Postbonding

There are two benefits claimed for post-bonding; a reduction in wear rates and
improved marginal sealing.

Wear reduction
The method first became popular as a technique to reduce wear. In a study
with a conventional composite, occlusal adjustment created a large number of
small cracks. This damaged surface was susceptible to high wear, which could
be eliminated by applying a "surface penetrating sealant" to smooth the
surface and fill the cracks at the filler/matrix interface. Naturally, the reduction
in surface wear was apparent only during the initial months of service, after
which the wear rates of the composite with or without surface sealant reached
equilibrium.
The amount of damage depends on the finishing instrument and the size of
the filler particles, more microcracking occurs if the material contains larger
filler particles such as the material tested at that time. Modern fine particle
hybrid composites benefit very little from surface sealants in relation to wear.
(This was shown in an unpublished study.)

Improvement of marginal adaptation

Marginal gaps or irregularities can also be infiltrated in the same manner, and
with the composite resins in use today this is certainly the more important
reason.

Application Techniques
There are two application techniques for post-bonding. The primary goal of both
techniques is the infiltration of gaps or small enamel fractures which have been
caused by the shrinkage.
Technique 1: Post-bonding after finishing, re-etching technique.
After completion of occlusal adjustment and removal of marginal excess, etching gel
is applied to the surface of the composite and the margins, rinsed and dried. The
unfilled resin (which should not a dentin bonding agent containing a solvent) is
applied, blown to a thin layer, and polymerized.
Technique 2: Post-bonding after polymerization
Here, the post-bonding resin is applied after completion of the final polymerization,
but while maintaining isolation. Gross excess can be removed without water spray
prior to applying the bonding agent, but no etching or rinsing is performed.
Perhaps at this point we should consider which problems we want to solve. It is
frequently claimed that post-bonding can eliminate the problem of white lines at the
margins, so what causes these?

White Lines
There are a number of potential causes for white lines at the margins, which can be
gaps, discontinuous voids, or microfractures in the tooth substance or the restorative
material. White lines at placement frequently become black lines later, so it is
certainly preferable to correct them immediately.
In general, white opacity is created by differences in the refractive index. Everyone
has noticed the bleaching effect when teeth are dried, this is the effect of replacing
the water with air. One can see the same effect when a light curing composite is
spatulated, the incorporated air lightens the shade.
For reference, the clinically relevent refractive indices are approximately:
enamel = 1.7; water = 1.4; air = 1.0; and composites are in the range of 1.5 -1.6.
White lines are therefore most visible when the tooth is dry, since the difference in
refractive index between air and enamel is larger than the difference between water
and enamel.
Briefly, we can summarize the potential causes:
Preparation Instruments. Diamonds with a grit size over about 60 m lead to
marginal enamel fractures and "derangement" of prism boundaries - small
discontinuous internal cracks parallel with the prisms (Xu). Margins should be
finished with 15-40 m diamond burs. Finer diamond grits cause fewer fractures, but
cut more slowly: 25 m diamonds combine minimal fracturing with reasonable
efficiency.
Carbide burs can produce good results if they are new, and they must also be used
with minimal pressure. Carbide burs become very traumatic when dull, and should
probably be used for only one or two teeth before discarding.
Preparation Angles. Undercut prisms frequently fracture during shrinkage of the
composite resin. We want to avoid unnecessary overextension of our preparations,
but must avoid undermining prisms. (A separate paper is available on request
concerning prism orientation.)
Contamination of a shrinkage gap with blood or saliva
severity of white lines, provided that the resin can infiltrate the defects. I post-bond
practically every medium to large direct restoration prior to contamination (Class 2s
prior to removing the matrix). One doesn't really need to buy a special product, any
unfilled, solvent-free resin will work but not typical adhesives.
If you have gaps or small enamel fractures, it seems sensible to fill them
immediately. Once you have contaminated them with water or saliva, it is nearly
impossible to to rinse anything back out of these small gaps. If you hold two glass
microscope slides together and put etching gel or a dye between them, then try to
rinse it back out, you will see what I mean.

These defects may have significant depth, and are probably nearly impossible to
clean thoroughly if penetrated by blood, saliva, or water.

A disadvantage common to both techniques is the polymerization kinetics. If we

assume that perhaps ten minutes has been required for placement, the shrinkage of
the composite is approximately 90% complete, and the composite will continue to
shrink during the subsequent hours.
Post-bonding may therefore seal a marginal gap, but the gap may reopen. Naturally,
this will depend on the cavity size, the compliance of the tooth and restoration, and
the level of initial cure.

