‘Bonding boom’ - composite bonding insights for dental professionals

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Direct composite bonding is used across a wide range of clinical situations, including closing gaps between teeth, restoring tooth form, rehabilitating worn dentitions, managing tooth discolouration, and correcting minor positional discrepancies. It may also complement orthodontic treatment.

However, as with any procedure that becomes ‘fashionable,’ rising popularity is often accompanied by increased patient dissatisfaction - logically, because of the volume of procedures taking place. Data from the Dental Complaints Services reported an increase in the number of complaints about composite bonding (as an overall proportion of clinical complaints received) from 18% in 2021 to 22% in 2022. These figures have, however, reduced recently. Anecdotally, as part of GDC Fitness to Practise investigations, composite bonding is one of the most frequent types of case I have reported on over the past three years.

In this blog, I outline the stages of the patient journey and highlight some of the recurring themes on the concerns related to this procedure and explore what dental professionals can learn from these patterns.

Pre-treatment related factors

Concerns about composite bonding often arise from shortcomings in:

• diagnosis
• treatment planning
• the consent process.

The following illustrative examples show how these issues can happen in practice.

Example 1: Patient A presented with severe tooth erosion associated with an eating disorder characterised by cycles of binge eating, followed by inappropriate compensatory behaviours including self-induced vomiting. There was no documented history, clinical examination, or evidence of valid consent. Nevertheless, several bonded composite restorations were placed to repair their acid damaged worn-down front teeth, and a large proportion failed within just a few days of placement. Inadequate aftercare and poor complaints handling contributed to a significant deterioration in Patient A’s oral and general health.

Example 2: Patient B received twelve composite restorations, resulting in an unplanned occlusal (bite) change. Later assessment revealed a complex occlusal relationship with limited space to place the material, alongside signs of a habit of bruxism (involuntary grinding or clenching of teeth). These issues had not been identified or discussed pre‑treatment; Patient B then required complex, specialist-led remedial care.

Example 3: Patient C sought bonding to close gaps caused by splayed, protruding upper front teeth. Six teeth received bonding, producing an unsatisfactory aesthetic result described by the patient as, “chipmunk like teeth,” with signs of rapid staining and some reopening of spaces. Subsequent assessment revealed advanced periodontal (gum) disease with significant bone loss, compounded by smoking and tobacco chewing. These factors had not been recognised before treatment, resulting in inappropriate case selection and poor long-term predictability.

In each case, undertaking appropriate baseline assessments and evaluations would have raised red flags. Comprehensive medical, dental, and social behavioural history, supported by thorough extra- and intra-oral examination can help to identify aetiological and complicating factors that may influence suitability, prognosis, or the safe and effective delivery of care. Underlying psychological issues may also affect expectations or treatment appropriateness and require particularly careful management, especially considering the additional impact of social media with the promotion of aesthetic idealism.

Potential complications are thought to be more likely when bonding is attempted without sufficient enamel (as in Patient A’s case, where the effects of repeated acid exposure from vomiting had resulted in advanced tooth wear), or when key assessments of hard tissues, periodontal screening, tooth wear assessment, and evaluation of the occlusion and the aesthetic (smile) zone are inadequate or incomplete. Where indicated, investigations such as radiographs, study models/ intra-oral scans and pre‑treatment photographs may be taken to support accurate diagnosis and planning.

The above steps provide the foundation for a complete and accurate diagnosis, enabling logical (and defensible) treatment planning. In some cases, stabilising oral health and delivering tailored preventive care to control aetiological factors would logically precede elective aesthetic treatment. I have encountered scenarios where composite bonding was provided in the presence of widespread, undiagnosed caries (tooth decay), often during a one-off aesthetic appointment at a new practice - issues that should have been identified and addressed from the outset. Delivering care in the patient’s best interests may require balancing aesthetic desires with oral health needs and long-term prognosis. Clear, complete, accurate and concise records remain essential to demonstrate sound reasoning and provide clarity to any third-party reviewer.

A more robust diagnostic process would also have highlighted the complexity of care required in the above cases and allowed clinicians to assess whether the proposed treatment was appropriate and within their scope of practice. Although composite bonding can be minimally invasive, the demands of more complex presentations should not be underestimated.

Communication, consent, and patient expectations

In many of the cases referred to us, a recurring theme is poor communication - particularly around patient expectations and consent. Composite bonding can be an excellent, minimally invasive treatment choice with acceptable outcomes when carefully planned and executed. ¹However, patients must have a clear understanding of the risks, limitations, reasonable alternatives, and maintenance commitments involved. ² Meaningful, well documented discussions support informed decision making and help align expectations, reducing the likelihood of dissatisfaction or complaints.

Many concerns we see stem from patients not being made fully aware of the maintenance requirements and material limitations of composite. These have typically included:

• staining. Being more porous than enamel, composite is prone to staining from food and beverages like coffee, tea, red wine, smoking, and spices such as turmeric
• gradual loss of gloss of the bonding material (lustre)
• wear
• chipping or fractures
• decay, de‑bonding, or significant fracture.

When these realities have not been properly explained and the need for regular polishing, refurbishment/ repair, or replacement arises, especially in the presence of early or unexpected failure, they can come as a shock. Oversimplifying bonding as “simple,” “reversible,” or “risk free/ non-invasive” risks misleading patients and undermines valid consent. Patient information sheets can help, but patients must genuinely understand the content. Accurate, comprehensive records of these conversations are essential.

