Veneers or composite...

[JavadiCavity]

---

Members do not see this ad.

50 year old patient presented to clinic the other day with chipped and worn incisal edges from 6 to 11. Pt. gave me the green light to add composite to the incisal edges of 8 and 9. A week later, Pt. returns and is really happy with the results and wants to do the same thing to 6, 7, 10, and 11. The occlusion looks good with zero protrusive interferences. At this point I talk to him about Veneers as an alternative to Class IV composites. Pt. decides he'd like the veneers. Pt returns a couple of weeks later to start the Tx plan, and the supervising Dr. convinces the pt. that veneers are not the best option. Instead, the Pt. should go with the composites.

At first, I was annoyed. But, after completeing more of the work (7 and 10) and seeing that he looks good, I decided that composites weren't such a bad idea. Since then, I've been bouncing the following question around in my hiead: Have I been conditioned by dental school and the media to prefer one treatment option over others? And, what other treatments (i.e. implants vs. bridges or alloy vs. compositeis) do I also erroneously prefer?

Here are some pictures of the results. I assumed composite wouldn't look as good as veneers, and perhaps they don't from a dentist's perspective, but my pt. has been really happy with the results. You'll notice that I still need to finish up 6 and 11.

Before
http://bp0.blogger.com/_O7i2x2ShrW4/Ral57jZrXzI/AAAAAAAAAAM/EiBbsMBf0qU/s1600-h/Before.jpg

After
http://bp0.blogger.com/_O7i2x2ShrW4/Ral57jZrX0I/AAAAAAAAAAU/lZl2Mss0YJs/s1600-h/After.jpg

Perhaps in the future I should be a bigger fan/proponent of a simple touch up with composite.

 

[12YearOldKid]

You did a nice service for your patient there. I love doing anterior stuff in composite. It's a fun challenge and the patients are always grateful. But in this case, I think porcelain would have looked better. Not because your work was lacking, just because he could have benefitted from changing the entire appearance of the teeth.

My concern with those types of restorations is that there is a good chance the composite will start staining, probably within the first few years. If the patient is a tea drinker, all bets are off. Thoughts?

 

[gryffindor]

I agree that although your result is nice, veneers would have looked nicer, if your patient's chief complaint suggests it. You were not erroneous at all to suggest a veneer if the patient wanted optimum esthetics. I would think that if cost was an issue or the teeth were pristine except for a tiny incisal corner chip, then the composites are a good alternative to fix the incisal edges.

There are some stickler faculty who like yours will convince patients of a treatment plan opposite of what you were thinking. You know, like the dentists who insist that amalgam is the only material that belongs in the posterior, even though you patient is begging for "no silver." Neither option is wrong. That's what's nice about dentistry, there are lots of ways to solve problems.

 

[HuyetKiem]

I've had similar case recently. My preceptor's approved for 3 different treatment plans :

1. optimal : veneers
2. first alternate: procera crowns
3. second alternate: composites

I will present those treatment plans with pros and cons and let the patient decide.

Peace of mind 🙂 🙂 🙂

 

[deeyala]

Have I been conditioned by dental school and the media to prefer one treatment option over others? And, what other treatments (i.e. implants vs. bridges or alloy vs. compositeis) do I also erroneously prefer?

Probably it has more to do with school.
I've been personally taught that class IV composites don't last unless the broken part is tiny, because of stress concentration on the incisal portion of anterior teeth and so..
So i would have personally gone for veneers..
BUT 1)it's your patient's desire, and you've got to listen to what he has to say
2)they look wonderful
3)they're MUCH more conservative

SO we can always give it a try and see how it takes the occlusal stress and biting force....etc and go for a veneer, IF it turned out as unsatisfactory..

You did the right thing

 

[deeyala]

That's what's nice about dentistry, there are lots of ways to solve problems.

I always thought of that as one of the "not so nice" aspects of dentistry
It sort of always makes me wonder , did i do "the" right desicion...

 

[OceanDMD]

Obviously the first thing to take into consideration is the financial aspect. Nice job with the bonding, if a patient does not have limitations financially I would not have offered bonding as a longterm viable option. From your after picture you can see the "stained" interproximal restorations on 7 and 8. I would just about guarantee that in 5 years this patient's bonding will likely be either chipped or stained. With todays porcelains, you can do a conservatively prepped veneer (pressed veneers need less reduction for stability) and have great LONGTERM results for patients. If this were your smile, what would you want to have done?

 

[DrJeff]

50 year old patient presented to clinic the other day with chipped and worn incisal edges from 6 to 11. Pt. gave me the green light to add composite to the incisal edges of 8 and 9. A week later, Pt. returns and is really happy with the results and wants to do the same thing to 6, 7, 10, and 11. The occlusion looks good with zero protrusive interferences. At this point I talk to him about Veneers as an alternative to Class IV composites. Pt. decides he'd like the veneers. Pt returns a couple of weeks later to start the Tx plan, and the supervising Dr. convinces the pt. that veneers are not the best option. Instead, the Pt. should go with the composites.

