I be bonding all my amalgams?

Answer: Not yet. Although laboratory studies are promising, and there are clinicians who strongly feel all amalgams should be bonded, we need long–term clinical studies comparing the clinical performance of conventionally placed and bonded amalgams in similar arches.e
At this time amalgam bonding is recommended for restorations where retention is a primary concern, such as build-ups and large cusp replacement restorations.
Many clinicians feel that done properly, bonded amalgam should last at least as long as amalgams placed with copal varnish since the resin interface would be less soluble. Clinical testing will need to verify this.

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