Aesthetic composite fillings are a direct restoration performed in one visit reproducing the natural color and shape of the tooth. This breakthrough technology in which the refractive index of the composite is identical to that of natural tooth enamel results in a restoration that meets the most demanding expectations of optical and aesthetic properties. The result is a very natural filling with no visible transition line.

The modern nano-hybrid composite restoration materials that we use in our clinic show clinical advantages, such as:

– chameleon and opalescence effect,  natural fluorescence (reflecting light like a natural tooth which adapts to the color of the treated tooth and neighboring teeth)

– minimally invasive preparation that preserves tooth tissue

– stabilization and durability due to the (chemical) adhesive connection of the filling with the tooth enamel and dentine

– the optimal composition of the filling particles translates into a high level of polishability and a superior cosmetic effect

– the highest quality components guaranteeing high flexural strength

– reduction of polymerization shrinkage in nano-composites allowing obtainment of very tight fillings

Such good clinical results stem not only from improvements in adhesion binding techniques (chemical bonding of tooth tissues with enamel and dentin), but also from significant improvement of the physical properties of hybrid composites compared to older materials with micro and macro fillers. Nano-hybrid composites were created on the basis of micro-hybrid materials through the use of nano-fillers. This has led to a significant increase in filler content in these materials and a significant improvement in their physical properties.

Composite fillings are used as an alternative to prosthetic restorations performed indirectly, such as inlays, onlays, overlays, crowns, or veneers.

Modern nano-hybrid composites are used for minimally invasive, yet permanent restoration in the anterior and lateral areas. They combine optimum aesthetics, ideal polishability, and tightness and stability of the restoration for an extended period of time.

The choice of treatment method – direct method performed wholly in the office or indirect method requiring preparation in a technical laboratory – depends on many factors, and the doctor, in consultation with the patient, chooses the appropriate treatment method.

Factors affecting the type of the planned filling depend, among others, on:

– the size of the planned restoration

– aesthetic requirements of the patient

– oral hygiene

– tendency of discoloration (consumption of large amounts of coffee or tea, smoking)

– occlusion issues (bruxism, grinding, crowding of teeth, missing teeth)

In the case of larger restorations, a reconstruction visualization is recommended before the planned treatment. This involves a mock-up based on diagnostic waxing ( wax-up) and a silicone index allowing the desired shape to be given to the restoration.

This type of visualization is done in a technical laboratory based on a tooth impression.

Unfortunately, not every patient is eligible for this type of reconstruction, and the patient will learn about possible treatment alternatives at the consultation visit after individual examination of the oral condition.

ICON – modern, minimally invasive treatment by dentine infiltration

ICON is a modern method of treatment of early stages of tooth decay involving the infiltration / reinforcement  of the weakened tooth surface with resin. Infiltrant, or liquid resin, is absorbed into the carious system of micropores in the damaged tooth, filling them and blocking the penetration of bacteria and acids responsible for the development of tooth decay. Thanks to this, early caries can therefore be quickly stopped, while preserving tooth tissue, without the need to use a drill, with medical benefits, without anesthesia, and often with fully aesthetic results.

This technique was developed by the German pharmaceutical company DMG in cooperation with the Charite Institute in Berlin and the University of Cologne.

Air and water trapped in carious lesions have a lower refractive index than the healthy hard tissues of the tooth. This causes unsightly discolorations known as white spots.  ICON, which penetrates deeply into the porous tissue of the tooth, has a similar refractive index to healthy enamel. Of course, the most important effect of the ICON method is strengthening the surface of the weakened tooth and significantly reducing the risk of the carious process developing further, but additionally through resin infiltration, the white spot can disappear completely, decrease in visibility, or become similar to the surrounding healthy enamel.

Indications and contraindications

The indications for the procedure are incipient carious lesions without loss of enamel, not exceeding one third of the dentine depth. ICON is often used to reduce the aforementioned white spots (e.g. caused by orthodontic correction, fluorosis, or poor hygiene).

ICON cannot be used in cases of advanced caries. This applies in particular to the case of caries which present as a proper tooth cavity. In this case, a traditional method of treatment is necessary.

Advantages of the ICON method

• Strengthens the tooth surface and arrests the progression of early enamel lesions
• Provides an aesthetic and minimally invasive treatment of white spots
• Restores the natural color of the tooth
• Gentle method of treatment without drilling and without anesthesia
• A friendly method of treatment for the patient
• Satisfactory effect often in one or two visits

Procedure

In order to achieve the desired effect, it is important that the procedure is preceded by hygienisation (comprehensive cleaning of the teeth with the use scaling and sandblasting along with surface polishing), so that the resin comes into direct contact with the weakened surface of the tooth. Whitening may also be helpful in achieving a full aesthetic effect.

Veneers are aesthetic prosthetic devices in the form of very thin porcelain “flakes”, with a thickness of 0.4-0.8 mm, which are placed on the labial surface of the teeth. Depending on the width of the smile, you can put them on all the front teeth from cuspid to cuspid or even from first bicuspid to first bicuspid. In this way, the shape and color of the teeth can be improved very quickly.

Patients have many types of veneers to choose from:

1. composite – which has the advantage of fast execution time and low price, but has the disadvantage of a tendency of discoloration or yellowing over time
2. porcelain (ceramic) (leucite, feldspar, with zirconia, with aluminum oxide)
3. all-ceramic ultra-thin veneers (| Soft, Veneers, Nobel Procea) up to 0.3mm thick which do not require grinding – used in very small corrections of the shape of the teeth

Indications for veneers:

1. teeth resistant to whitening

• discoloration after treatment with tetracycline
• bleaching failure

2. significant morphological anomalies

• peg teeth
• diastema and open interdental spaces
• excessive incisal edge

3. extensive reconstruction

• extensive fractures of the tooth crown
• extensive enamel loss resulting from wear or grinding
• generalized morphological anomalies (congenital or acquired)

Thanks to veneers we can:

• correct the shape of the teeth
• close diastema and gaps between teeth
• aesthetically rebuild a partially damaged tooth
• change the color of teeth, cover discoloration or stains
• correct the position of the tooth in the arch

Advantages of porcelain veneers:

• little preparation of tooth tissue
• very good cosmetic effect – unchanged appearance and color throughout the period of wearing the veneers (they do not discolor)
• porcelain is well-tolerated medically

Contraindications:

• high tendency to caries
• oral para-functional activity, teeth clenching, grinding
• poor hygiene
• very short teeth

Crowns are recommended for teeth after root canal treatment and rebuilt with root fiberglass inlays  because teeth that have been treated endodontically are often significantly damaged (having large fillings), which makes them more susceptible to fractures.  In such cases, a crown protects the tooth from all sides.

However,  in some cases a veneer can be used despite root canal treatment if the loss of tooth tissue is small.

Porcelain veneer procedure:

At the first visit, an impression is made based on which the technician creates a wax-up in the laboratory, that is, the technician designs the shape of the prosthetic from wax on plaster models.

During the next visit, the dentist performs a so-called mock-up of the final prosthetic on the patient’s teeth. Any corrections are discussed with the patient at this time. After patient acceptance, tooth preparation for veneers begins.

Next, impressions are taken and sent to the dental technician. The prepared teeth are secured with temporary veneers made of composite.

After the laboratory completes the necessary work, the patient reports for the fitting and the final bonding of the veneers.