RIBBOND TECHNICAL PROBLEMS : TROUBLE SHOOTING

RIBBOND TECHNICAL PROBLEMS : TROUBLE SHOOTING

The three most common reported problems with Ribbond are:

1. Debonding

2. Exposed fuzzy fibers

3. Difficulty adapting the Ribbond to the teeth.

The problems can usually be easily avoided. This paper describes how to evaluate these problems and respond to them.

DEBONDING

The most common structural failure of a Ribbond prosthesis is debonding. There are three types of debonding failures. You can determine the type of debonding by where the composite resin is located:

1. Composite resin is on the Ribbond and not on the tooth: This commonly indicates a problem with the bonding technique or possibly a problem with the bonding resin itself. We recommend that the dentist contact the manufacturer of the bonding adhesive and review their bonding technique.

2. Composite resin on both the Ribbond and the tooth: This most likely indicates that the dentist had too thick of a layer of composite resin between the fibers and the teeth and this bulk of composite resin itself fractured.

The need for a thin bond line is well established. When a carpenter glues two pieces of wood together he uses clamps to tightly press the pieces together. This minimizes the thickness of the glue. The thicker the layer of glue is the higher the chance will be for the glue itself to fracture. This phenomenon is the same reason why orthodontists try to minimize the thickness of composite resin when they place orthodontic brackets. This same principle applies to Ribbond as well, which is why our instructions state to press the Ribbond through the composite resin and place the Ribbond as closely against the teeth as possible. This minimizes the thickness of the composite resin and minimizes the chances for this particular type of failure.

The most common location for having a thick layer of composite resin between the Ribbond and the teeth is in the interproximal contacts. For best results place the fibers deep into the interproximal contacts.

3. Composite is on the tooth and not on the Ribbond:

a. Perhaps the most likely reason for this type of failure is that the dentist used a bonding adhesive that contained a dentin primer or acid etchant to wet the Ribbond. We do not recommend using bonding resins that contain either a self-etching component or a dentin primer to wet the Ribbond. Our concern is that if you don’t completely evaporate these added solvents or acids with an air syringe, it could have an adverse effect on the cured resin over time.

There are hundreds of fibers that are woven together to make Ribbond and it can act like a sponge in the sense that it might be difficult to fully evaporate the solvents and acid etchants. For that reason we recommend 4th generation bonding resins to wet the Ribbond. Please see the list of suitable resins to wet the Ribbond at the end of this document (Page 6).

b. The second reason for this would be voids. Be sure when using Ribbond that there are no voids between the Ribbond and the composite resin on the teeth. Please see the last section in this document titled “RIBBOND PLACEMENT ISSUES” that describes how to avoid problems when placing the Ribbond against the teeth.

c. The third possibility is that the dentist used a thick viscosity composite resin and only gently placed the Ribbond onto the composite resins instead of pressing the Ribbond though the composite resin. Be sure to press the Ribbond through the composite so that the Ribbond is placed closely against the surfaces of the teeth.

Maxillary anterior periodontal splints debonding:

Mobile upper anterior teeth tend to be pushed forward toward the labial during normal function. When a periodontal splint is placed on the palatal side of the teeth, the teeth are pushed away from the splint during function. This stresses the bond of the resin to the teeth and the splint is prone to debonding. For that reason we recommend placing the Ribbond in a shallow groove preparation on the facial side of the teeth so that the teeth push into the splint instead of push away from the splint. A dentist with adequate composite skills can easily conceal the Ribbond in the groove so that it will not be visible.

We recommend that the dentist present these concerns to the patient so that the patient can make the decision whether to risk debonding of the splint by placing it on the palatal, or possibly compromising the esthetics by placing it in a groove on the labial surface.

EXPOSED RIBBOND FIBERS

Problems with fuzzy exposed fibers are likely due to initially making the Ribbond prosthesis too bulky. If a prosthesis is bulky, the dentist might use a burr to shape it and accidently cut into the fibers. The best way to avoid cutting into the fibers is to make the prostheses as thin as possible.

Ribbond fibers do not polish well. The same fibers used to make Ribbond are used to make bulletproof vests. The advantage of using such tough fibers is that fracturing of the fibers is generally not a mode of failure. However, because the fibers are so tough they will not polish to a smooth surface.

