composite

In general, the use of composite is significantly more common in Europe than the United States.  Let me clarify that by saying that although composite is a primary restorative material for posterior fillings, Class V restorations and anterior cosmetic dentistry in both Europe and the USA – I believe that we in the States under utilize composite for managing the more advanced full mouth wear patients in lieu of ceramic restorations. It has been well documented in the literature that composite can be used successfully to manage these types of patients. 1,2

There are many advantages of using composite:

  • It’s conservative
  • It can restore both function and esthetics
  • The reduction of overall financial cost to the patient
  • It’s more easily repairable if fracture occurs

For the most predictable restorative success, case selection can be important. Given the strength differences between ceramic and composite, using composite on patients with an erosive or abrasive loss of tooth structure may be more predictable than using it on attrition patients where force management is more of an issue. This patient presented at the office holding a treatment plan from her current dentist for a full mouth reconstruction with crowns and veneers utilizing implants in all four posterior sextants. (Figs. 1-3)

composite

Her treatment goal was to improve both the esthetics and function, as she didn’t feel she could eat normally without breaking the thin edges of her anterior teeth.  The treatment plan that I presented utilized composite resin to help restore the esthetics and function.  Given that she had been without molars for many years, she was fine with not having these teeth replaced.  The treatment plan was developed using the facially generated treatment planning process beginning with the determination of the maxillary incisal edge position. (Figs. 4-5)

composite

The entire occlusal thought process and design was worked out on mounted models utilizing a diagnostic wax-up.  (Figs. 6-8)

composite

The placement of the direct composite was performed in a single visit and was well tolerated by the patient. (Figs. 9-11) It not only accomplished the treatment goals, but it did so in a very conservative manner.

References:

  1. A comprehensive and conservative approach for the restoration of of abrasion and erosion.  Part 1: concepts and clinical rationale for early intervention using adhesive techniques. Dietschi D, Argente A.  Eur J Esthet Dent  2011;6(1):20-33
  2. Tooth wear treated with direct composite restorations at an increased vertical dimension: results at 30 months. Hemmings KW, Darbar UR, Vaughan S..  J Prosthet Dent 2000 Mar;83(3):287-93

Comments

Commenter's Profile Image William Westmoreland
December 4th, 2014
I am curious how you charge for this procedure. Very nice.
Commenter's Profile Image Lee Valentine
December 5th, 2014
These before and afters are great. So show us the clinical steps......
Commenter's Profile Image Arturo
December 12th, 2014
As it had contributed to an analysis with digital Smile designs?
Commenter's Profile Image Danilo Strumendo
December 20th, 2014
What about treating the black triangles ?
Commenter's Profile Image Brent Hehn
January 10th, 2015
Any thoughts on how the lower right canine will function on the upper right lateral over time?
Commenter's Profile Image Colleen Tracy
February 10th, 2015
Great case, but how do you charge for this? Thank you
Commenter's Profile Image Gregg Kinzer
February 10th, 2015
Brent, Thanks for your question with regard to how the lower right canine will function against the upper right lateral over time (the same could be asked about the left maxillary lateral against the lower canine). My answer is: it will most likely be perfectly fine. The reason I'm not concerned about this case from a functional standpoint is the nature of the wear. Note the characteristic of the laterals and centrals in the pre-op photos....you can see the paper thin facial incisal enamel is present. This tells me that the parafunctional activity is minimal if not completely absent. If there was any type of grinding, those thin enamel areas would be flat facets. She may have been able to reach the right maxillary lateral with the lower right lateral in a right lateral excursive movement, but you can see the lower right lateral was significantly reduced in height. The lack of visible "attrition" type facets makes this case pretty predictable from a functional standpoint.
Commenter's Profile Image Gregg Kinzer
February 10th, 2015
A few questions on how to charge for something like this. Given that these are the definitive restorations, they were charged out as composites by surface. Pretty straight forward. If however this was a case that you were using composite to help set the case up for "phasing" (where indirect restorations were to be used at some point down the road), then I would charge these restorations out as composite build-ups. Hope this helps!