Typically, dental esthetics are measured by the look of the front teeth. A recent report projects that growth in esthetic dentistry in the United States will approach $30 billion by the year 2024, due, in part, to an aging generation of baby boomers.1
There are a number of ways to fix a less-than-stellar anterior appearance. And whether treatment is direct or indirect, artistic skill in shade matching, contouring, creation of life-like characterizations, and finishing and polishing comes into play in addition to clinical know how.2 Fortunately, new technologies and material developments have gained significant ground in both mechanical and esthetic respects over the past several years.
Composite resin is usually the material of choice for direct restorations in anteriors. Composite dental materials are typically composed of a resin matrix and inorganic fillers ranging from silica and glass to ceramics and crystalline quartz. Fillers affect viscosity and other characteristics, including handling, wearability, strength and esthetics.3
Composite materials have undergone generational changes since the macrofills of the 1960s. It’s taken a while to find the right mix of particle density, sizes and shapes, but developers seem to have hit on a winner. By using a well-bonded mix of very small filler (nanosized) particles, they are concocting materials capable of creating strong yet dazzling restorations.3
Currently, nanofilled, and nanohybrid composites appear to be the materials du jour because they feature a broader mix of particle sizes than nanofills. Nanohybrids, in particular, are garnering attention for their esthetic properties and strength.3
Offering a wide range of colors, lifelike translucencies and excellent polishability, such restoratives allow the creation of fine details and characterizations in anterior applications. These materials also reportedly offer easy handling and sculptability, low polymerization shrinkage, and can be used throughout the mouth. Some of the most recent formulations are also endowed with bioactive properties that can support minimally invasive treatment of early-stage caries.3
When indirect restorations are indicated, feldspathic porcelain restorations are considered by many clinicians to be the essence of high art for anterior restorations. With their beautiful, layered translucencies and characterizations, they can pass for real teeth.2 But porcelain is brittle and has a tendency to fracture under certain conditions. If fortified with a metal substrate, as in porcelain-fused-to-metal crowns, it’s not uncommon for the metal to show around the margins and cast a gray shadow through porcelain.4
Other ceramic materials, such as lithium disilicate and zirconia, have entered anterior restoration territory with the advent of computer-aided design and computer-aided manufacturing. Particularly in the case of zirconia, esthetics have vastly improved from restorations that look like they fell out of a Chiclet box to those that are truly translucent, with gradations resembling natural dentition.4,5
Improving the Odds for Anterior Excellence
Whether you’re performing direct or indirect restorations, composite resin probably figures into the equation. Therefore, isolation spells success. What better way to keep moisture and soft tissues under control than with integrated systems such as Isolite 3, Isodry and Isovac?
These systems not only offer evacuation and retraction, but obturate your patients’ throats and airways, protecting them from aspiration or swallowing of any restorative by-products that might go flying. And the LED white light on the Isolite 3 provides illumination, while its true amber light will not interfere with light-sensitive materials.
Restorative materials have come a long way since the days when amalgam was the only choice. It will be exciting to see what new developments are poised to elevate dentistry to the next level.
- Grand View Research. Market research report: Cosmetic dentistry market analysis. Available at:https://www.grandviewresearch.com/industry-analysis/cosmetic-dentistry-market. Accessed January 25, 2019.
- Stone R. Second nature. Mentor. 2018;9(2):20–25.
- Stone R. Leave no trace. Mentor. 2017;8(7):18–22.
- Stone R. Haute pursuit. Mentor. 2017;8(5):22–29.
- Lowe R. A zirconia option for anterior restorations. Dentistry Today. Available at: https://www.dentistrytoday.com/dental-materials/10280-a-zirconia-option-for-anterior-restorations. Accessed January 25, 2019.