How can the longevity of restorations with adhesive pooling be improved?

Improving Longevity of Restorations with Adhesive Pooling

To improve the longevity of restorations with adhesive pooling, proper surface preparation with sandblasting using 50-μm Al2O3 and careful selection of resin cement are crucial for achieving high and durable adhesive retention. 1

Understanding Adhesive Pooling and Its Impact

Adhesive pooling occurs when excess bonding agent accumulates in certain areas of the restoration, particularly at margins or internal angles. This can affect:

• Bond strength and integrity of the restoration 2
• Marginal adaptation and potential for microleakage 2
• Overall clinical performance and longevity of the restoration 3

Key Strategies to Improve Longevity

1. Surface Preparation Techniques

• Sandblasting with 50-μm Al2O3 is recommended for titanium base abutments to achieve optimal adhesive retention 1
• Ensure surfaces are completely dry before applying adhesive, as moisture will prevent proper adhesion 4
• De-epithelialize the area to create a clean and compact base for the adhesive to adhere properly 4

2. Material Selection

• Select high-strength materials like monolithic or micro-veneered restorations utilizing high-strength zirconia for improved durability 1
• Choose appropriate resin cement, as this plays a crucial role in the clinical success of restorations, particularly those using the titanium-base abutment concept 1
• For ceramic framework materials, design is paramount - use unveneered shoulders and maximize connector areas by reducing embrasure size 1

3. Application Techniques

• Apply the least amount of adhesive necessary to avoid excess material that could cause pooling and subsequent complications 4
• Use appropriate application tools such as a 30-gauge needle or micropipette for precise control 4
• Consider one-step self-etch adhesive systems, which have shown higher tensile bond strength even in contaminated conditions compared to two-step systems 5

4. Preventing Complications

• Implement meticulous occlusal analysis and planning, especially for cantilever restorations 1
• For cantilever units, ensure contact only in maximum intercuspal position on flat surfaces, not oblique surfaces 1
• Keep cantilever units out of contact in all excursive positions to reduce mechanical stress 1

Clinical Considerations for Different Restoration Types

Implant-Supported Restorations

• For titanium-base abutment concepts, the bonding stability between titanium base and ceramic components is critical for success 1
• Consider monolithic designs that can be milled and adhesively cemented to titanium base abutments extra-orally 1
• Be aware that implant-supported cantilever fixed dental prostheses show higher incidence of prosthetic complications (risk ratio 2.56, p=0.008) 1

Adhesive Restorations for Tooth Wear

• Full-mouth rehabilitations using adhesive restorations have shown 90.1% survival rate over 60 months 6
• Anterior restorations show fewer complications than posterior restorations in cases of severe tooth wear 6
• Proper adhesive application is crucial for preventing marginal microleakage and postoperative sensitivity 6, 2

Common Pitfalls and How to Avoid Them

• Avoid excessive adhesive application which leads to pooling and compromised marginal integrity 2
• Prevent salivary contamination during bonding procedures, as it significantly reduces tensile bond strength of two-step adhesive systems 5
• Be aware that no current adhesive system can guarantee hermetically sealed restorations with margins free of discoloration for extended periods 3
• Recognize that adhesive pooling is significantly more likely with certain adhesive systems; proper selection can minimize this issue 2

By implementing these evidence-based strategies, clinicians can significantly improve the longevity and clinical performance of restorations affected by adhesive pooling, leading to better patient outcomes and reduced need for replacement or repair.