Some manufacturers of glass fibers claim that the glass fibers can be cut and polished. However, cutting fibers weaken the reinforcement. Just like you would not want to climb a mountain using a rope that has been cut, you would not want to reinforce resins with cut fibers.

Ways to minimizing the bulk of a Ribbond prosthesis:

1. Place the Ribbond as closely against the teeth as possible.
Close adaptation of the Ribbond will not only minimize bulk and prevent the need to finish the prosthesis with a bur but it will also maximize the laminate effect of the prosthesis. See the next section titled PROBLEMS ADAPTING RIBBOND that addresses reasons for thick layers of composite resin between the teeth and the Ribbond.

2. Use the right kind of filled composite resin to attach the Ribbond to the teeth.
After preparing the teeth, (clean, etch, bonding resin and cure) apply a thin layer of composite to the teeth. Do not use a standard flowable composite for the layer of composite resin between the fibers and the teeth. Standard flowable composites lack the tackiness to hold the fibers in position during placement and will likely result in unnecessary bulk.

Ribbond, Inc. and some other manufacturers make tacky and relatively viscous flowable composites that are easy to push the Ribbond through and are tacky to hold the fibers against the teeth during placement.

If a tacky flowable composite is not available use a standard soft paste-like viscosity anterior restorative composite resin. When using a standard paste viscosity restorative composites for the initial layer of composite between the teeth and the Ribbond, apply a thin bead of this composite to the teeth and then flatten it with an instrument prior to adaptation of the Ribbond. http://ribbond.com/Periodontal-Splint.php (2:42 -3:02) shows flattening the composite on the teeth. Flatten the composite so that it follows the contours of the teeth, especially towards the interproximal contacts.

3. Cover the Ribbond with a flowable composite to smooth the prosthesis.
Use a standard flowable composite for the covering layer of composite resin. Using a thicker viscosity composite for the covering layer will result in excessive bulk and non-smooth surfaces that likely will lead to shaping with a burr and can result in exposed fuzzy fibers. Using a standard flowable composite will result in a smoother and less bulky covering layer of composite. This will minimize or eliminate the need for shaping the Ribbond prosthesis with a burr.

Apply enough flowable composite to allow for wear. Aim for this layer to be approximately 0.5mm thick. Applying the flowable composite in multiple coats and briefly curing between coats is a predictable technique for making a smooth and comfortable covering layer.

4. Make sure that the ends of the Ribbond are well covered with composite.
The most vulnerable part of an extra-coronal Ribbond prosthesis is the terminal ends and gingival and incisal edges of the Ribbond. When measuring and placing the Ribbond be sure to keep the ends of the Ribbond mesial to the proximal ridges of the terminal teeth. Be sure that the Ribbond ends are adequately covered with flowable composite. Also be sure that the gingival and incisal edges of the Ribbond are also covered with the flowable composite.

Not enough covering layer

Well covered at end of Ribbond

5. Do not cut the cured Ribbond with a burr to alter its length against the teeth: Sometimes it is difficult to accurately pre-measure and pre-cut the Ribbond before placement. If the Ribbond is too long and is cured against the teeth this would result in the need to cut it with a burr. If the Ribbond is too long, use the Ribbond scissors to trim the length BEFORE curing. http://ribbond.com/Periodontal-Splint.php (5:18-5:25) shows this.

6. Place the Ribbond within a preparation in the enamel for patient comfort or if there are issues with opposing dentition:
Although a Ribbond periodontal splint or the wings of lingual bonded Ribbond bridge are thinner than probably any other material option, there will still be some bulk to the prosthesis. For patient comfort or if there is a clearance problem with opposing dentition, cut a shallow groove within the enamel and then bond the Ribbond within that groove preparation.

RIBBOND PLACEMENT ISSUES

The following tips make it easy to adapt Ribbond closely against the surface of the teeth.

1. After wetting Ribbond with resin, Ribbond can be touched with gloved fingers.
S
ometimes dentists do not realize that the Ribbond can be touched with fingers or powder-free latex gloves after it is wetted with resin. Before the Ribbond is wetted with bonding resin, use cotton pliers and metal instruments to manipulate the Ribbond. You can touch the Ribbond with gloved fingers after it is wetted with the bonding resin.