Unmet expectations sit at the heart of many bonding related complaints. Taking time to discuss alternative treatment options, encouraging questions, and using visual aids such as mock ups, (digital) smile design, or diagnostic wax ups may help patients better understand what is realistically achievable. These tools also aid clinicians in identifying when a patient’s desired outcome is unrealistic and may also help to demonstrate planned changes to the occlusion and the consequences of this.

Good case selection is equally important. Composite bonding may be unsuitable for patients with bruxism, unrealistic expectations, poor oral hygiene, or limited commitment to maintenance. Providing treatment unlikely to succeed is inconsistent with professional standards. When expectations cannot be aligned, or when the proposed treatment is clinically inappropriate or outside a practitioner’s competence or scope of practice, clinicians must be prepared to decline treatment and discuss reasonable alternatives. This is central to the duty of care: to put the patient’s interests first and undertake only those procedures for which they are appropriately trained, competent, and confident to provide. Dental Professionals must critically reflect on whether the treatment they are proposing is within their scope of practice, such as diagnosing conditions which may be aetiological or those which may become exacerbated as a result of poor treatment planning and execution, or whether they are well-placed to discuss appropriate alternative treatment options - especially where treatment is provided under direct access.

I have reviewed several cases where clinicians (including dental therapists) have attempted composite bonding for complex presentations and/or made occlusal alterations most likely without the necessary skills or experience. Such situations place patients at risk and heighten the likelihood of a complaint or regulatory scrutiny.

Treatment

Success with resin composite veneering relies on a solid understanding of adhesion, material science, occlusion, dental aesthetics and tooth morphology - skills that take time to develop. The clinical protocol itself demands meticulous execution, proper material choice and a high level of operator proficiency.

Some of the complaints we receive relate to substandard technical care, including:

• inadequate pain control
• poor isolation
• removal of tooth tissue that was not discussed or consented to
• rushed or incomplete bonding procedures
• over or under contouring of the restorations
• insufficient material placement
• poor aesthetics
• inadvertent closure of interdental spaces that hinder oral hygiene
• the use of inappropriate materials
• restorations lacking sufficient bulk leading to recurrent fractures,
• inadequate finishing and polishing
• failure to properly check the occlusion, resulting in unintended bite changes.

Additive procedures such as composite bonding can also influence lip support, speech and occlusion. I have seen cases where patients reported altered speech, a feeling of bulk or difficulty chewing after treatment. Patients should be advised that a period of adjustment may be needed, and that further adjustment or selective removal of material may be required if symptoms persist.

The increasing use of social media to showcase clinical work also presents risks. Concerns arise when photographs are taken or shared without appropriate, informed patient consent. Promotional material must be accurate, not misleading, and consistent with the GDC’s guidance on ethical advertising.

Aftercare

One area where public (and sometimes professional) misunderstanding is common is the notion of “reversibility". While composite can technically be removed, achieving complete removal without altering or damaging enamel is extremely difficult. In several cases I have reviewed, attempts to remove composite resulted in clear loss of tooth tissue with readily detectable dental bur marks, despite this being denied by the treating clinician. It is essential that patients are not misled.

High quality pre-treatment photographs can provide vital evidence, particularly when the underlying tooth structure is already compromised but the patient may not have been properly aware. Equally, good post-treatment photographs create a reliable baseline and are invaluable during third party investigations. I have encountered cases where the clinical outcome was objectively excellent, yet the patient under intense self-scrutiny produced detailed sketches of their desired appearance, many of which were not clinically achievable.

Concerns also arise when premature failure occurs and the complaint is handled poorly. Unclear fees (where patients often expect free of charge repairs), lack of continuity of care when a clinician may leave a practice, refund arrangements, or ambiguity with treatment guarantees (and the conditions under which guarantees do not apply) often contribute to dissatisfaction. Clear written treatment plans and transparent communication about costs and expectations are essential.

When treatment fails, taking a step back is often necessary and may require involvement from other dental professionals. I have seen cases where this did not happen, leading to repeated re-bonding and repeated failure often because underlying occlusal issues were not addressed. In such scenarios, patients commonly become disgruntled and lose confidence. In one case I reviewed, the clinician escalated from repeated composite repairs to porcelain veneers, which failed due to insufficient enamel, and then to full coverage crowns, which also failed. By this stage, significant amounts of healthy tooth tissue had been unnecessarily lost.

Where can professionals go if they need more help or want to know more?

Composite bonding can achieve excellent results, but many complaints arise when assessment, consent and expectations are not managed properly. Ensuring careful case selection, honest communication and skilled execution can help prevent avoidable problems and support safer, more predictable outcomes.

The following sources of information may also be helpful:

• Standards for the dental team
• GDC Scope of Practice Guidance 2025 (PDF)
• Guidance on using social media

References:

1. Mehta SB, Lima VP, Bronkhorst EM, Crins L, Bronkhorst H, Opdam NJM, Huysmans MDNJM, Loomans BAC. Clinical performance of direct composite resin restorations in a full mouth rehabilitation for patients with severe tooth wear: 5.5-year results. J Dent. 2021 Jul 3; 112:103743.
2. Al Hussein Hamed and Shamir B Mehta. Unmasking the risks and reality of direct composite bonding with a clinical and ethical imperative. Aesthetic Update 2026 2:4, 201-205.

This blog is part of a series by Shamir Mehta, please read his other blogs:  

How patient consent can help build trust and confidence

Dental record keeping: what is professional, reasonable and in the interest of patients? 

Clear aligner treatment: What can we learn from complaints and concerns? 

Drills, spills, and protocol: when dentistry doesn’t quite go to plan