Composite restorations are a wonderful alternative to the traditional amalgam restoration. For smaller carious lesions, composites are not encumbered by the need for macro-mechanical undercuts locks nor other traditional form factors. Composite restorations allow us to minimize the sacrifice of sound tooth structure and provide minimally invasive, conservative dental restorations.
111 Deerwood Rd, #350
San Ramon, CA, 94583
(925) 718-8970
Family & Cosmetic Dentistry
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This patient came to our office as an emergency patient with a fractured the upper right central incisor to the level of the dentin. Treatment options considered included preparing the tooth for a crown or veneer, or more conservatively, doing the restoration with composite filling material. We decided to pursue the third option, utilizing multiple layers of composite of varying shade and translucency. The aesthetic result is greater depth of color and a more natural finish to the composite restoration than the adjacent porcelain-fused-to-metal crown. Additionally, the restoration was completed chairside without the use of local anesthetic, with minimal loss of existing sound tooth structure, and the patient was able to return to work with a final restoration immediately following the treatment.
The patient came to our office with the fractured tooth and missing filling. In this case, there is a likely clenching habit (which can be diurnal, nocturnal, or both) that lead to failure of the existing restoration and tooth structure. Over time, the hole in the tooth allowed for the accumulation of food debris, plaque and bacteria, leading to the formation of cavities within the hole and under the failing, fractured existing restorations.
Removal of caries shows that the lesion is significantly larger than the first image would suggest. The infected areas of tooth and existing filling material were selectively removed. Then the tooth was restored using multiple layers of composite material.
This patient presented to the office for a check-up without any pain or discomfort. During the exam we noticed a small hole on the surface of a molar. Radiographs showed a large cavity in the tooth.
Upon opening the tooth, it was easy to see a very large cavity beneath the small surface hole. The second image of the slideshow is prior to final excavation and removal of the caries within the cavity. Despite the large size of the cavity within the tooth, we kept our opening as small and conservative as possible.
The tooth was restored with composite material placed in small increments. An opaque shade was selected to differentiate the patient's sound tooth structure from the composite.
Patient before treatment -- significant loss of enamel with heavy staining
Please note that lighting values were kept as similar as possible between before and after images
This patient presented to the office with multiple deep, heavy stains on their teeth. The patient is very diligent about their toothbrushing, often brushing multiple times per day. This is reflected in the patient's pink, healthy gingiva (we can even see small specks of blue, likely from the patient's toothpaste). The patient also has a history of acid reflux. The patient felt very embarrassed about their teeth and their smile due to the heavy staining, which they said even affected their level of happiness and social behavior. The patient was confused and frustrated by the staining despite their meticulous brushing regimen. In this case, a combination of heavy brushing and acid reflux likely contributed to the loss of tooth enamel, leading to exposure of the underlying, rougher dentin or roughened enamel. Their previous dentist recommended crowns and veneers to correct the situation, but the patient was concerned about the loss of tooth structure during preparation of teeth and cost associated with the treatment plan.
Patient after composite restorations -- minimal tooth structure sacrificed. Multiple layers of differing shades and opacities of composite used to mimic natural tooth structure
The patient was presented with several treatment options, but ultimately decided to try composite restorations to restore tooth structure and ultimately, their smile. While the final restoration is not perfect, nor necessarily as stable or aesthetic long-term as fixed restorations, such as crowns and veneers, we were able to achieve a level of aesthetics that was acceptable to the patient without sacrifice or loss of appreciable tooth structure. We purposely kept the shade off white for a more natural look. In the future, if the patient decides to bleach her teeth, we can modify the composite shade to match. Composite restorations also allow for relatively easy modification of shape or shade, or can be used to assess form and aesthetics for later fixed restorations, if the patient desires, with minimal sacrifice of tooth structure for preparation.