Bonding, which offers a quick and easy way to mask many stains and discol­orations, is often an excellent treatment alternative for patients who are not good candidates for bleaching.

Direct bonding is a relatively simple process in which a plastic fluid is molded onto the teeth. The surfaces of the teeth are etched first with a mild acid to create stronger adhesion. If teeth are darkly stained, an opaque whitish layer is also applied and a more durable coat of resin is added to mask the stain completely. The restoration is then allowed to self-cure, or it is cured with a high-intensity light.

This 41-year-old woman was dissatisfied with her fillings, which discolored too rapidly. When front teeth have as many large fillings as these, the larger surface area is susceptible to stain each time they are replaced. Although crowning may be the final solution, an alternative to the full crown is bonding with composite resin.

One of the most exciting techniques in cosmetic dentistry today involves bonding a thin laminated veneer made of porcelain to the etched enamel tooth surface. The primary advantages are the beauty and durability of the material. Because porcelain doesn't stain like composite resin, it remains attractive for a much longer period of time. In addition, gum tissues tolerate porcelain well, thus reduc­ing the likelihood that gum problems will develop.

The drawbacks of porcelain laminates are similar to those of laboratory-con­structed laminates. The procedure requires two office visits and costs more than conventional bonding. In addition, the restoration is more difficult to repair should the laminate crack or chip. Again, however, the many benefits of porcelain laminates often make them the treatment of choice for patients seeking long-term solutions to the problem of stained or discolored teeth.