Why radiopacity is an important feature of dental adhesives

Fig. 1: Radiolucent areas under resin composite restorations as a result of adhesive pooling.

The reason is quite obvious: Despite a thorough clinical examination, it is impossible to tell if the radiolucency is the result of secondary caries, a lack of marginal adaptation (producing gaps or voids), or simply a thick layer of a radiolucent dental adhesive (Figure 2). Hence, the removal of the existing restoration is the only chance to find the source of the radiolucency immediately. If the adhesive was the cause, nothing will be found underneath the restoration, and overtreatment results. To prevent this possible overtreatment, the dental practitioner needs to monitor the situation and take action only if clinical and radiographic changes are detected during one of the following visits.

The fact that the decision to replace or not to replace a (composite) restoration is often affected by a thick layer of a radiolucent adhesive beneath it has been confirmed in different scientific studies.1,2 The results of an in-vitro study conducted at the Federal University of Santa Maria, Brazil, show that it is twice as likely for a dental practitioner to replace a restoration when there is a dark area visible on a radiograph that is caused by a thick layer of a non-radiopaque dental adhesive.1 Another in-vitro study from Ege University School of Dentistry in Izmir, Turkey, reveals that the use of a radiolucent adhesive leads to a greater number of incorrect radiography-based replacement decisions than the use of a radiopaque adhesive.2

Fig. 2: Possible reasons for radiolucent areas underneath a restoration.

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