Anterior Teeth Aesthetic Rehab: Composites Evolve

Aesthetic rehabilitation of anterior teeth is a popular treatment which is in demand with younger patients. Direct chairside composite restoration for such cases is far superior to indirect porcelain laminate veneer restorations.

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Evolution of Composites

Dental composites are categories of synthetic resins which are usually used in dentistry as adhesives or restorative material. They are composed of a coupling agent, an organic matrix as well as an inorganic matrix chemical material. Composite resins require a procedure for bonding to ensure reliability and durability, the resins must be biocompatible and must bond well with both the dentin and enamel. In order to demonstrate mechanical properties that look like those of natural teeth and to resist masticatory forces, direct restorative materials are required. In order to replace the silver amalgam for direct fillings, the composite resins, therefore, must be essayed to use. Microleakage caused concern in the 1990s due to its likelihood of leading to sensitivity and secondary caries.

Composites of between 24 and 32 shades were available and more elite clinicians embraced the composite layering technique (Chaturvedi et al. 2019. 9). However, with the development of micro-hybrids, dentists began to build teeth architecturally and the chemistry used in composites enhanced. The polishability and the physical characteristics of composites enhanced with a heterogeneous aggregate of fillers. The, however, were unable to retain their final gloss. The composite resins of today produce long-lasting and highly esthetic restorations for many indications and with the increased understanding of enhanced layering techniques, fracture rate and microleakage concerns have significantly decreased. Enhanced filler particles allow excellent longevity, polishing and finishing wile fewer shades of composites comprising of better chameleon effects advance esthetic outcomes.

Particle and material refraction indices, as well as integrated value scales, enables proper selection of shade in order to build enamel and dentin characteristics. Composite resins are now increasingly being used for posterior and anterior restorations hence have undergone evolution considerably. The modern composite resins prove less shrinkage, greater durability, enhance bond strengths, better handling characteristics, highly esthetic outcomes as well as improved polishing. However, composite placement remains technique-sensitive and post-polymerization shrinkage is still an issue of concern.

Aesthetic Dentistry

There are various types of teeth problems which can make one lower his/her self-esteem and feel self-conscious. These problems may include undesired gaps between teeth, chipped teeth, a misshapen tooth, receding gums or even discolored teeth. The modern-day technology, however, has enabled dentists to help individuals with such problems have a healthy and bright smile. In dentistry, there is the branch known as aesthetic dentistry which involves techniques and skills used to enhance people's smile appearance, size, shape, alignment, color as well as its overall function and health. Other people may tend to infer aesthetic dentistry as cosmetic dentistry which is not the case since both are quite different.

Even though cosmetic dentistry has the same goal as aesthetic dentistry of perfecting people's smile, aesthetic dentistry aims at improving the appearance of people's smile along with functionality and oral health while cosmetic dentistry aims at only improving people's smile. This means that an individual who has done cosmetic dentistry has a smile that looks "Hollywood approved" with perfectly shaped pearly white teeth while another individual who has had aesthetic dentistry, has a smile that matches the original teeth shape and color and hence looks natural.

Some of the general aesthetic dentistry techniques include dental bonding which involves the repair of chipped or cracked teeth and can help with discoloration fixing. Veneers help in fixing conceal chips or cracks in teeth and the gaps between teeth. Veneers are thin porcelain layers that are placed over the teeth in order to restore discoloration or protect enamel (HOLYOAK, 2013. 40). Dental implants are techniques that involve a prosthetic replacement for missing teeth which can either be removable or permanent. Dental bridges are techniques used in the bridging the gap between teeth in order to enhance the bite as well as to maintain the shape of the mouth. Dental bridges are permanent and usually require regular oral care. Another technique is the dental crown which can be described as a cap used to cover a sensitive, damaged, decaying or week tooth. The cap appears in the same shape as a natural tooth although it is made of porcelain. Aesthetic dentistry technologies are day by day developing to ensure enhanced appearance and health of people's smile.

Aesthetic Rehabilitation in The Anterior Dentition

Minimal or no-preparation veneers allied to enamel preservation provides predictable results in the esthetic dentistry while the indirect additive anterior composite restorations represent a repairable, quick, inexpensive and minimally invasive option for a smile improvement treatment plan. The current laboratory techniques allied to a strict clinical protocol usually satisfy the esthetic and restorative needs of the patients. The new composite and ceramic materials have augmented conservative treatments of the compromised anterior teeth. During the 1980s, the indirect additive veneering was presented as an alternative to full-coverage crowns. The concept of minimal or no-preparation has come after the advancement of appropriate enamel bonding procedures.

