Direct anterior composites: A practical guide

Primary Dental Care Research Group, University of Birmingham School of Dentistry, St Chad's Queensway, Birmingham B4 6NN, UK.
Dental update 04/2009; 36(2):71-2, 74-6, 79-80 passim.
Source: PubMed


For more than 40 years dentists worldwide have been using directly placed resin-bonded composite to restore damaged anterior teeth. While such techniques are invariably more conservative of tooth tissue than indirect procedures, operative techniques using direct composite can be challenging and are considered technique sensitive. Clinicians require both technical and artistic skill to provide composite restorations that restore function and aesthetics to blend seamlessly with the residual dentition. This paper provides an update on the aesthetic considerations involved in the restoration of anterior teeth with directly placed composite and outlines the contemporary materials, equipment and techniques that are available to optimize every clinical stage.

Clinical relevance:
Successful restoration of anterior teeth with direct composite is an integral component of contemporary clinical practice.

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    • "For the past few years, composite has become current restorative material and today it often replaces amalgam restorations in posterior teeth [28–31]. Nevertheless, restorative composite is not able to bond to dental tissues. "
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    ABSTRACT: Our experiment evaluated the microleakage in resin composite restorations bonded to dental tissues with different adhesive systems. 40 class V cavities were prepared on the facial and lingual surfaces of each tooth with coronal margins in enamel and apical margins in cementum (root dentin). The teeth were restored with Z100 resin composite bonded with different adhesive systems: Scotchbond Multipurpose (SBMP), a 3-step Etch and Rinse adhesive, Adper Scotchbond 1 XT (SB1), a 2-step Etch and Rinse adhesive, AdheSE One (ADSE-1), a 1-step Self-Etch adhesive, and AdheSE (ADSE), a 2-step Self-Etch adhesive. Teeth were thermocycled and immersed in 50% silver nitrate solution. When both interfaces were considered, SBMP has exhibited significantly less microleakage than other adhesive systems (resp., for SB1, ADSE-1 and ADSE, P = 0.0007, P < 0.0001 and P < 0.0001). When enamel and dentin interfaces were evaluated separately, (1) for the Self-Etch adhesives, microleakage was found greater at enamel than at dentin interfaces (for ADSE, P = 0.024 and for ADSE-1, P < 0.0001); (2) for the Etch and Rinse adhesive systems, there was no significant difference between enamel and dentin interfaces; (3) SBMP was found significantly better than other adhesives both at enamel and dentin interfaces. In our experiment Etch and Rinse adhesives remain better than Self-Etch adhesives at enamel interface. In addition, there was no statistical difference between 1-step (ADSE-1) and 2-step (ADSE) Self-Etch adhesives.
    International Journal of Dentistry 05/2012; 2012:852841. DOI:10.1155/2012/852841
    • "Although amalgam has served dentistry for over a century, the clinicians have become more in favour of composites in the recent times. This transition is due to the alleged health concerns and environmental considerations regarding amalgam, the dental professions desire for an adhesive material that demands less invasive cavity preparations, and the patient demand for tooth-coloured restorations even in the posterior teeth.[1] The suitable esthetic posterior restorative materials are competing in the present esthetic era to best suit the above requirements. "
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    ABSTRACT: To evaluate the effect of glass and polyethylene fiber inserts and flowable composite as a liner on the microleakage of Class II composite restorations with gingival margins on root surfaces. Class II slots were prepared on both the proximal sides of thirty freshly extracted mandibular molars and were divided into six groups, according to the type of fiber insert and use of flowable composite (Filtek Z350) as a liner. Filtek P-60 (3M/ESPE) posterior composite was used to restore all cavities. The specimens were thermocycled and stained with 2% Basic Fuchsin dye, and sectioned to evaluate the dye penetration under Stereomicroscope. Statistical analysis was done using Kruskalwallis test and Mann whitney U test. This study showed that, fiber insert groups, with or without flowable liner, had reduced microleakage scores as compared to the control groups. However, statistically no significant difference was found between the groups with fiber inserts. Less microleakage was seen in Group IV (With flowable liner and without Fiber inserts) as compared to Group I (Without flowable liner and Fiber inserts).
    Journal of Conservative Dentistry 04/2012; 15(2):166-9. DOI:10.4103/0972-0707.94590
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    ABSTRACT: Unlabelled: Direct placement resin composite is revolutionizing the restoration of posterior teeth. Compared to amalgam, its use not only improves aesthetics but, more importantly, promotes a minimally invasive approach to cavity preparation. Despite the benefits, the use of composite to restore load-bearing surfaces of molar and premolar teeth is not yet universally applied. This may be due to individual practitioner concerns over unpredictability, time and the fact that procedures remain technique sensitive for many, particularly with regard to moisture control, placement and control of polymerization shrinkage stress. New materials, techniques and equipment are available that may help to overcome many of these concerns. This paper describes how such techniques may be employed in the management of a carious lesion on the occlusal surface of an upper molar. Clinical relevance: Direct posterior composite is the treatment of choice for the conservative restoration of primary carious lesions.
    Dental update 04/2012; 39(3):211-2, 215-6.
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