by Dr. Frenda Williams
Composite bonding for the anterior teeth can be utilized for both cosmetics as well as for restoration of small cavities and damaged tooth structure. By utilizing composite bonding, abrasions, cracks, chips, discoloration, gapped and sometimes misaligned teeth can be given a more desirable and enhanced looked.
Minor Cosmetic Applications
There are many patients that would like to correct minor gaps or diastemas between their anterior teeth, but want an instant fix or are not interested in or cannot finance orthodontic treatment. As a result, cosmetic bonding to close the spaces between two teeth or multiple teeth is an option. With the proper placement of the composites the asymmetry of the teeth can be corrected.
Some patients experience discoloration of their anterior teeth from either intrinsic or external staining. The intrinsic staining can come from developmental or trauma while the external can be developmental, or habitual. External staining is 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 composite veneers.
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. As a result, on a daily basis dentist are challenged with replacing missing tooth structure in the esthetic area of the mouth. Bonding offers dentists a quick option to restore chipped damaged teeth so that no further damage occurs and there is an immediate aesthetic improvement. The extent of missing tooth structure as well as the age of the patient will dictate if a bonded restoration is indicated or if a porcelain restoration such as a veneer or crown is indicated.
Let’s take for example a 15 year old male had an accident while playing soccer. The patient was not wearing an athletic guard and the soccer ball accidently hit the patient in the face breaking off ½ of tooth #8 with no pulpal exposure. What do you do? One option is to consider placing a composite restoration. Why? Ideally a ¾ or full coverage crown would be indicated if the patient was older. But, because the patient is still maturing facially and skeletally to place a permanent restoration like a crown would result in the patient needing to have a new crown placed when he was older because the crown would look anatomically too small or disproportioned.
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 do you recommend to the patient to restore #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 bonding that it is a short term solution and the bonding comes 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 veneer therefore becomes more of a long term restoration with a bonding being a short term restoration.
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, giving the tooth the appearance of being in alignment or being ‘flush’ with adjacent teeth.
Bruxism, brushing too hard or with too abrasive of a toothbrush, chewing on ice, nail biting etc. can all cause small abrasions or abfractions on the facial of both anterior and posterior teeth. A composite bonding is a quick and conservative solution to restoring the damaged areas and reduce sensitivity. Patients must then be told that in order to prevent further damage to their teeth as well as prevent them from ‘popping’ out the newly placed composites, a night guard is indicated if patient clinches/grinds or patient must change their oral habits like eating hard items like ice or biting on nails.
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, drink or smoke the composites pick up staining. This is partly due to the porous nature of composites. An alternative is for patient to have porcelain veneers/crowns placed. Because the veneers/crowns are made of impervious porcelain most staining on the facial of the veneer can be polished out.
- Another disadvantage is that the dentist cannot always exactly match the composite to the patient’s tooth. This can be for a variety of reasons but mostly because the patient may have characteristics in the 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 veneer or crown is indicated. Although composite restorations are strong, they are best utilized to replace small defects or damage to tooth structure. The larger the composite restoration the less longevity.
- If cosmetics and esthetics is the priority in improving a patient’s smile then veneers and/or porcelain crowns are the choice. This is because:
- Composites are more opaque than porcelain making them less translucent while porcelain has a glass-like translucency and mimics the light handling characteristics of tooth enamel more closely.
- Composites lose their form through wear and stain as they age
- 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.