Making Conservative Restorations More Accessible: Additive Dentistry and Your Practice

When it comes to esthetic dentistry, patients have high expectations. Direct composites are both an affordable and conservative option for creating beautiful, esthetic restorations and, in some cases, offer a welcome alternative to porcelain veneers. While creating “freehand” direct composite veneers can be technique sensitive and time-consuming, we have seen an evolution in both products and techniques that make these restorations easier to create, further expanding the tools at the clinician’s disposal.

Additive composite techniques support minimally invasive dentistry

Minimally invasive dentistry is a treatment philosophy that involves choosing the most conservative option for every clinical decision. According to an analysis published in the November, 2021 issue of The Journal of Prosthetic Dentistry, “Considerable advancement has been made in minimally invasive dentistry, as demonstrated by the increase in the number of publications linked with collaboration among various authors, nations, and institutes.”¹ Along with increased research on the topic, clincians report that more and more patients are expressing a desire to preserve their natural tooth structure, for example, after orthodontic treatment. Porcelain veneers require, in many cases, tooth preparation and removal of healthy enamel – but with additive composite techniques, we can offer patients a non-invasive, conservative, and esthetic alternative.

Benefits of additive composite dentistry

Direct composites present a number of advantages for both patients and dental practices, including conservation of tooth structure, the ability to provide same day dentistry, repairabilty, and affordability. Composites have become the obvious choice for small fractures and carious lesions in the anterior region, and are also used extensively to restore larger coronal defects. New matrix systems further facilitate the use of advanced composite materials in practical, predictable ways for more challenging clinical cases, like closing black triangles and creating ideal tooth contours in multiple-unit anterior cases, as seen below.

Image 1: Black triangle closure using the Bioclear™ Black Triangle Matrices and method. Images courtesy of Dr. Charles Regalado, DDS

Image 2: 6 Composite Veneers using the 3M™ Filtek™ Matrix. Images courtesy of Dr. Lois Duerst, DDS While there are inherent optical and esthetic differences between composites and porcelain ceramic materials, composites today have evolved to allow for natural light reflection and translucency and blend naturally into the surrounding dentition. In addition, opaquers are available to mask darkened enamel, tetracycline stains, and even amalgam tatoos, thereby providing a clean canvas on which to create a natural-looking, esthetic restoration. For patients who are considering a cosmetic change to their smile, it’s often comforting to know that composites are easy to adjust, modify and repair as needed, as opposed to indirect porcelain veneers. Additionally, composite restorations wear similarly to natural tooth structure, while insufficiently polished porcelain may wear the patient’s opposing dentition.²

Addressing affordability for patients, and profitability for providers

When it comes to esthetic dentistry, many patients want treatment but can’t afford indirect restorations. No matter how beautiful porcelain veneers may be, they are sometimes simply out of reach financially. This is especially true for younger patients just starting out in their careers or older patients on a fixed income. Having said that, income limitations don’t change the fact that everyone wants and deserves a beautiful smile. Creating form and symmetry using free-hand techniques requires a high level of technical skill and increased chair time, which may increase the cost to your patients.³ However, utilizing additive composite techniques and matrix systems that are efficient, predictable, and deliver highly esthetic outcomes can benefit your practice.

Feeling Good About Additive Composite Dentistry

Clinicians and patients alike want to preserve tooth structure and achieve beautiful results. As such, it can be incredibly rewarding to be able to help patients who may otherwise not be able to afford the smile of their dreams. While porcelain veneers may be the ultimate esthetic solution, today’s materials, techniques, and matrix systems provide more conservative, esthetic, and cost-effective options than ever before. By expanding your additive composite dentistry skills, you can provide solutions for the unmet needs of your patients, as well as discover opportunities to grow your practice.