COMPOSITE BONDING FOR ANTERIOR TEETH

Composite bonding for anterior teeth can be utilized for both cosmetics as well as for the restoration of small cavities and damaged tooth structure. By utilizing composite bonding, abrasions, cracks, chips, discoloration, gaped and sometimes misaligned teeth can be given a more desirable and enhanced looked.

Minor Cosmetic Applications

Gaped Teeth

There are many patients that would like to correct minor gaps or diastemas between their anterior teeth, but want an instant fix. In this case the use of orthodontic treatment would be useless and cosmetic bonding a more viable option. The asymmetry of a single or multiple teeth can be quickly corrected with the proper placement of composite restorations.

Discolored Teeth

Some patients experience discoloration of their anterior teeth from either internal or external staining. Intrinsic staining can come from a variety of reasons including developmental issues like fluorosis or even trauma. While external discoloration can form due to habits like smoking as well as developmental issues like amelogenesis imperfecta. To mask or correct internal discoloration is often difficult and not always straight forward. Porcelain veneers or crowns as well as internal bleaching are some of the methods used to improve the esthetics of the involved tooth or teeth. These processes can be both time consuming as well as costly. On the other hand, external staining can be easier to mask or correct (depending upon the color) with whitening. But what if the patient is too sensitive to utilize a take home or in-office bleaching system. Then a cost effective alternative to brightening a patient’s smile is a composite veneer.

Chipped/Fractured Teeth

Accidents occur on a daily basis, whether it’s a car accident, a fall, a sports related injury or simply biting on a metal fork while eating. As a result, dentists are consistently challenged with how to replace missing damaged tooth structure in the esthetic area of the mouth. Bonding offers a dentist a quick option to restore chipped damaged teeth so that no further damage occurs to the remaining tooth structure while simultaneously creating an immediate aesthetic improvement.The extent of missing tooth structure as well as the age of the patient, dictates if a bonded verses a porcelain restoration is better suited to restoring the missing tooth structure.

Let’s take for example a 15 year old male who had an accident while playing soccer. The patient was not wearing an athletic guard and the soccer ball accidentally hit the patient in the face breaking off half of tooth #8 with no pulpal exposure. What do you do? One option is to consider placing a composite restoration. Why? Ideally, a ¾ veneer or full coverage crown would be indicated if the patient was older. But, because the patient is still maturing facially and skeletally, placement of a permanent restoration like a crown or veneer, would result in the patient needing to have a new restoration placed when he is older. This would be indicated because the crown or porcelain veneer would look anatomically too small or dis- proportioned to the patient's adjacent fully developed anterior teeth.

Let’s take one more example. Let’s say that a 30 year old female patient chipped her front tooth #9 while eating a candy apple. The entire incisal edge is chipped away with exposed dentin.

What should be recommend to the patient to restore tooth #9?

One option is to restore the chipped incisal edge with composite. I am sure most dentists have experienced that when restoring the incisal edge with composite bonding, that it becomes a short term solution and the bonding chips out over time.The second and best option when restoring incisal fractures as well as moderate fractures of teeth where that is adequate tooth structure, is a porcelain veneer. A porcelain veneer adds both strength and cosmetics to the fractured anterior tooth, making for a more optimal long term restoration.

Misaligned Teeth

Composite bonding can be utilized to correct one or two teeth that are slightly out of alignment. In order to do this the dentist will need to remove/reshape some tooth structure then add composite in order to reshape the tooth. This gives the appearance of the tooth or teeth being in alignment or being ‘flush’ with adjacent teeth.

Abrasions/Abfractions

Bruxism (grinding teeth), abrasion ( non-carious mechanical wear of tooth structure most often caused from abrasive toothbrushes or aggressive brushing techniques), ice chewing, nail biting, acidic foods etc, can all cause abfractions, abrasions or erosion to appear on the facial of anterior and posterior teeth. These areas of damaged tooth structure result in thinner enamel and exposed dentin, which is more susceptible to caries and can become sensitive to patients over time. A composite bond is a quick and conservative solution that results in reduced sensitivity as well as reduced risk in the formation of a cavity.

Correct Tooth Size

Composite restorations can be utilized to correct the size and length of teeth. By adding bonding to teeth that are pegged, or anatomically shorter, a better enhanced look can be attained by improving symmetry as well as proportionality.

Disadvantage of Composites in Anterior

* One of the major disadvantages of cosmetic composites in anterior teeth is that as the composite ages and patients eat or drink foods that stain as well as smoking, composites pick up staining. This staining is embedded into the restoration, partly due to its porous nature.Therefore, in order to remove the staining, part and sometimes all of the restoration must be removed and replaced. An alternative to having to periodically remove and replace a composite restoration is to have porcelain veneers/crowns placed. Because the porcelain is impervious to staining, any stains that do accumulate, can be polished out. This makes porcelain restorations the best option for longer lasting strength and esthetics in a restoration.

* Another disadvantage is that the dentist cannot always exactly match the composite to the patient’s tooth color.This occurs for a variety of reasons. But, a major contributing factor is the unique colors and characteristics found in a tooth like mauving or striations that cannot be mimicked.

* If there is a large fracture in a tooth or if root canal therapy is indicated, then a porcelain veneer or full coverage crown is indicated. Although composite restorations are strong, they are best utilized to replace smaller defects or damage to tooth structure. A rule of thumb is the larger the composite restoration the higher the risk of fracture, the less longevity the restoration will have.

* If cosmetics and esthetics is the priority in improving a patient’s smile, then veneers and/or porcelain crowns are the best choice. This is true because:

o Composites are more opaque than porcelain making them less translucent and less esthetic. Porcelain has a glass-like translucency and mimics the light handling characteristics of tooth enamel more closely.

o Composites lose their form through wear and stain as they age.

o Composites cannot be polished down to the same degree of surface smoothness as porcelain. As a result, porcelain is better for gingival health.

Composite restorations in the anterior teeth are a viable option when restoring small cavities, addressing minor cosmetic issues, when an instant restoration is needed and/or when finances come into play. Dentists and patients should always have a clear and in-depth conversation about what is the best option to restore their damaged anterior teeth that not only meets the patient’s expectations, but also restores the damaged tooth/teeth in a way that the patient will have longevity and great smile.