What is Tooth Bonding?

My nine-year-old son broke off a tooth in a motorcycle accident. It was his permanent top front tooth. It broke a good size diagonal piece off it. Our dentist bonded (I think that's the correct term) some composite onto his tooth to make the shape and size of his original tooth. The only problem was that it did not last but four months until it broke off again and has had to be repeated. Is it not possible to get a temporary cap for this tooth? It would seem that it would last longer than a few months and would look a lot more natural.

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You should consult with your dentist regarding this. A radiograph will reveal the development of the nerve tissue in the affected tooth. Typically in children, the nerve is still very large, thereby contraindicating major restorative work. However, sometimes trauma to the tooth can cause the nerve to "shrink" more quickly. In other words, the tooth is stimulated to lay down more dentin (layer of tooth structure between the outer enamel layer and the nerve of the tooth) between the enamel and the nerve tissue.

It does appear from your description that eventually the tooth may need a crown. Since it is an anterior tooth, porcelain would most likely be the material of choice. For a porcelain crown, a certain amount of tooth structure must be removed to accommodate for the thickness of the porcelain. The nerve tissue may be too close to the surface of the tooth to be able to accomplish adequate tooth removal for a "permanent" crown at this time; therefore, you might discuss using a different type of bonding material in an attempt to achieve a stronger bond. The other possibility is to remove a minimal amount of tooth structure to create a rough crown preparation. An impression of this can then be made and either sent to a lab technician or kept in the office to aid in construction of a well-fitting custom temporary crown. I have had a small number of patients for whom a long-term temporary crown or bridge has been necessary. Our lab technician has made very nice fitting temporary crowns from composite resin (tooth-colored filling material), which has been specially treated in her lab to increase its strength.

A porcelain veneer might also be possible, although this will depend upon the amount of missing tooth structure. If too much tooth structure is missing (i.e. more than 1/3 of the tooth), this may not be possible. The advantage of a veneer over a crown is that less tooth structure needs to be removed because porcelain veneers are usually fairly thin.

If you decide to go with the bonding again, please remember that this will not be as strong as your son's original tooth structure once was. He will need to be careful with hard or sticky foods on this tooth. For example, hard bread crust may need to be bitten with other teeth, or apples may need to be sliced instead of biting right off the apple core. Taking some precautionary measures should increase the life of any restoration until a final crown can be done. These caveats may be true for a porcelain veneer as well. While porcelain veneers are quite strong once they are bonded to the tooth, it is practically impossible to create a restoration which is as strong as the original tooth structure.

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