composite restorations
When most people think about composite, they think about composite bonding — whether that is edge bonding or composite veneers. But composite is a restorative material rather than a treatment in its own right.
Its uses extend beyond improving the appearance of teeth. Composite can be used to change the shape, size and, in appropriate cases, colour of teeth, but it can also be used to restore tooth decay and replace tooth structure lost through tooth wear.
The important question is therefore not simply whether composite can achieve the change you want, but whether it is the right material for your teeth, your oral health and your long-term goals.
What can be achieved with composite restorations?
Composite is a material which can be used for both aesthetic and functional purposes. Aesthetic composites mimic the natural tooth in the way they reflect the light. Functional composites provide stable surfaces with high strength, which can withstand the forces of chewing over time.
Aesthetic composite can be used to create changes to the shape, size and colour of the teeth. This is often referred to as composite bonding, and includes composite edge bonding and composite veneers. Aesthetic composite is particularly useful where mild to moderate changes are required, although more significant changes can be achieved in carefully selected cases.
Functional composites can be used to replace lost tooth surface, in particular on back teeth. This application allows a tooth-coloured restoration to repair teeth which have been affected by tooth decay or tooth wear.
When might they be appropriate?
Aesthetic composites can be used in conjunction with tooth alignment to provide the finishing touches to a smile, by making the edges of teeth appear even, and closing black triangles (dark spaces) in a smile which may have occurred as a result of orthodontic movement.
Aesthetic composites can also be used on anterior teeth to repair worn teeth and edges.
In some cases, composite can be used to change the shape of teeth to camouflage mild misalignment, and close gaps between teeth. They can be used to make congenitally small teeth appear to the be a more proportionate size, and to close spaces between teeth. In addition, it can be used to camouflage teeth like canines which have been moved as a result of orthodontics into an atypical position.
Functional composites can be used on teeth affected by tooth wear to restore biting surfaces in a hard-wearing and definitive manner. They can also be used to replace lost enamel when abrasion or erosion have affected buccal or lingual surfaces of teeth.
When might another approach be better?
Composite performs best when there is healthy enamel to bond to. It relies on this bond for its strength and longevity. For this reason, where enamel is lacking, an indirect restoration like a porcelain restoration may perform better over time.
In patients who have poor oral hygiene, especially where the gums bleed spontaneously or when brushing / using interdental aides, composite is not indicated until this is managed. Composite needs a dry environment to bond to the tooth, and where there are bleeding gums, this can compromise the longevity of the restoration.
Where active acid erosion is contributing significantly to tooth wear, this should be addressed before definitive composite treatment, otherwise the underlying process may continue to affect both the tooth and the restoration.
How I approach treatment
When I intend to use composite to restore the teeth, my assessment begins by considering how much healthy enamel remains, where it remains, and whether there is enough in the right areas to provide a predictable bond. I assess the oral hygiene and whether the treatment area can be kept dry and free from contamination while the restorations are placed. I then assess the bite and the forces acting on the teeth. This helps me select an appropriate composite and plan how it will function on the different surfaces of the tooth. This assessment helps me select the appropriate composite and design the restoration according to the demands placed on each surface of the tooth.
Finally I assess the aesthetic demands of your case. Where we are changing the shape and size of the teeth, this includes an assessment of any crowding and spacing in your smile, any lack of symmetry, and what is visible when you smile. This enables me to assess whether adjunctive treatments may be needed to achieve a harmonious outcome. To aide in this assessment, I may take photos, measurements and scans of your teeth.
What does treatment involve?
Aesthetic composite treatment is usually carried out without local anaesthetic. Before placing the composite, I carefully clean and isolate the teeth to create the best possible environment for bonding.
The composite is then applied in small increments and shaped directly on the tooth to achieve the planned form. Once the desired shape has been created, the restorations are polished and refined.
The final stage is particularly important. I check the restorations both when you smile and when your teeth come together, making any necessary adjustments to ensure that the result works aesthetically and functionally.
Where composite is being used to restore tooth decay or significant tooth wear, additional preparation may be required and local anaesthetic may be necessary.
In many cases, composite restorations can be completed in a single appointment, although this depends on the number of teeth involved and the complexity of the treatment.
Longevity and maintenance
Aesthetic composite can be an effective medium-term restorative option, although its longevity varies depending on the tooth, the forces placed on it, oral hygiene and individual circumstances.
Over time, composite can chip, stain and lose its shine. One of the advantages of composite is that it can often be repaired or re-polished if it chips, stains or loses its surface lustre. For aesthetic composites, polishing annually in combination with hygiene treatments is recommended to keep the restorations looking vibrant.
Composite restorations can over time suffer from decay around or underneath them. For this reason, it is important to maintain good oral hygiene, in particular in between the teeth to prevent this from happening.
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