We Now Know What We Thought We Knew

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Posted on By Gerald Benjamin In Esthetic Therapy (General)

During the last 10-15 years lecturers have been telling us that the dentinal adhesive bond had a life expectancy of 10 years. Frank Spear and I had disagreements on how long my bonded restorations would last.
Well.....we now KNOW that the adhesive bond will last TWENTY years and perhaps more.

One of my Targis restorations, one of Ivoclars first major material failures, developed a chip and I decided that I should replace it with an Emax onlay. The overwhelming number of Targis restorations started to fail within 6-12 months and the product was removed from the market in about a year. That year was 1997.

I removed the old restorations and not only was the bond completely intact but there was zero leakage under the restoration. I intentionally left a thin layer of Targis material to show that the bond remained firm.

The full crown should ALWAYS be the restoration of last resort and partial coverage should become the dominant restoration. My patient is 60 and my new restoration will probably last the rest of her life: One tooth, One life.

The majority of the Targis onlay removed. No leakage observed indicating that the adhesive bond can and does last 20 years.

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5 Comments

Did you restore it with composite? Do you have final picture? Gregory


Reply

Great stuff....Biomimetic Dentistry....absolutely. More of this gaining thankfully in dentistry. Thanks for sharing. Next time...more images please. regards Maurice


Reply

Hi Gregory; I am in the final 5-7 years of my career..Everyone 60 and older will have final emax restorations, preferably partial coverage... I will post the final when I bond it to place. Hi Maurice; I have been practicing Biomimetic restorative dentistry for a quarter of a century and before it was called that. I rarely crown a vital tooth unless it is in a full mouth rehab case and then my patient is usually in their 60s.. I use composite for patients 20-60 and Emax for 60 plus (for extensive restorations.) To paraphrase my friend...One tooth, One Life...lol I did not photograph the original chip on the Targis restoration because I was not aware of the significance of the situation until I removed all of the existing onlay...Then I realized that I had a game changer Regards, gerald


Reply

Gerald, I agree with you 100% because I have had the same extended life expectancy myself. However, I feel the main reason why so many dentists debate the concept of conservative preparations, well bonded restorations and a more conservative approach to their patients' oral care problems is that cutting down a tooth for a full crown is so much easier. And another thought...motivation for more aggressive restorative dentistry may well be funded by insurance coverage as one dentist told me he only does full crowns because he benefits much more from insurance payments. So I think it is time for insurance companies to realize that well done conservative dentistry pays off in both short and long term by saving tooth enamel and resulting in less endodontic eventual treatment.


Reply

Dr. Goldstein;
YOU wrote the book,literally and figuratively. I just bought it, read it and followed it.

With the exception of implant dentistry, many of the other areas of dentistry are in decline for the same reasons that you mention.

I thank you for your mentorship. See you in Florida
Regards,
gerald


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