Aesthetic rehabilitation of anterior teeth using direct composite restorations

From this article you will learn:

• what is aesthetic dental restoration,
• how it is carried out, patient reviews,
• price for restoration of front teeth in Moscow.

Artistic dental restoration is an aesthetic method of restoring damaged teeth, which gives them a natural appearance by simulating dental tissues with various materials. This method differs from conventional tooth filling in that in this case it is not just about restoring the shape and function of a damaged tooth, but when the doctor tries to achieve high aesthetics (so that the restored tooth cannot be distinguished from a healthy one). In dentistry, the terms aesthetic or cosmetic can also be used to refer to this type of restoration.

The artistic restoration method is more expensive compared to conventional traditional dental fillings, which has its justification. To achieve good aesthetics, it is important to restore not only the shape of the tooth, but also its color and transparency. Restoring the latter is the most difficult, because... Human teeth have different shades and transparency all the way from the cutting edge to the neck of the tooth. Therefore, making a tooth natural in color and transparency, as well as indistinguishable from neighboring teeth, requires not only skill and more expensive filling materials, but also a lot of time.

Dental restoration: photo (restoration of the 14th tooth, i.e. the first premolar of the upper jaw)

It should be clarified that the method of artistic restoration is used not only to restore teeth destroyed by caries, but also for congenital or acquired changes in the color of the enamel, age-related abrasion of teeth, chipping of the incisal edge, as well as for changing the unsightly shape of a tooth or moderate correction of its inclination. An alternative to the aesthetic restoration of teeth with filling materials can be other methods of cosmetic dentistry - ceramic and metal-ceramic crowns, as well as veneers.

Methods of aesthetic dental restoration –

Probably, as you already understood, this article will talk about “direct restorations,” i.e. when tooth restoration is carried out using filling materials. However, there are also so-called “indirect restorations” (see below).

• Direct dental restoration – also known as dental restoration using light-curing composite material (i.e., photopolymers), and is done by dental therapists. It is this type of restoration that we will examine in detail in our article. This method also includes restoration of teeth with composite veneers, more about which you can read in the article at this link.

• Indirect dental restoration - in the manufacture of this type of restoration, an orthopedic dentist (prosthetist) takes part, as well as a dental technician sitting in a dental laboratory.
  This includes prosthetics with ceramic veneers, metal-ceramic ceramic crowns, restorative ceramic inlays. In this case, the tooth is first prepared and then an impression is taken of it. Based on this impression, an inlay, veneer or crown is made in a dental laboratory, and then fixed to the teeth using cements. For indirect restoration methods, mainly only ceramics are used - this can be Emax, zirconium dioxide, feldspathic ceramics. If we are talking about aesthetic restoration with metal-ceramic crowns, then for their metal frame they use not an ordinary cobalt-chromium alloy, but alloys of precious metals (for example, gold-palladium). Alloys containing gold give metal-ceramic crowns a more natural shade. Read more about indirect restoration methods in the articles:

→ Restoration with ceramic veneers → Restoration with metal-ceramics → Restoration with ceramic crowns

Orthodontics

A branch of aesthetic dentistry aimed at correcting bites and straightening uneven teeth.

In what ways can a bite be corrected?

This can be done using braces made of various materials or a transparent acrylic aligner, which is invisible on the teeth. Ceramic braces made to match the color of teeth are very popular. The cheapest are metal devices. The most effective are the Damon System and Damon System Q. Invisible to others are lingual braces made of metal, which are installed on the inside of the teeth. The lingual brace system “Incognito” (Germany) is very comfortable to wear.

Restoration of anterior teeth using composite filling materials –

In this chapter we will talk about how artistic restoration of the front teeth is carried out using specific examples - 1) in the first video you will see the replacement of an old, darkened restoration of a front tooth with a new one, 2) in the second video the restoration of an extensive chipped front tooth is shown. These videos perfectly demonstrate how artistic aesthetic dental restoration differs from conventional tooth filling.

For example, a special cast is used here to accurately restore the palatal surface of the tooth, as well as a layered restoration technique, which allows, by combining filling materials of different shades, to obtain an aesthetic result that is close to ideal (so that the restored part of the tooth does not differ in color and transparency from the natural tooth tissues). In fact, not all dentists have such skills, and there is no doubt that a certain artistic talent is needed.

