What is the recommended bonding agent for a healthy adult patient presenting to the emergency department (ED) with an intact veneer that has fallen off?

Emergency Department Management of Dislodged Veneer

Emergency departments should not attempt to re-cement dental veneers, as this is not an appropriate ED procedure; instead, patients should be referred immediately to a dentist with the veneer stored in milk or saline, as ED physicians lack the specialized equipment, materials, and training required for proper veneer bonding.

Why EDs Should Not Re-Cement Veneers

Lack of Appropriate Resources and Training

• Emergency departments are not equipped with the specialized dental bonding materials, curing lights, or surface preparation equipment necessary for proper veneer cementation 1.
• Emergency physicians do not receive training in dental bonding procedures, which require precise technique including proper tooth surface preparation, adhesive application, and light-curing protocols 2, 3.
• The cementation of ceramic veneers is a "time-consuming and technique-sensitive procedure critical to long-term success" that requires specialized dental expertise 4.

Technical Complexity of Veneer Bonding

• Successful veneer bonding requires multiple steps including tooth surface conditioning, application of specific adhesive systems (etch-and-rinse or self-etch), proper handling of the ceramic surface, and controlled light-curing 2, 3.
• Modern dental adhesives are classified into complex systems (etch-and-rinse, self-etch, or multi-mode) that require specific clinical protocols and understanding of their interaction with enamel and dentin 3.
• The bonding procedure differs significantly depending on whether the veneer preparation extends into dentin versus remaining entirely in enamel, requiring clinical judgment beyond ED scope 4.

Appropriate ED Management Protocol

Immediate Assessment

• Verify that this is truly a non-urgent dental issue without associated trauma, infection, or airway compromise 1.
• Examine for any underlying dental trauma, fractures of the underlying tooth structure, or soft tissue injury that would require more urgent intervention 1.

Veneer Storage Instructions

• Instruct the patient to store the intact veneer in cold milk or saline solution to preserve it until dental evaluation 5.
• Handle the veneer carefully by the edges only, avoiding touching the bonding surface 5.
• Never store in tap water, as this can damage bonding surfaces 5.

Referral Strategy

• Provide immediate referral to a dentist, ideally within 24 hours, as the likelihood of successful re-cementation decreases with time 5.
• When ED resources are limited and alternative options for non-emergency dental care are readily available, referral away from the ED is acceptable for this non-urgent condition 1.
• Document that the patient was counseled about the need for urgent dental follow-up and provided with appropriate referral information 1.

Critical Pitfalls to Avoid

• Do not attempt to use medical adhesives or tissue glues (such as cyanoacrylate used for laceration repair) for veneer bonding, as these are completely inappropriate for dental applications 1.
• Do not delay referral to search for bonding materials in the ED, as proper veneer cementation requires specialized dental materials not stocked in emergency departments 5.
• Avoid dismissing the patient without clear instructions for veneer storage and urgent dental follow-up, as improper handling can compromise future bonding success 5.