At first, I was annoyed. But, after completeing more of the work (7 and 10) and seeing that he looks good, I decided that composites weren't such a bad idea. Since then, I've been bouncing the following question around in my hiead: Have I been conditioned by dental school and the media to prefer one treatment option over others? And, what other treatments (i.e. implants vs. bridges or alloy vs. compositeis) do I also erroneously prefer?

Here are some pictures of the results. I assumed composite wouldn't look as good as veneers, and perhaps they don't from a dentist's perspective, but my pt. has been really happy with the results. You'll notice that I still need to finish up 6 and 11.

Before
http://bp0.blogger.com/_O7i2x2ShrW4/Ral57jZrXzI/AAAAAAAAAAM/EiBbsMBf0qU/s1600-h/Before.jpg

After
http://bp0.blogger.com/_O7i2x2ShrW4/Ral57jZrX0I/AAAAAAAAAAU/lZl2Mss0YJs/s1600-h/After.jpg

Perhaps in the future I should be a bigger fan/proponent of a simple touch up with composite.

One of the keys to the success of your treatment plan (nice job BTW👍 ) is the demographics of the patient. Most 50 year old men, have very simple esthetic requirement, where to generalize, "as long as it looks like a tooth, its fine". You fixed the irregular shaped edges, made the patient happy, discussed options with him, you did a good job. Now to generalize again, if this was a 35-55 year olf FEMALE, then esthetics tend to be a bigger issue, and the greater control of the esthetics you can get with porcelain might have been a better option.

You always have to remember to treat the person and not just the tooth.

 

[Mach band]

At UCSF, we were taught as follow:
- Porcelain veneer:
Plus: aesthetic, great longevity, stain resistance, less technique sensitive
Minus: may require wax-up, most insurance do not cover, many visits, more tooth reduction
Ideal for: discolored teeth, slightly rotated/mis-aligned teeth, lengthen short/fractured teeth, enlarge small teeth, large diastemas
- Direct composite:
Plus: immediate results, moderate costs, flexibility in design and adjustment, less tooth reduction
Minus: longevity, stain resistance, strength, long appointments, more technique sensitive
Ideal for: small fractures, small diastemas, hypocalcified spots, eroded/abraded lesions
Hope that helps.

 

[adnaniqedu]

That Might help you: http://dentgap.com/veneers-before-and-after-how-it-is-done

 

[dyesht]

At UCSF, we were taught as follow:
- Porcelain veneer:
Plus: aesthetic, great longevity, stain resistance, less technique sensitive
Minus: may require wax-up, most insurance do not cover, many visits, more tooth reduction
Ideal for: discolored teeth, slightly rotated/mis-aligned teeth, lengthen short/fractured teeth, enlarge small teeth, large diastemas
- Direct composite:
Plus: immediate results, moderate costs, flexibility in design and adjustment, less tooth reduction
Minus: longevity, stain resistance, strength, long appointments, more technique sensitive
Ideal for: small fractures, small diastemas, hypocalcified spots, eroded/abraded lesions
Hope that helps.

Would composites really work for small fractures? I was under the impression that the composite would fracture or chip off, if the original fracture was too small.

 

[DrJeff]

Would composites really work for small fractures? I was under the impression that the composite would fracture or chip off, if the original fracture was too small.

Very often that will depend on what the etiology of the small fracture is.

If the small fracture was caused by an "accidental" traumatic event such as using one's teeth as a bottle opener, finding and biting on a random piece of bone in a hamburger, tripping and falling and hitting their incisors on something, etc, then direct composite can work quite well for small chips with good longevity and minimal removal of adjacent, healthy tooth structure

If the small fracture was caused by biological parafunctional "trauma" such as clenching or grinding, then the reality is those natural parafunctional habits will continue and the majority of small, direct composite resortations to replace those fractures will fail, and likely relatively quickly

The history of what caused the small fracture is the key to restoring it successfully

 

[dyesht]

Very often that will depend on what the etiology of the small fracture is.

If the small fracture was caused by an "accidental" traumatic event such as using one's teeth as a bottle opener, finding and biting on a random piece of bone in a hamburger, tripping and falling and hitting their incisors on something, etc, then direct composite can work quite well for small chips with good longevity and minimal removal of adjacent, healthy tooth structure

If the small fracture was caused by biological parafunctional "trauma" such as clenching or grinding, then the reality is those natural parafunctional habits will continue and the majority of small, direct composite resortations to replace those fractures will fail, and likely relatively quickly

The history of what caused the small fracture is the key to restoring it successfully

Thanks so much!