Techniques/Procedures
Restorative Bonding
Composite
The goal in restoring teeth in modern dentistry is not only to regain proper function but also to re-establish strength, integrity, and the natural look and feel of each individual tooth. With that, composite materials (also known as white filling or tooth-colored filling) are made of polymers and once they are set in their final state, they resemble hard plastic with characteristics of moderate strength with good durability and some flexibility and wearability. Because of its inherent nature, it is utilized only for small restorations where the underlying sound tooth structure supports the restoration. The following Before and After case photographs exemplify the use of composites in restorative dentistry.
Anterior Chipped Teeth
These maxillary and mandibular incisor teeth were chipped from sports accident. It has been estimated that the prevalence of traumatic dental injuries among school children in different parts of the world varies from 3% to 45%, of which 9% involved permanent incisor teeth.
These injuries involving permanent anterior teeth may lead to eating restriction, changes in physical appearance, speech defects and psychological impact that affect the child's quality of life.
Multi-layering of composite along with white tint was utilized to better blend in with the surrounding tooth structure in the maxillary and mandibular incisors. The restorations were then shaped, contoured, and polished to high shine to prevent detection. Mouth guard was recommended and should be worn when playing sports, especially contact sports to minimize oral-facial complex injury.
Diastema Closure
Patient has history of periodontal (gum) disease resulting in a significant loss of interdental papilla (gum between the teeth) which causes unsightly smile. The periodontal condition has been stable for years, and now the patient wants enhancement of her smile without any additional compromise to her already weakened teeth and gum.
No removal of tooth structure was necessary or required since this is an additive case. Teeth were simply cleansed, and the spaces between the teeth (diastema) were closed by layering composite. In addition, using composite the right central incisor was brought into alignment with the left central incisor onto the same plane to enhance harmonious integration or flow of the incisors.
Hypocalcified Teeth
This 7-year old patient has a condition that causes his to have soft, weak, and incompletely formed enamel on his erupting permanent adult teeth. This hypoplastic enamel condition, for this patient, resulted from inadequate systemic calcium absorption during the formation of adult teeth from lack of Vitamin D. This condition is obviously debilitating to a developing child and requires very conservative cosmetic enhancement considering the age of the patient.
The teeth were slightly roughen and were prepared for bonding. The photo depicted here shows the initial layering to mask deficiencies and to obtain a neutral background from which additional layers of composite can be built and integrated.
The final layer of composite was placed, shaped, and contoured. Natural tooth texture was created and the finished composite veneers were polished to obtain luster similar to that of the adjacent primary teeth.
Amalgam Replacement
Pre-operative: Patient requested replacement of existing amalgam restorations from objections during a jubilant smile.
Even though the existing amalgam restorations were in somewhat good conditions, marginal leakage is observed. This is a common occurrence with amalgam restorations which do not bond to the underlying tooth structure resulting in marginal staining and microleakage.
Post-operative: Restorations replaced with composite which enhances not only the vitality of tooth but also the marginal integrity through chemical bonding and eliminating microleakage.
Cervical Restoration
Patient complains of root sensitivity from this leaky restoration with recurrent caries. Root sensitivity is a common occurrence among adult population, and it is most commonly caused by mechanical abrasion from improper tooth brushing technique causing V-shaped wear in the neck of the tooth which in turn exposes nerve endings resulting in sensitivity to touch and temperature.
An appropriate shade of composite restorative system that best matches the color at the cervical portion of the root was selected and was bonded and sculpted in placed following removal of the failing restoration. It was then contour and polish to prevent staining and recurrent caries.
Direct Composite Veneers
Pre-operative: This patient's main concern was to replace the discolored composite on her front tooth and to have overall whiter, brighter, and healthier smile without any compromise to her tooth structure.
Post-operative: The nature of this case lends itself to beautify her smile with composite system which can be artistically blended, handled, and sculpted to achieve cosmetic desires of the patient. In addition, the strength of the composite system is utilized to manage and develop proper occlusal scheme to minimize or prevent wear and chipping at the edges of the teeth.
Occlusal/Functional/Esthetics Demands
This patient presented with significant tooth wear on maxillary and mandibular canines resulting in the alteration of the occlusal scheme. This tooth wear was caused by nocturnal parafunctional habits as revealed on her existing nightguard. The oral hygiene was meticulous with sound periodontium. Other than the wear on the canines, no other tooth wear was observed.
Treatment plan was simply to restore loss tooth structure and to regain a mutually protected occlusal scheme followed by a new nightguard which the patient must faithfully wear to minimize and prevent further destruction of tooth. A composite stratification technique was used to replace loss tooth structure on the canines followed with proper contouring and polishing of the restorations to obtain seamless integration of the restorations with the remaining dentitions. This replacement also enhances the smile to it's natural appearance and helps to reestablish a mutually protected occlusal scheme. This case shows appropriate use of composite in replacing loss tooth structure and at the same time reestablishing functional deficiency.
