Cosmetic Procedures: Making Patients Ready for Their Close-ups with Composite

You use composite to fix cavities and restore function. But do you ever consider the ways dental composite resins can enhance a patient’s smile? From chips to stains to closing diastemas, cosmetic treatments with dental composite resins can help your patient be ready for their close-ups.

Part of what makes these cosmetic treatments minor is the dental composite resin materials themselves. Sculptable and polishable, today’s composite resins can shape and mold the patients’ dentition and retain a high gloss and natural look after finishing. Here are a few cosmetic procedures you can do with composite:

Repairing Chips: Fixing chips in the teeth is an everyday use for bonding in the anterior. In repairing chips, Sarah Jebreil, DDS, AAACD chooses her composite based on several factors. Does it polish well? Is the shade matching simple? Can it layer easily?

Finishing an Invisalign Case: Dr Jebreil says she finds that using cosmetic bonding after an Invisalign treatment gets the teeth ready for their close-ups.

“I get the teeth in the right position, and then I’ll just zhuzh it up with some bonding and make it look nice,” Dr Jebreil says.

Fixing Hypocalcifications: Another quick anterior treatment Dr Jebreil thinks composite makes easier is fixing hypocalcifications. She takes them out and then bonds those areas. She says even this quick and easy anterior fix makes a significant difference to patients.

“It’s just a tiny little spot, but fixing it makes a huge difference to somebody’s life, and it’s pretty easy,” Dr Jebreil says.

Closing Diastemas: Diastema closures are another way you can use composite in the anterior esthetic zone. First, the clinician chooses the shade and opacity needed to close the gap. Then, after isolating with a rubber dam, the dentist prepares any misalignments in the teeth, if required, followed by etching on the enamel surface of both teeth. Next, the material is applied simultaneously and contoured to the facial half of the preparations for both teeth and light-cured. Following that, dentists can use a matrix to layer the lingual half of the diastema and cure it. Last, the dentist finishes and polishes it.¹

A 2019 case report in the Journal of Dental and Medical Sciences closing a diastema with composite is an excellent way to improve a patient’s smile in a minimally invasive way. Researchers suggest that the direct composite veneer provides proper esthetics and costs less than other options, like a full crown. Also, clinicians can do it in a single appointment.²

Dr Jebreil doesn’t like diastema closures, preferring bonding for smaller areas, although she has done her fair share of diastema closures with composite when patients ask. The challenge with bonding for a large area in the anterior is that it expands over time and collects stain. Dr Jebreil prefers to do a super-thin contact lens veneer for a diastema closure using a porcelain prosthetic because the porcelain doesn’t stain, remains smooth, and looks prettier in the midline of the mouth.

“I will do a diastema closure with composite if someone asks, but I always say it’s a temporary, not a permanent, solution,” Dr Jebreil says.

Balancing Tooth-Size Discrepancies: Dr Jebreil uses composite bonding to fix a tooth-size discrepancy for patients with narrow teeth. When placing veneers on the laterals or 4 veneers on the front, Dr Jebreil says that clinicians sometimes have too much space and need to work on balance of teeth proportions for the patient.

“If you feel like you don’t want to make the laterals too wide to close the space, you can do a proportional lateral. Then, add composite from the mesial lingual of the canine in the contact area. It gives you nice proportions, and from the mesial lingual angle, the composite doesn’t get as much stain,” Dr Jebreil explains. “That is one of my favorite ways to use composite.”

Essential Considerations for Composite in the Anterior

Having a tooth shade match the surrounding dentition is essential for using composite cosmetically in the anterior. As a result, many composites today have optimized their blending and shade matching.

Studies suggest that layering composite is an excellent way to create esthetic restorations that have the characteristics of dental structures. Researchers in the International Journal of Esthetic Dentistry recommend employing a natural stratification of the anterior teeth using a dentine hue, and a predefined thickness of enamel or by implementing a single layer of composite enhanced with the placement of pigment and opacities will achieve predictable esthetic results.³

In the anterior, shade matching is only part of the cosmetic concern. Polishing is another crucial area. Dr Jebreil says that having a broad bevel is essential because that helps blend a composite into the natural dentition.

Per Spear Education, the bevel is a crucial area for beautiful anterior composite. First, create a facial feather using a round-end cylinder diamond to make a 2mm bevel on the facial that “feathers out” from dentin to enamel. Then create a facial starburst to make different depths and widths to the bevel, which enable the composite to blend effortlessly. Finally, Spear recommends a lingual 1 mm chamfer for strength.⁴

“A wide, broad bevel helps,” Dr Jebreil says. “Then I like to use the whole sequence of disks, and when I get to the finer ones, I use water with it to hydrate the composite.”

The Influence of Technique

However, the best composites in the world don’t help a dentist who is uncomfortable with their technical performance in the esthetic zone. Studies have shown that while the composites have reached a point in their development where their performance is about the same across the board for mechanical and esthetic properties, the treatment environment and the clinician’s placement technique significantly influence the success of therapeutic outcomes.⁵

With so much riding on a dentist’s ability to use materials properly, it is essential to continue to train in new techniques. To get more comfortable with cosmetic procedures, Dr Jebreil recommends going to American Academy of Cosmetic Dentistry (AACD) conferences to get more experience. Dr Jebreil says the hands-on courses are great because you can use the different kinds of composite and learn various techniques to see what works for you and what does not. She also thinks accreditation from the AACD is essential too.

“The process is great because it gives you a lot of practice,” Dr Jebreil says of the AACD accreditation. “And it truly trains your eyes to evaluate the esthetics and what is the proper treatment for each patient.”

References

1. Six Steps to Consider When Closing Diastemas. Aacd.com. Published 2010. https://aacd.com/proxy/files/Students%20and%20Faculty/AACD_6_steps.pdf.

2. Mai Abdulgani. Closing Diastemas With Resin Composite Restorations; A Case Report. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 18. 30-33. Published 2019. Retrieved from https://www.researchgate.net/profile/Abu-Hussein-Muhamad/publication/331589564_Closing_Diastemas_with_Resin_Composite_Restorations_a_Case_Report/links/5ccf3028458515712e9547f4/Closing-Diastemas-with-Resin-Composite-Restorations-a-Case-Report.pdf.

3. Varvară, Elena & Mesaros, Anca & Culic, Bogdan & Adrian Mihai, Varvara & Dudea, Diana. (2018). Resin composite layering technique for direct anterior teeth restorations. Palestrica Of The Third Millennium - Civilization And Sport. 19. 234-238. 10.26659/pm3.2018.19.4.234.

4. Wehking D. Simple Process for Making Beautiful Anterior Composites - Spear Education. Speareducation.com. Published 2018. https://www.speareducation.com/spear-review/2018/08/a-simple-process-for-making-beautiful-anterior-composites-the-dentin-samich-technique.

5. Dietschi, D., Shahidi, C., & Krejci, I. (2019). Clinical performance of direct anterior composite restorations: A systematic literature review and critical appraisal. The International Journal of Esthetic Dentistry, 14(3), 252-270. Retrieved from https://archive-ouverte.unige.ch/unige:121627