International Dentistry - Vol. 12, No. 2 - 28

C H A N D R A PA L

Figure 4 and 5: Composite shade tabs illustrating enamel and dentine alongside the combination of the two for true comparison
(Inspiro - Optident).

It is essential that the clinician ensures the composite system
being used has its own shade guide constructed of the resin
material and not acrylic. Such guides are now also available
in an outer shell of enamel and internal dentine to give
combination effects to mimic the effect of layering two
specific shades together.
The last 10 years have empowered the clinician to think
more laterally about the tissues he/she is attempting to
reproduce. As such, the industry has responded by
constructing shade guides that are now designed to mimic
the layers, rather than a Vita acrylic block that can at times
lead us to incorrect results.
Figures 4 and 5 illustrate such an example of composite
resin shade tabs arranged in enamel and dentine, but also
allowing the combination of the two. Such resources have
really changed the way the clinician is able to perceive the
desired shade.

Empirical longevity studies
As with most forms of clinical and academic dentistry, we
now have more clinical research to be suggestive of greater
success rates using direct materials. This is in part due to an
improvement in the materials, but also techniques of isolation,
bonding protocols and being more aware of the limitations.
Academics such as Jürgen Manhart and Didier Dietschi
have been pivotal in providing the clinician with valuable
data to suggest our methods of direct resin restorations are
showing promise, not only in the short term, but anything up
to 25 years of data have now been produced to support
such techniques (Hickel et al, 2000).
It is important that clinicians make themselves familiar with
such research to support their techniques and update them

accordingly. However, the current stance is that using strict
isolation and bonding protocols, direct resin restorations are
being shown to have very good longevity - albeit remaining
sensitive to clinical technique.

Tooth preservation
The strive to become ever more conservative within the last
10 years has spearheaded the need for direct resin
restorations to have a resurgence within the dental market.
Organisations such as the British Academy of Cosmetic
Dentistry have been widely promoting, where possible,
minimally invasive dentistry to create lifelike results with everimproving longevity.
This results in dentistry that is both appealing, and costeffective to the patient, as well as generally safer methods
of application when compared to aggressive preparations
that are related to indirect techniques.
With this said, it remains the clinician's level of experience
and expertise that must make the correct judgement as to
what will obtain the best result in the interest of the patient
for short and long terms time spans.

CAD/CAM hybrid composites
The drive to make clinical dentistry more digital has led to
the industry producing hybrid composites that are effectively
machined within our own surgical environments using
CAD/CAM technology. The last 10 years have vastly
improved in terms of scanning technology and thus the use
of hybrid composite, often containing ceramic fillers to be
used in clinician scenarios where perhaps indirect
restorations that were lab based were being utilised.
The discussion as to whether such resins remain to be truly

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

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