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When Bonding Falls Short

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Categories: Orthodontics;
When Bonding Falls Short

Orthodontists weigh in on poor aesthetic outcomes

On the Orthotown message boards, a discussion about a poorly bonded peg lateral restoration turned into a broader critique of restorative quality, and a call for better collaboration between orthodontists and general dentists.

A frustrated orthodontist shared the following image of a direct bonding case on a peg lateral (Fig. 1), describing it as disappointing work that ultimately fails the patient.

From color mismatch to contouring issues, the post struck a chord with many others who regularly see similar outcomes once patients return from their restorative visits.
When Bonding Falls Short
Fig. 1

Beyond just the wrong shade
The most obvious flaw called out was the shade, described as a glaring mismatch. But as others pointed out, the problems went far deeper. The incisal angles were poorly defined, the gingival embrasures were blocked out and excess composite had bonded adjacent teeth together, making flossing impossible. The facial surface appeared rough and unpolished, likely because of improper finishing techniques.

For many, it was the kind of case that highlighted the limitations of direct bonding in the hands of inexperienced providers, or perhaps simply rushed work without attention to anatomy or function.

A common, yet difficult, procedure
Despite the criticism, the conversation quickly acknowledged the difficulty of bonding peg laterals well. Creating natural contours, good emergence profiles and proper contacts without overhangs or impinging on the gingiva is no small feat, especially when working freehand in the aesthetic zone.

Several orthodontists discussed strategies they’ve seen work better, including the use of crown forms to help guide shape and avoid bonding adjacent teeth. Others advocated for using a lingual putty matrix created from a wax-up to help ensure incisal and facial anatomy are predictable and aesthetic. Still, many admitted that gingival overhangs on peg laterals remain a tough challenge, no matter how carefully the procedure is done.

Indirect may be worth the investment
Some contributors suggested that when properly executed, the time and complexity of a well-done direct bonding procedure might actually justify an indirect solution, such as veneers or lab-fabricated composite restorations. This route, while potentially more costly, could provide a superior and more predictable result.

There was also talk about the need for improved continuing education. A few orthodontists expressed interest in creating or recommending hands-on courses specifically aimed at helping general dentists perform better anterior bonding. The goal: Reduce frustration for everyone and deliver better care for patients.

More than just a rant
While one participant questioned whether the original post was simply a vent, the broader thread revealed a consistent theme: concern about the state of restorative work in some regions and frustration with seeing poorly executed aesthetic cases walk into their offices day after day.

Many orthodontists agreed they’ve had similar experiences, especially with final implant restorations or bonded peg laterals. The consensus wasn’t about blaming individual providers, it was about recognizing a widespread issue and seeking ways to raise the bar.

Bottom line
Anterior bonding, especially on peg laterals, is technically demanding and aesthetically sensitive. While some general dentists excel at it, many others struggle, often because of lack of training, time pressures or limited experience. For orthodontists, this can be a constant source of frustration, particularly when beautiful orthodontic results are compromised by subpar restorative finishes.

Rather than simply criticize, many in the thread emphasized the need for better collaboration, communication and education. Because in the end, it is ultimately about delivering a result everyone, especially the patient, can be proud of.


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