The integrity and color of dental tissue substrates towards that veneers to be bonded are crucial for clinical success. The use of additional veneers that have a thickness of between 0.3 mm and 0.5 mm, a percentage between 95-100 of enamel volume usually remain after preparation and there is usually no dentin is exposed (AUGUSTI et al. 2014). Most of the clinical studies conducted in the past have concluded that bonded laminate veneer restorations gave good results in a period of 10 years and more. Most of the failures were observed in the form of marginal defects or fracture of the restoration. On the contrary, pure adhesive failures are hardly seen whenever enamel is the substrate with the shear bond strength values going beyond the cohesive enamel strength. Some of the indications of the no-preparation veneering may include alterations in the superficial enamel texture, erosion, corrections for short as well as small crowns and the incisal edge microfractures.

The restoration of a missing dental tissue with composite resin is inexpensive, quick and minimally invasive whereas the resulting restorations are easy to repair whenever necessary. For both the direct and indirect techniques, the cosmetic enhancement of the smile is possible, and the latter procedures may require a more than a single appointment but are preferred once multiple teeth are involved in the treatment plan as well as when color matching or accurate tooth reshaping is needed. In the final esthetic result, previsualization is extremely crucial for both the patient and clinician with indirect techniques. This helps in the testing of preferences and desires related to a new smile before an irreversible teeth preparation is carried out hence a diagnostic approach is recommended highly whenever the interventions focus on the mouth's anterior area.

Direct/indirect choice in materials in anterior veneers

Those patients with discolored teeth always present themselves to the dentist asking for restorations that are designed for improving or enhancing their appearance. For those teeth that are sound but on the contrary are discolored, indirect or direct lamination resin composite veneers are crucial. The main purpose of a veneer, in this case, is that it acts as a thin layer used for covering the labial surface of a tooth, hence covering the underlying discoloration. Indirect porcelain laminate veneers usually require minimal irreversible preparation of the teeth. The dental laboratories make the restorations from impressions of consequently two appointments that are required and of the prepared teeth.

The modern dental adhesive systems are used to bond the veneers to the teeth. Restorative dentists usually use the resin composites extensively. There have been innovative uses of the resin composites that have been developed over the past two decades. The direct composite resin veneers are usually a one-visit procedure whereby the dentist usually adapts or employs the use of restorative material to the teeth in order to mask the underlying discoloration. The problem with the veneers produced in this way usually wear out and discolor quickly in comparison to the porcelain veneers and hence requires frequent replacement, repair or refurbishment.

Nevertheless, the direct technique has an advantage over the indirect technique of being quicker and having good initial aesthetics. The indirect technique consumes more time due to the need of two appointments as well as the certainty of an increased loss of the structure of the tooth during preparation. The direct veneering becomes a better treatment option once the material properties improve and once practitioners are familiar with manipulating them. Introduction of the light-cured composites has enabled more time for modification of the veneer beforehand it is set. Therefore, better results may be achieved.

Factors to consider before aesthetic treatment

Traditionally the role of the dentist was to prevent and treat dental disease. However, with advances in material sciences and bonding, optional aesthetic treatments are becoming available. Some of these treatments may not be conservative, and often interdisciplinary planning may be required. Some of the factors that one should consider before undertaking anesthetic may include ensuring that one understands his/her motives fully, taking time to ensure that one has explored all the options, ensuring that one is informed and familiar with all realistic results that are achievable through aesthetic treatment, ensuring that one knows the costs of the whole procedure as well as how he/she will fund it, knowing the risks, as well as the recovery time, is taken after undergoing aesthetic treatment and listening to post and pre-operation pieces of advice (SARIN, GILBERT, and ASIMAKOPOULOU, 2014. 683).

These factors are important as they help an individual make a wise decision regarding aesthetic treatment. Frequently reputable clinics usually have a cooling off period immediately after a consultation which is meant to allow a patient to digest as well as reflect on all the information that the patient has gathered to ensure that once the patient decides to go ahead with the treatment, he/she is fully informed as well as certain proceeding with the treatment is the right option. The patient should always ensure that he/she undertakes the treatment for the right reasons, should do a thorough research, he/she should have realistic expectations, should be prepared to do as told in the pre and post-operative advice, he/she should consider the costs and should be aware of the risk involved as well as the recovery time.

Case selection in treatment in direct composite veneers

Direct composite veneering leads to the maximum preservation of better teeth structure and minimal invasion once compared to the indirect restorations. Direct composite veneering easily repairs such restorations making it a preferable and conservative option than replacement. It is as a result of this that restorations that most young...