Restoration of anterior teeth: video

The main stages of dental restoration:

1. Preparation for restoration - at this stage it is necessary to hygienically clean the teeth from plaque and tartar, determine the color of the tooth being restored using a special scale and, in accordance with this, select the colors of the composite filling materials that will be used in the restoration process.
2. Local anesthesia (if necessary)
3. Drilling out tissues affected by caries - if an old unsatisfactory-looking restoration is being replaced, then the old filling is drilled out.
4. Isolating a tooth from saliva - the use of cotton balls is almost universally a thing of history.
   Their use does not allow reliably isolating the tooth from saliva, as well as from the patient’s wet breath, which also significantly worsens the quality and reliability of fillings and restorations made of composite filling materials. Now a rubber dam is used for this purpose. It is a latex scarf with holes for the teeth, which is pulled over the teeth. Composite dental restoration performed without reliable isolation from saliva and wet breath may not last long. Firstly, excessive moisture will cause a violation of the marginal seal of the filling to the tooth tissue, which can lead to the appearance of a dark strip or caries at the filling/tooth interface. Secondly, your restoration may simply fall out at one point, because... moisture impairs the adhesion of filling material to tooth tissue.
5. Fixing the pin in the canal - this stage is carried out if the crown of the tooth is destroyed by more than 1/2 and the tooth is pulpless. In this case, it is necessary to strengthen the filling by installing a pin, otherwise the restoration may fall out under load (24stoma.ru).
6. Restoring the shape of a tooth with filling material – to make the tooth look natural, the layered restoration technique is used. In this case, layers of filling material of different shades and different transparency are applied to each other, which together then give the tooth a natural appearance. And this is real art.
7. Finishing of the tooth – finishing should be understood as the final modeling of the tooth shape using burs, as well as grinding and polishing of the filling.

Historical reference

Human civilization has strived for aesthetic perfection, including dental perfection throughout history. The desire to “create beauty” was characteristic of all eras and peoples, although in different parts of the world ideas about the beauty of the dentition differed and were often very specific. For example, archaeological finds of the remains of skulls of representatives of the Mayan people made it possible to establish that even then cosmetic contouring of teeth was carried out: they were specially sharpened, and for a greater “effect” they were decorated with inlays of precious stones.

In South America and Central Africa there was also a custom of sharpening teeth. On the island of Bali, using a method called grinding, women ground off their enamel, because... dark teeth were considered an aesthetic ideal.

In ancient times, the so-called postulates of beauty appeared, which subsequently influenced the aesthetic canons of our time. They concerned not the “creation” of beauty, but the proportions that determine it. For example, the ancient Greek sculptor Polykleitos determined that the height of the face fits into the height of the body 10 times1, and it was thanks to his discovery that in modern aesthetic dentistry the concept of physiognomic height of the face * appeared, and it became obvious that it is the teeth that hold, preserve, and determine proportions the lower third, and, accordingly, the entire face. Another important discovery for aesthetic dentistry was the law of equality of the frontal, nasal and oromental sections, discovered by the great Michelangelo.

In the 20th century (60s), the scientist Ricketts found that the law of the golden ratio “works” in aesthetic dentistry. Soon after this, aesthetic dentistry began to develop very actively and with every decade it provides people with more and more new opportunities to improve the aesthetics of their teeth. Most of these opportunities relate to aesthetic dental restoration.

Restoration of chewing teeth –

In videos 3 and 4 you can see how the restoration of chewing teeth is carried out with composite filling material. In video 3, the restoration can hardly be called “artistic”, because... The chewing surface of the tooth with all its fissures was restored only “satisfactorily”. However, this video does a good job of showing the restoration of the side walls of the tooth and the contact points between the teeth. Video 4 shows the final stage of a truly artistic restoration.

Treatment methods

Depending on the clinical picture and the set of problems that need to be solved, it is recommended to resort to one of the treatment methods: direct or indirect.

The direct method involves the immediate elimination of defects such as chips and cracks. The extension occurs directly in the oral cavity, in just one visit to the doctor, which is why the method is called direct. This includes artistic extensions using light composites.

The indirect method is prosthetics. It involves the installation of special structures, the manufacture of which is possible only after taking an impression. That is, restoration will require at least two visits to the doctor - first, the teeth are prepared and impressions are taken, after which the dentures are created in the laboratory. At the second stage they are fixed. This includes the installation of veneers, lumineers and crowns.

Dental restoration: prices in clinics

For dental restoration, the price in different dental clinics will vary greatly, but truly high-quality aesthetic work in this case definitely cannot be cheap. To obtain a close to ideal aesthetic result, you need an experienced dentist with certain skills, training for which costs a lot of money, more expensive filling materials are also required, as well as a significant investment of time. All this increases the cost of the service.