2. Use the correct viscosity of composite resin between the teeth and the Ribbond.

We recommend using either a thicker viscosity tacky flowable composite or a soft paste-like viscosity anterior restorative composite resin for the layer of composite resin between the teeth and the Ribbond. Do not use a standard flowable composite for this part of the procedure as these composites lack the tackiness and body to “hold” the Ribbond during adaptation.

If a tacky flowable composite is not available use a standard soft paste-like viscosity anterior restorative composite resin. When using a standard paste viscosity restorative composites for the initial layer of composite between the teeth and the Ribbond, apply a thin bead of this composite to the teeth and then flatten it with an instrument prior to adaptation of the Ribbond. http://ribbond.com/Periodontal-Splint.php (2:42 -3:02) shows flattening the composite on the teeth. Flatten the composite so that it follows the contours of the teeth, especially towards the interproximal contacts.

3. Adapt the Ribbond from the free un-adapted end.
When placing the Ribbond, start at one end and press the Ribbond into the uncured composite resin on the tooth. Hold the adapted piece of Ribbond against the tooth with a gloved finger or instrument and sequentially adapt the Ribbond from one tooth to the adjacent tooth, to the next adjacent tooth, etc. Like packing retraction cord we want to place the Ribbond in a way that does not move the already adapted Ribbond.

4. Temporarily stabilize periodontally mobile teeth with polyvinyl siloxane impression material.
Before placing the composite resin and the Ribbond, temporarily stabilize the teeth with a polyvinyl siloxane impression material in the gingival embrasures. This will prevent the teeth from moving during placement of the Ribbond. The polyvinyl siloxane impression material will also minimize clean-up of composite resin after placing the Ribbond.

Composites Used with Ribbond® Fibers (Not an exclusive list) List compiled: 4/3/17

“Wetting” or bonding adhesive to wet Ribbond fibers:

Use a plain unfilled-enamel bonding resin (usually the last bottle of a multi-bottle system) to wet the Ribbond fibers. Do not wet the Ribbond fibers with a one bottle dentin-enamel bonding system, a bonding system that contains fillers, a self-etch bonding system, or a flowable composite. There are a thousand tiny fibers in Ribbond and it will difficult to evaporate solvents and acids from the wetted Ribbond. Active solvents and acids can have an adverse effect to the cured resin over time and could lead to failure.

Filled Composite:

Use a moderately viscous, paste-like viscosity, anterior restorative composite to attach the Ribbond closely against the teeth. Flattening this composite against the teeth in a ribbon shape will make the placement of the Ribbond easier. Do not use a standard flowable composite for this layer. A flowable composite is too “slippery” and is not tacky enough to hold the Ribbond in position prior to curing.

Flowable composite to cover fibers:

Because it flows, it is used as a smoothing layer over the adapted Ribbond fibers.

Wetting Resin Filled Composite to attached fibers to teeth Flowable Composites

3M Scotch Bond Multi-purpose Filtek Supreme Filtek Flow

(do not use Universal) Z-250

3M Unitek Transbond XT Transbond LR or XT ----------

Light cure primer Light cure adhesive paste

Bisco ALL-BOND D/E Resin Aelite All Purpose Body Aeliteflo

(do not use Universal)

Caulk/Dentsply ---------- TPH Esthetics Flow

Den-Mat Tenure Quik True Vitality FlöRestore

DMG Ecusit Mono Ecusit Ecuflow

Ivoclar HelioBond Tetric or Helio Molar (microfill) Tetric Flow

Kerr OptiGuard Herculite or Prodigy Porcelite or Nexus

Kuraray Clearfil SE Bond and Majesty Esthetic Majesty Flow

Clearfil SE Bond 2
(do not use Universal)

Reliance Light Bond Sealant L.C.R (Light Cure Retainer) ----------

Shofu ---------- Beautiful Flow Plus F00 (Zero Flow) Beautiful Flow

Ultradent Permaseal ---------- Permaflow

Voco Solobond Plus Adhesive GrandioSo Heavy Flow GrandioSo Heavy

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