International Dentistry - Vol. 12, No. 2 - 24

CLINICAL

Direct restorations: the last 10 years
Andrew Chandrapal1

The notion of recreating the natural form of teeth was once a technique and art form
left to those at the very top of the 'direct restorative food chain'. Some of these
individuals remain at the forefront of inspirational dentistry and display their work around
the globe.
For those of us mere mortals who practise everyday general dentistry and in particular
direct restorations, the main focus has remained to take the patient through a
comfortable and clinically suitable journey to improving their dental health, using one
or several materials available on the professional commercial market.
If the last 10 years has taught us anything, it is that the general practitioner is able to
practise excellence in direct restorative dentistry, enabling natural yet functional
outcomes that are not only representative of the natural tooth form but also attempting
to conserve as much tooth tissue as possible.
In other words, the last 10 years has given the general dentist the opportunity to
recreate the natural dentition and not just a 'filling'.

Composite resin - material changes over the last 10 years

Andrew Chandrapal BDS
MFGDP(UK) DPDS(Bris)
MClinDent (Pros)
Private Practice, London, UK

Composites, by definition, are simply 'the combination of several parts or elements'.
The adaptation of filler particles, monomers, photoinitiators, and coupling agents has
changed hugely over the past 10 years. Filler particle size has changed from hybrid
to nano and even micro particles. In real terms, 1µm particles have reduced to 0.04µm,
as a direct comparison. This, as well as filler volume variation, has created improved
hand fling, better aesthetics, greater fracture resistance and improved polish retention
within the oral environment.
The direct result of this is the fact we now apply composite resin to more clinical
applications than we ever thought possible. Figure 1 illustrates the natural and
harmonious results obtained using composite for direct veneers. Although the recall is
only at one year, it shows how well the material is able to support and mimic the
surrounding dentition using no preparation techniques.
It is now possible to conduct full mouth rehabilitations using direct composite resin to
very good levels of predictability. Following on from this, it has enabled our dentistry
to become far less invasive to the tooth substance than previous versions of the material.
In the right circumstances, prep-less dentistry is possible using modern composites that
have improved wear properties and aesthetic qualities.
Obtaining suitable combinations of varying nano filler size with filler weight has
enabled the industry to create strong yet highly polishable materials that are suitable
for both anterior and posterior dentition.
Now that such materials are available, the key is learning how to use them in such
a way to obtain optimal results. This means learning how to handle, manipulate, layer,
finish, and polish the material.

24 INTERNATIONAL DENTISTRY - AUSTRALASIAN EDITION VOL. 12, NO. 2

Table of Contents for the Digital Edition of International Dentistry - Vol. 12, No. 2