When choosing a doctor, it is not enough to rely on reviews - ask to see before and after photos (of real patients treated in the clinic). It’s usually not worth relying on photographs on clinic websites, because... Most dental clinic websites do not post their own work, but pictures copied from the Internet. Below we will calculate the cost of dental restoration in a mid-price clinic (prices in premium segment clinics can be 2 or more times more expensive).

1) Complete restoration of the tooth crown –

In photos 7-9 you can see a real case of artistic restoration of the front teeth, performed with the crown part completely missing. When restoring tooth crowns, fiberglass pins and a composite light-curing filling material were used. For such dental restoration the cost will be no less than 6,000 rubles per tooth.

Restoration of anterior teeth: before and after photos

The cost of a complete tooth restoration consists of the following items.

• Anesthesia – from 400 rub.
• Applying a rubber dam to isolate a tooth from saliva – from 700 rubles.
• Sterile kit – from 150 rub. this includes: a mask and gloves for the doctor, shoe covers and a bib for the patient, the cost of sterilizing the instrument.
• Restoring a crown from a light composite costs about 3,500-5,000 rubles.
• Fixation of a WDW fiberglass pin in the channel – RUB 1,500.
  this is a very important stage (Fig. 8)! The pin is necessary to prevent premature breakage of the restored tooth crown due to the fact that it will experience significant mechanical stress when chewing and biting off food. For the restoration of front teeth, it is very important that the pin is fiberglass and not metal - otherwise the metal will show through the filling material and the crown of the tooth will be bluish in color. Of course, you can install cheaper pins, for example: a) a metal pin (cost 50 rubles), but in this case, the restored tooth will not have the same transparency and natural shade “like natural teeth.” Although for teeth that are not included in the smile line, this is not so scary. b) Russian-made fiberglass pin (cost 50 rubles), but such pins also do not have proper light conductivity, and in addition have insufficient adhesion (stickiness) to filling materials. This leads to their poor fixation in the root canals and the risk of the “extended” tooth falling out along with such a pin. Total: the cost of tooth restoration is from 5,000 to 7,000 rubles.

2) Restoration of half a tooth –

If a full crown restoration (using a fiberglass pin) costs 5-7 thousand rubles, then restoring half a tooth crown without a fiberglass pin, but taking into account all other costs, will cost approximately 1500-2000 rubles less. Total: from 3500 to 4000 rubles.

3) Restoring a chipped cutting edge of a front tooth –

Restoring the angle of a tooth crown using a light-polymer filling material will cost from 1,500 to 3,000 rubles (depending on the amount of work/size of the chip).

A good clinic is important!

Startsmile recommends that you take your choice of an aesthetic dentistry clinic seriously, since any dental correction requires high skill and deep knowledge from an aesthetic dentist. All dentists offering services in the field of aesthetics, presented in the Startsmile catalog, work at the highest level and according to international standards, and also have positive reviews from patients.

Our smile is the first thing that others notice and appreciate; a smile is our ticket to the world of opportunities, which is why it is so important for us not to be ashamed of it and not to be afraid that something is wrong with it. Problems with the aesthetics of a smile, no less than problems with excess weight, depress our psychological state and provoke stress and even nervous breakdowns. This is one of the reasons why aesthetic dentistry today occupies a well-deserved equal place among other dental disciplines.

Publisher: Expert magazine about dentistry Startsmile.ru

Dental restoration: reviews

Very often, patients are dissatisfied with the way the restoration of the front tooth was performed (in terms of its shape, color and transparency).
Those. First of all, complaints are made specifically about insufficient aesthetics, and often the restored tooth simply looks like a real plastic crown, i.e. artificial and unnatural, standing out against the background of natural dental tissues. Examples of unsuccessful dental restorations: photos

Restoring aesthetics during restoration has 3 key points:

• Tooth shape - in fact, the work of restoring the anatomical shape of a tooth is very similar to the work of a sculptor who sculpts his model, but not from clay, but from filling material. Try to mold a tooth from simple plasticine with all its surfaces, cusps and fissures. I think that you will immediately understand that this requires a certain talent and artistic flair.
• Tooth color – it is necessary to achieve full matching of the shade of the restored tooth with the shades of neighboring teeth.
  Filling materials have numerous shades (colors). For example, one factory package of Filtek filling material may contain 20 syringes of the material, each of which will have its own shade. The possibility of layer-by-layer application of a material with one shade onto a material with another shade (i.e., their combination) allows you to ultimately obtain all kinds of color combinations. Unfortunately, most dentists simply do not know how to use all the possibilities of modern filling materials and “play” with colors. The problem is further aggravated by the fact that the color of the tooth in the direction from the cutting edge to the neck of the tooth is always different, it changes, and this also needs to be taken into account. Otherwise, the restored tooth will be completely different from the patient’s neighboring “native” teeth.
• Transparency of the tooth - in addition to the fact that the tooth changes its color in the direction from the cutting edge to the neck of the tooth, the transparency of the tooth also changes in exactly the same direction. Therefore, when restoring the cutting edge and cusps, those filling materials are used that, after exposure and curing, will have higher transparency.

