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The Importance of Direct Resins in Dental Practice

Aesthetic dentistry has assumed an important role in the contemporary practice as patients increasingly request treatments that reflect society's emphasis on health and beauty. A youthful appearance is often directly related to the perception of one's well-being, and improving the aesthetics of a patient's smile can be beneficial in establishing this image. Aesthetic dentistry can be utilized to improve a patient's self-image, and allows the clinician to generate additional income, experience positive patient feedback, and exercise artistic skills. 

Dental professionals and manufacturers have generally been able to satisfy the demand for improved aesthetic techniques and products. The range of restorative materials available to the clinician is expanding daily, and adhesive bonding procedures have continued to be refined. Direct resins are available in a variety of shades that range from ultralight to dark opaque, which allows the treatment of even bleached or geriatric dentition. Innovative materials also offer various degrees of translucency and opacity that can mimic dentin and enamel and provide characterization for any anterior tooth. Handling properties of the composite resins have been improved with low-viscosity flowable systems and packable materials that simulate the handling characteristics of amalgam. Sculptable composite resins that easily maintain their shape have also been developed, which permits the clinician to replicate tooth contours during material insertion and minimize finishing procedures. 

Despite the availability of excellent direct restorative materials, indirect laboratory-fabricated porcelain or resin materials are being placed with increased frequency. Although their use is often justified due to generalized discoloration, extensive loss of tooth structure, or occlusal considerations, these restorations are often used indiscriminately to treat aesthetic situations, and patients are provided no other restorative option. By embracing indirect restorations for the treatment of the majority of aesthetic situations, the clinician and the patient will miss several important aspects of direct restorations. Although a direct restoration may have a more limited life span than an indirect restoration, this can present certain clinical advantages. Porcelain longevity is often measured by the appearance and the durability of the restorations. Since direct resins are weaker than tooth structure, they have a significantly reduced potential to damage opposing dentition in comparison to porcelain materials. Composite resins can also be more easily repaired than porcelain, which can be a benefit in certain instances. 

In addition, the placement of indirect restorations always requires a degree of tooth reduction. Although these preparations are conservative by conventional standards, the defect-specific cavity designs currently utilized with direct restorations preserve greater tooth structure. Numerous situations (eg, diastema closure) require no preparation when restored with direct resin procedures. Although malaligned teeth are often aesthetically straightened with indirect restorative techniques, this requires large amounts of tooth reduction to provide proper aesthetics and space for seating of the restoration. Direct modalities, however, can utilize illusionary techniques to perform realignment without significant loss of tooth structure. 

Unfortunately, the expense involved in aesthetic dental treatment may preclude patients from enjoying its benefits, particularly when indirect restorations are utilized. The increased expense associated with quality laboratory-fabricated restorations must be reflected in an overall treatment cost that many patients cannot afford. Although the longevity of a direct restoration may be shorter, the expense of its replacement is less than that of indirect options over time. 

The aesthetic options presented to the patient are often relegated to the clinician's expertise in the procedure involved and the anticipated income derived from its successful completion. The lack of instruction with aesthetic direct resin procedures during university training often does not provide the clinician with the technical skills and confidence necessary to offer a full range of direct restorative services. Although numerous continuing education opportunities focus on indirect techniques, quality courses are available for the aesthetic placement of direct composite restorations as well. The technical proficiency and knowledge acquired in these courses--along with continuous monitoring of the professional literature--will benefit the clinician not only with direct restorations, but also with the entire aesthetic armamentarium.  

 

Case Presentation

A 76-year-old female patient presented with malaligned dentition and aesthetic concerns (Figures 1 and 2). The patient was unwilling to have orthodontic treatment and unable to afford indirect restorations. The use of direct resin restorations provided an affordable option for the treatment of the patient with a reasonable amount of chairtime and conservative reduction of tooth structure. 

Using a flame diamond bur, the existing restoration on the left maxillary central incisor was removed, and the facial and proximal contours of the central and lateral incisors were adjusted to provide space for composite rebuilding (Figures 3 and 4). The teeth were restored with a combination of hybrid composite and microfilled resin to establish the desired shape and contour (Figures 5 and 6). The definitive restoration provided the desired aesthetic result and satisfied the objectives of the patient. 

 

Conclusion

As the aesthetic expectations of the public continue to evolve, it is important that clinicians utilize restorative techniques and materials that achieve these objectives in a conservative, durable, yet affordable manner. When properly used, direct resin materials can provide solutions to numerous aesthetic challenges while still providing adequate practice revenues. By capitalizing on the learning opportunities that are currently available, dental students can develop techniques for the incorporation of these techniques and materials to the mutual benefit of patient and clinician alike. 

 

*Professor and Chair, Department of Operative Dentistry, University of Iowa Dental School, Iowa City, IA.

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