Incorrect preparation angles

"Bonding to enamel" is primarily preparation technique. A preparation parallel to the
prisms at the margin will lead to gaps, any preparation angle leaving unsupported
enamel prisms at the margins generally will frequently create a white line. Prisms are
NOT at 90 to the surface, but you need to know the prism direction in order to
prepare correctly.
There are all sorts of recommendations for the divergence of inlay preparations, pro
and contra opinions on bevels, etc. I prefer to talk about preparation angles rather
than bevels, because we need the correct angle to get across the prisms to get an
etch pattern to get a stable bond. White lines are observed primarily at occlusal
margins, but also at axial walls of proximal boxes in Class 2 restorations.
Occlusal Margins: On occlusal surfaces the enamel prisms intersect the cusp slope
at 60 to 65 (Uribe). There is no magic angle for inlay preparations because it
depends on the cusp slope: the restorative material should ideally form a 45 angle
(Note that this is not a 45 bevel from the long axis of the tooth, but rather 45 from
the cusp slope). For maxillary premolars with steep cusps, an inlay preparation with a
divergence of 6 may be ideal; but the same angles for a lower molar totally wrong. If
the restorative material margin forms an angle over 60 you have unsupported
prisms that fracture parallel with the margin. The result is frequently a white line.
Axial Margins: The simplest approximation of the prism orientation for axial margins
is based on the ideas of Alan Boyd. From the occlusal view, think of radial lines from
the center of the tooth. Your axial preparation angle should always cross these lines
toward the outside; i.e. toward buccal or lingual. While not quite as accurate as the
radial lines, another simple clinical guideline can be used: the remaining enamel
should never form an angle of less than 90 when viewed from the occlusal (Opdam).
The development of the SonicSYS with KaVo was based on these considerations along with some other factors. These instruments offer practically the only method to
prepare the ideal axial margins for conservative Class 2's.

Application technique and materials

With the almost hypnotic emphasis on dentin bonding, enamel has practically been
forgotten. Thick layers of the hydrophilic bonding agents on enamel can compromise
your marginal stability. With the relatively poor strength development of these
materials, the shrinkage stress of the subsequently applied restorative composite can
cohesively fracture the bonding layer.
The best solution is to keep your bonding agents thin, then control shrinkage stress
with your application technique (Unterbrink).
Direct restorations cusp deformation. indirect restorations
Finishing and Polishing
There is always a static intrinsic stress at the margin, and trauma during finishing can
lead to stress release with microfractures. We want to use the most "atraumatic"
finishing technique possible. The often repeated recommendation to finish from
restorative toward the tooth is probably correct, but not that important. If we ignore
dull and/or eccentric burs and bad handpieces, the biggest problem is pressure. One
major advantage of discs, at least where you can use them, is that the pressure is
limited automatically by the flexure. Otherwise, the best we can do is use as light a
touch as possible. I use discs where I can, 15-25 m diamonds for other margins,
the KaVo EVA reciprocal handpiece where access is limited, and then go to silicone
rubber tips or polishing pastes.
Conclusion
If I had to "prioritize" the reasons for white lines, I would put incorrect preparation
angles at the top of the list. Preparation techniques with the right instruments and
correct marginal angles, controlling the shrinkage stress, minimizing finishing trauma
at the margins, and post-bonding larger restorations are the keys to avoiding this
problem.
If the white line has resulted from enamel fractures during preparation, one can try to
postbond with a reetching technique, but the white line will probably not disappear.
(One could reprepare the margin with a small round finishing diamond, then etch and
rebond, but must consider the advantages and disadvantages.
If the line is a gap due to shrinkage stress, postbonding can be done . In many such
cases this is a result of intentional compromises during the preparation technique.
Since the composite restoration at this stage will still shrink further, postbonding will
probably at best reduce gap formation.

Basically, no matter how careful we are, there are many little things that can go
wrong; in particular at occlusal margins. Post-bonding can eliminate or reduce the
negative consequences.

Dr. Gary Unterbrink

Xu HH, Kelly JR, Jahanmir S, Thompson VP, Rekow ED. Enamel Subsurface
Damage Due to Tooth Preparation with Diamonds. J Dent Res 1997; 76(10):16981706
Uribe Echevarria J, Priotto Elba G, de Uribe Echevarria N. Angulacion de las
vertientes cuspideas internas en relacion con las estructura adamantina y los
tallados cavitarios para amalgama. Avances en Odontoestomatologia 1988; 4(4):
200-208
Boyd A. Anatomical considerations relating to tooth preparation. In: International
Symposium on Posterior Composite Resin Dental Restorative Materials. Vanherle G,
Smith DC eds. Utrecht. Peter Sculc Publishing Co. 1985: 377-403
Opdam N, Roeters J, Kuijs R, Burgersdijk R. Necessity of bevels for box only Class II
composite restorations. J Prosthet Dent 1998:80(3):274-279
Unterbrink GL, Liebenberg WH. Flowable composites as "filled adhesives", literature
review and clinical recommendations. Quintessence Int 1999;30:249-257

In dentin, course and fine give same margin quality

Carbides cause fractures like rough diamonds

Increased pressure does not improve efficiency of finishing

diamonds
Course and supercourse almost equally efficient

Adhesive prep less invasive than conventional

Never rub etched enamel

Always prepare surface whether etched or self-etch