The permeability of the sulcular epithelium and its sulcular fluid flow is eliminated by gently rubbing the sulcular tissues with the viscous solution and the plastic infusion device (Figures 21 and 22). The soft padded ends of the plastic infusors are recommended for addressing delicate sulcular epithelium. The sulcus is firmly rinsed and evaluated for dryness (Figure 23). If the sulcular epithelium is partially denuded at the time of bonding, extra precautions are necessary relative to hemostasis. If any acid conditioner contacts the denuded tissues, bleeding may be reinitiated. In these situations, a cord with hemostatic should be placed submarginally or extra care taken with the infusion device. Etchant contact to soft tissues should be minimized. Bonding steps, from acid conditioning (Figure 24) to primer (s) application (Figure 25) and coating with a prebonding  resin, will occur uneventlylly (Figure 26).    

Figure 28. A dual cure high-filled composite luting resin,  Permalute, is mixed and loaded into a syringe. Resin is  expressed from the syringe

Figure 26. A prebonding type resin (Permagen Bonding  Resin without light curing is used here) is applied  to wet the preparation surfaces relative to the  luting composite.

Figure 27. Primer and prebonding type resins have been  applied in the absence of sulcular fluids. If not  controlled, sulcular fluids or blood may  cause contamination.

The absence of sulcular fluids following prebonding resin application is evident (Figure 27). The porcelain crown has been appropriately treated for bonding. A quality chemical or dual cure luting resin (eg, Permalute, Ultradent Products, Inc., South Jordan, UT) is mixed and loaded for syringe tip delivery (Figure 28). The crown is seated in place (Figure 29). Note the aesthetic restoration (Figures 30 and 31).  
The evolution of aesthetic techniques is a progression of change from the 3/4 cast restoration on the molar, placed in 1975, followed by a metal-ceramic restoration on the second premolar in 1985, and finally the all-ceramic bonded restoration on the first premolar in 1995. The emphasis on aesthetic dentistry is on the increase, due to the demand by society for better appearance and higher quality of life. Advancements in dental technologies and materials have facilitated our abilities to accommodate these demands.    

Figure 29. The all-ceramic crown is seated to place with  gentle labiolingual rocking motion to express excess  luting resin.

Figure 30. Occlusal view ot the all-ceramic restoration  of the maxillary left tirst premolar (tooth #12).

Figure 31. Labial view of the definitive restoration of the  maxillary left first premolar (tooth #12).

CONCLUSION

Good tissue management prior to impression making and bonding is the foundation essential for all restorations adjacent to the gingiva. “Active” hemostasis and fluid-control, as discussed, are necessary for successful restorative dentistry, whether with dentin bonding or other restorative procedures. The integrity and longevity of the restored tooth and the surrounding soft tissues are maximized.

REFERENCES

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