Dentaltown March 2020 - 38

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Here are her photos. Based on my current experience, I feel confident that, managed well, composite
today can be a very legitimate long-term aesthetic
solution for patients that provides them with a noninvasive option with respect to their teeth. Personally,
I have had more porcelain veneers than composite.
When I have had to replace a porcelain veneer
on a cosmetic case, it has been a lengthy process.
Composite is a quick same-day repair.
Rather than ask, "If I do this thing, how long will my material last?" we may do well to
ask, "If I do this thing, how long will the tooth last?" We can replace or repair our restorative
material, but we cannot replace enamel ... yet. I have many patients who tell me when offered
composite versus porcelain that they are OK with and prefer a little bit of maintenance over time
if it means that they can keep the integrity of their tooth structure intact. Maybe if we all asked
ourselves more questions like this (and drastically changed the American diet), we would see a
population with fewer root canals, extractions and dentures.
We like to see the long-term photos because we are curious how things have held up over
time to risk. The two main concerns we typically have with composite restorations are:
1. Chipping. This is a factor of two things: One, the amount of force applied to the material,
and two, the strength the material has to withstand fracture. Both of these factors are
within our design to manage. We can address the functional forces and ensure that the
potential forces applied to the material are shared and balanced, distributing the force
and lowing the risk. We can address the strength of the material by selecting the strongest
composite appropriate for where we anticipate the most functional forces and by ensuring
that our incisal edge (probably the most common place we see chipping) is as thick as
possible while still remaining appropriate-increasing the material's resilience to withstand
fracture. (I prefer 1.5-2mm thick on the incisal edge.)
2. Staining. Why do we see staining? There is either (1) a blemish in our surface finish,
(2) a fault in our margin or (3) uncured resin at the surface (air-inhibited layer). Natural
teeth accumulate surface staining, and need to be polished, Why do we think it a failure
if composite does the same? We can regularly clean and polish the material, just like our
natural teeth, to keep it looking nice over time. If we are aware that surface blemishes can
increase the risk of staining, we can use a material less prone to air inclusions or bubbles
and ensure that we use a protocol that leaves a highly polished, maximally polimerized,
surface. This risk can be managed. If we are aware that margins may pick up stain over
time, we can select a protocol that includes a highly polished transition and does not place
a margin in the middle of the tooth where it can be seen. (We wouldn't typically consider
doing that with a porcelain veneer, why do it with composite?) And if we are aware that
any resin with an incomplete cure/air-inhibited layer at the surface will stain (particularly
to wine and coffee), then we can ensure that we apply a glycerine gel like Ivoclar's Liquid
Strip over our final layer before finishing and polishing to minimize this risk. These
two factors can be predictably managed to help ensure greater functional and aesthetic
longevity for our direct resin restorations. ■
12/13/2019

bourcier
Member Since: 08/09/01
Post: 68 of 87

Nice!
I don't understand why you used the palatal matrix to develop the palatal and length, then
the composite is made way longer, then cut back. ■
12/18/2019

MARCH 2020 // dentaltown.com

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Dentaltown March 2020

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