COMPOSITE

RESTORATIONS

The search for an ideal esthetic

material for restoring teeth has
resulted in significant
improvements in both esthetic
and material techniques for using
them.

Composites and the acid-etch

technique represent two major
advances.

Adhesive materials that have

stronger bonds to enamel and
dentin further simplify
restorative technique.

Although these materials are

referred to
as resin-based composites,
composite resins, and other
things, there are most direct
esthetic restorations as composites.

They are distinguished only from

porcelain/ceramic or glassionomer esthetic restorations.

There is also some information

presented about various types
of composites including
microfill, hybrid, flowable, and
packable.

The choice of a material to

restore carious lesions and
other defect in teeth continues
to be controversial.

Tooth-colored materials, such as

composite, are used in almost
all types and sizes of
restorations.

Such restorations are

accomplished with minimal loss
of tooth structure, little or no
discomfort, relatively short
operating time, and modest
expense to the patient when
compared with esthetic porcelain
crowns.

An interpretation of esthetics
primarily is determined by an
individuals perception and is
subject to wide variations.

What is pleasing for one patient

may be completely unacceptable
to another?

For example, some people have

no objection to gold or other
types of metallic restorations in
their front teeth, while most find
these restorations unesthetic.

It is the dentists responsibility to present

all logical restorative alternative to
a patient, but the patient should be given
an opportunity to help make the final
decision regarding which alternative
will be selected.

Explaining the procedure and

showing the patient color
photographs and models of
teeth that have been restored by
various methods are helpful.

Most people want their teeth

to look natural, including
areas of the dentition that
normally do not show.

BEFORE

AFTER

As for back as 1959, Skinner wrote,

The esthetic quality of a restoration
may be as important to the mental
health of the patient as the biological
and technical qualities of the
restorations are to his physical or
dental health.

Esthetic considerations
are still primary factors
for seeking dental
treatment.

The lifespan of an esthetic

restoration depends on many
factors, including:

The nature and extent of the

initial problem.

The treatment procedure.

The restorative material utilized.

and the operators skill.

as well as patient factors such as

oral hygiene, occlusion, and
adverse habits.

Failures can result from a

number of causes
including:

Trauma

Improper tooth preparation.

Inferior materials.

And misuse of dental

materials.

The dentist is responsible for

performing or accomplishing
each operative procedure with
meticulous care and attention to
detail.

However, patient cooperation is of

utmost importance in maintaining
the clinical appearance and
influencing the longevity of any
restoration.

Longrange clinical success requires

the a patient be knowledgeable of the
causes of dental disease and be
motivated to practice preventive
measures, including:

A proper diet.

Good oral hygiene.

Maintenance recall visits

to the dentist.

As is noted later, composite

restorative materials now
enjoy universal clinical
application.

They can be used almost

anywhere in
the mouth for any kind of
restorative procedure.

Naturally there are factors that

must be considered for each
specific application.

The reasons for such expanded

usage of these materials relate to
improvements in both their
ability to bond to tooth structure
(enamel and dentin) and their
physical properties.

TYPES OF ESTHETIC
RESTORATIVE MATERIALS

Many esthetic restorative

materials are available.

To gain a full appreciation for

available conservative esthetic
materials, it is appropriate to
review some of the toothcolored materials, even
though a few of these are no
longer used.

Fused Porcelain

Silicate cement

Silicate cement, the first

translucent filling
material, was introduced
in 1878 by Fletcher in
England.

It was used extensively

to restore carious
lesions in the anterior
teeth for 60 years.

Silicate cement was recommended

for small restorations in the
anterior teeth of patient with high
caries activity.

By virtue of the high flouride

content and solubility of this
restorative materials, the adjacent
enamel was though to be
rendered more resistant to
recurrent caries.

Tooth - matching ability, ease of

manipulation, and an anticariogenic
quality where favorable
characteristics
of silicate cement.

Failures of silicate cement are easy to

detect because of there discoloration
and loss of contour.

Acrylic resin

Self-curing (chemically activated)

acrylic resin for anterior
restorations was developed in
Germany in the 1930, but it was not
marketed until the late 1940
because of World War II.

Early acrylic materials

were disappointing
because of:

Inherent weaknesses such as poor

activator systems.

High polymerization
shrinkage.

High coefficient of thermal

expansion.

Lack of abrasion resistance.

Resulting in marginal leakage,

pulp injury, recurrent caries,
color changes, and excessive
wear.

Acrylic resin restorations are rarely

used today, but, as with silicate
cement restorations, may be seen
in older patient.