Anterior Composite Resin Restorations
In all my educational travels, I have observed an almost universal concern about the use of composite resins in the anterior segment of the mouth. Although dentists are preoccupied with color stability, handling, polishability, wear, and fracture toughness, these are all properties we need to consider when selecting from among the myriad of restorative systems currently available.
Unfortunately, the worst nightmare for the restorative dentist venturing into the esthetic arena seems to be cost-effectiveness. We all want to make a good living while promoting health, but unlike ceramics, composites don’t fit into the “Ford-ian” production line of dental practice. Composites are completely operator-dependent and often time-consuming to use; therefore, a practitioner who endeavors to be conservative through the use of composite resins will take longer and may not be able to charge as much as he or she would like.
This may be the hard truth, but are we really considering our benefit or that of our patients? If a peg lateral build-up with composites can be completed in one appointment using state-of-the-art materials and techniques, is it still acceptable for a dentist to decide to gently prepare that tooth, take an impression, send it to the laboratory for a lithium disilicate crown, and get it back the next day, charging double, triple, or quadruple the rate of the composite restoration?
In my viewpoint, the approach to CAD/CAM technology should be no different. Of course, it gives us the ability to complete the procedure in one appointment, but the invasiveness and cost factor must be considered.
What are the benefits of using composites in the anterior segment for old-school operative dentistry, such as Class III, Class IV, and Class V treatments? Why would I even consider doing six anterior composite veneers as opposed to pressed or CAD/CAM veneers?
Bottom line, although it will take longer, and the dentist might not attain the same financial reward as with ceramics, I consider non-invasiveness the primary factor in cases involving veneers, peg lateral build-ups, diastema closure, or any more comprehensive treatment plan.
For some practitioners, longevity may be a concern. To this end, composites are ultimately more effective tools in the hands of knowledgeable and skilled operators who are more conscious of health promotion than profit. If done properly, composites can last 15 years or longer.
After using and teaching both ceramics and composites for 30 years, I have discovered that there is a niche for both. The dentist simply needs to know how to best implement each technique.
As a final word for those who might still be challenging the cost factor of composites, I offer a quote from my good friend, Dr. Ronald Jackson: “If you don’t charge what you’re worth, you’ll end up being worth what you charge.” To this, I would add, “but, in order for you to charge what you are truly worth, first you need to earn that worth.” Earn it by pursuing additional knowledge and training in composite resins so that you can make the best treatment decisions for your patients.
About the Author
Newton Fahl, Jr., DDS, MS, maintains a private practice in Curitiba, Brazil, and is the scientific and clinical director of the Fahl Center.