What are lumineers and how are they different from veneers?

Many people have heard about Lumineers, but few know what it is. Essentially, these are the same veneers, only manufactured at a factory in the USA. Lumineers is a brand of an American manufacturer that has become a household name, like Pampers or Xerox. And it is often used by dishonest dentists to promote conventional veneers. No one can make lumineers for you; they can only be ordered in the USA. We do not work with this product because, in our opinion, it is not ideal aesthetically. In appearance, such ceramics resemble sanitary ware. Making porcelain veneers in a laboratory will be much cheaper and the results will be more attractive.

Disadvantages of restorations –

1. Restorations darken and lose their shine over time - fillings and restorations made from light-polymer filling materials tend to gradually darken. In addition, they lose the shine characteristic of healthy tooth enamel. If the loss of aesthetics on chewing teeth is not so terrible, then on the front teeth it is very unpleasant. Not very good restorations will have to be replaced every few years, but high-quality restorations should require periodic care (you need to visit the dentist once a year to polish them) - then their aesthetics will last longer.
2. Risk of breakage of restorations - if your tooth is destroyed by more than 1/2, and especially if it is also depulped (nerve removed), and you still want to chew meat, then there is a risk of breakage of the restoration.
   Depulped teeth are much more fragile than living ones. Particularly often, restored teeth break when the tooth is restored completely from the root. If the chewing load suddenly exceeds the strength limit of the restored structure, the restored part of the tooth breaks off. Sometimes this even causes a fracture of the tooth root (with the need for its subsequent complete removal). What is the best way to restore a tooth if it is destroyed by more than 1/2 - this is where indirect aesthetic restorations will help us, because ceramic crowns, veneers, etc.

Contraindications

If the patient has periodontitis, caries, bruxism, a small amount of enamel on the teeth, as well as in the case of some occlusion pathologies, insufficiently erupted teeth, it is first necessary to eliminate the existing pathology, and then carry out aesthetic restoration. At the same time, contraindications include malignant tumors during radiation or chemical therapy and some time after its completion, diseases of the skeletal system that reduce its regenerative capabilities, diseases of the circulatory system that impair blood clotting, serious diseases of the heart, central nervous and immune systems, intolerance anesthesia, mental disorders in the acute stage.

Alternatives to composite restorations –

An alternative to composite filling materials is ceramics, i.e. veneers, crowns, restorative inlays made from ceramics. The price corresponds to the quality, and therefore the cost of ceramic restorations will be significantly higher than composite dental fillings.

• Veneers – if your front tooth is destroyed mainly only on the front side, and the lingual part of the tooth is not very damaged, then in this case the best alternative to restoration would be a ceramic veneer. Precisely from ceramics, because ceramics do not darken at all and do not lose their shine over time. The only drawback of this type of prosthetics is its cost.

• Crowns (metal-ceramics or ceramics) - if your tooth is destroyed by more than 1/2 and especially if it is also depulped, we recommend abandoning restoration in favor of an artificial crown. By the way, restoring a tooth “from the root” costs the same as it costs to restore a tooth with a metal-ceramic crown.
• Inlays - if you need to restore a lateral chewing tooth, then an alternative to restoring a tooth from a composite filling material can be a restorative inlay. In terms of reliability, service life and aesthetics, ceramic inlays are at least 3-4 times superior to restorations. We hope that our article was useful to you!

Sources:

1. Personal experience as a dentist, 2. National Library of Medicine (USA), 3. Harvard Medical School (USA), 4. “Adhesive ceramic restorations” (Manier P.), 5. “Aesthetic dentistry and ceramic restorations ( Tuati B.).

Stages of restoration with ceramic veneers

1. Preparatory. The dentist performs the procedure of taking an impression of the existing dentition.
2. Based on the bite, a technician in the laboratory creates a plastic model of future teeth, which is tried on the patient.
3. If the patient is satisfied with the appearance of the teeth and the way they fit in the mouth, the technician makes ceramic veneers.
4. Then, after grinding the patient’s teeth, the veneers are permanently bonded to the surface of the teeth.

After installation of veneers, there is no expected recovery period. The first few days the patient may feel slight discomfort due to the pads, but this quickly passes. A prerequisite for patients with veneers is regular oral hygiene and preventive examinations by the dentist.