INTRODUCTION
Composite resin has been widely used during most of my dental career, which began in 1978. When light-cured composite resins were introduced to practicing dentists, many found that these materials answered the aesthetic desires of their patients while providing the physical properties needed for many restorations. With these materials, art can literally be created directly on the patient’s tooth structure. Matrix materials can be used to build the shape of the restorations, or they can be applied in a freehanded fashion. The final outcome is literally in the mind’s eye and hands of the dentist and it is well known that some clinicians have more artistic ability than others. The good news is that it’s an art that can be learned.
In today’s economy, some of my patients are choosing direct composite resin restorations rather than indirect restorations due to the cost alone. Some choose this modality as a first step in gaining or regaining aesthetics while planning to eventually replace the composite restorations with indirect restorations later on.
Advantages of direct composite over indirect aesthetic restoration include:
Minimal preparation—While most indirect restorations require preparation of the tooth to develop “draw” and eliminate undercuts, direct restorations can be built into undercuts and around corners, often requiring less preparation. Indirect restorations need a certain thickness for strength and then need to be cemented or bonded in to place. Directly applied composite resin can be made to be “paper thin” in areas.
Lower fee to the patient—Fees can often be lower for direct than for indirect procedures because of the time savings (no second appointment or laboratory charges).
Easily removed—When it is necessary or desirable to remove composite resin from the tooth, it can be accomplished by using a carbide-finishing bur in a high-speed handpiece without damaging the underlying natural tooth structure.
Easily repaired—When it is necessary to repair a fracture or chip, composite resin can be roughened by microabrasion (or with a diamond bur) and treated with phosphoric acid to clean the abraded surfaces. Then, a bonding agent can be applied and new composite resin can be added and light-cured. Once the new material has been finished and polished, the repair is often imperceptible and long-lasting.
Modern Materials
With today’s microhybrid and nanohybrid composites, we can expect both strength and a long-lasting polish. Materials with dentin, enamel, and incisal shades are now available allowing the clinician to implement aesthetic layering techniques. Handling properties have also steadily improved and offer a variety of choices; some composite resins have a stiff and sculptable feel while others are creamy and can be contoured with a brush. The material of choice for the individual dentist often comes down to shading and handling properties. Different clinicians will choose different materials according to their own likes/dislikes and get equally good results.
n today’s economy, it is likely that more patients will choose lower cost alternatives to indirect restorations. For those clinicians who can provide direct composite restorations with aesthetic results that compete with indirect alternatives, there will surely be ample opportunities for treatment.
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