Advances in Direct Composite

INTRODUCTION

In esthetic dentistry, material science has played a key role in the development of restorations with a more lifelike appearance. Despite the progress shown in the development and application of more minimally invasive dentistry (MID) with lab-fabricated restorations, direct composite resin still plays a vital role in conservative anterior and posterior restorations. During the last few decades, there has been a tremendous interest in recreating the natural appearance of a dentition while using conservative aesthetic- and restorative-dentistry treatment protocols. With current advancements in the physical and aesthetic properties of composite resins, direct resin restorations have developed into a viable long-term restorative solution

Philosophy of MID in Cosmetic Restorative Treatment

In correcting dental problems, one must understand the importance of approaching treatment planning with the appropriate material and clinical perspectives. With advances in material science, the ability to remineralize and heal demineralized tooth structure not only reduces the incidence of future caries, but it also allows for less tooth removal during the restorative treatment.

 Minimally invasive dentistry can correct failing alloy restorations with recurrent caries.. Direct resin restorations have developed into a viable long-term restorative solution.

Caries emerging along the margin of existing porcelain restorations will continue to be a prevalent problem in patients. A minimally invasive prep along the lateral incisor was done to remove marginal decay. An injectable composite resin (such as G-ænial Universal Flo [GC America]) can be an ideal dental material to use for minimally invasive repairs.

Adhesion dentistry allows for a conservative cavity design to be used instead of the original G.V. Black preparation designs. So that the restoration could not be dislodged, G.V. Black’s classification for cavity preparation was based upon the need to include resistance and retention form in the prep design. Additional tooth removal to create divergent internal axial walls and retentive grooves were requirements of G.V. Black’s cavity design.2 Presently, the cavity preparation design should be based on the preservation of natural dentition. Still, with the progress of dental adhesives, the additional tooth removal—once required to create mechanical retention and resistance—is no longer needed. Therefore, MID is now a realistic treatment goal with adhesive resins.

Injectable Composite Resins: A Real Game Changer 

In the last several years, there has been much progress within the arena of minimally invasive dental materials. Injectable composite resin is truly an outside-of-the-box material designed for fast application and polishing with high gloss retention. In comparison to conventional flowable composite resins, injectable composite resins can be used for long-term restorative purposes. Due to the delivery system used with these flowable composite resins, injectable composites can be used in hard-to-reach areas of the mouth. This gives the clinician another option to confidently restore all restorative classifications with direct resin. These injectable composite resins are a real game changer for minimally invasive restorative dentistry.

The idea behind an injectable composite resin (such as G-ænial Universal Flo [GC America]) is that this material combines the user-friendly aspects of flowable resins with the strength, shades, and ease of handling and polishing that is similar to sculptable state-of-the-art nanohybrid composite resins. Injectable composite resins can be used for both the anterior and posterior teeth  and results in excellent aesthetics. The unique chemistry of G-ænial Universal Flo features 200 nm strontium glass fillers homogeneously dispersed for high flexural strength, high wear resistance, and low flexural modulus.4 In this material, new silane coupling technology creates a stronger adhesion between the glass fillers and resin matrix, thereby increasing flexural strength of the resin and sustained high surface luster.

Composite resin veneers were first completed on both central incisors. Particular attention was given to create central incisors that would be mirror images of each other.  A silicone matrix was used to develop proximal, lingual, and incisal contours of the lateral incisors and canines.

After establishing correct incisal edge position, the composite resin veneers were sculpted to completion .

In closing multiple diastemas, it is important to develop correct tooth proportion to meet aesthetic needs.

With proper diagnosis, treatment planning, and treatment execution, beautiful aesthetic treatment can be achieved using minimally invasive techniques.

Universal Nanotechnology Composite Resins

The continued trend in direct restorative resins is for a material to be a universal composite resin for both anterior and posterior teeth. It is important that the material exhibit natural aesthetics that allow the clinician to easily achieve natural-looking dentition in all clinical situations. For an aesthetic material to be successful, it must reflect and refract light in a way that is close to that of natural tooth structure. When the composite resin closely matches the optical properties of the surrounding tooth/teeth, a chameleon effect is achieved that renders the restoration invisible. A new nanohybrid composite resin is showing great success because it reflects, refracts, and absorbs light in a similar manner to natural dentition, thus making it simple to achieve the highest level of aesthetics.

G-ænial Sculpt (GC America) is a strong, high-density material with uniform dispersion that was developed to have improved wear resistance and high gloss polishability for a long-lasting mirror-like surface finish. The new high performance filler features complete 360° silanization of the nanoparticles to strengthen the adhesion be­tween the nanosized (200 nm) glass particles to the resin matrix, thereby increasing the flexural strength and durability of the composite resin. This unique chemistry also gives the material a harder, ceramic-like surface and long-term wear resistance, along with outstanding handling characteristics during clinical placement. In the author’s opinion and clinical experience, G-ænial Sculpt is a true blend of strength and beauty in direct composite resin.

advances in MID