As clinicians we have an obligation to do what is best for our patients. When making clinical decisions we’re often faced with figuring out what treatment option is best for our patients while working toward a goal of being as conservative as possible. For myself and the patient, factors such as my comfort and skill level with the procedure, the cost of the procedure, the time required to complete it, and the possibility of preserving tooth structure influence these decisions. What if you had to choose between 2-4 veneers or direct composite bonding?
In my practice to complete the case with veneers, I would have a records appointment, send the case off to the lab for a waxup, have a prep/final impression and provisionalization appointment, and then a final seat appointment. This means three visits for the patient to receive his or her veneers. Direct bonding requires just one appointment to complete the case. I always present the available treatment options to the patient first. I let them know the risks and the benefits of each option. While I always recommend the most conservative options, ultimately the patient has to decide what his or her motivations are for doing a procedure.
Many dentists tend to shy away from direct bonding in the anterior and tell patients things such as, “It won’t last as long as porcelain,” “It is only temporary,” or “It is weaker than porcelain.” However, while composite may wear over time and porcelain does not, porcelain can chip or wear opposing teeth when friction is applied. Composite may pick up some staining, but the newer resin systems have incredible strength and polishability and are certainly capable of delivering excellent esthetics. The advantage of composite is the ability to color match in one appointment and the chameleon effect of composite color that blends with natural dentition. If occlusion is maintained and parafunctional habits controlled, then either material will deliver predictable long term success.
The technique of handling composite is another issue. However, with some basic understanding of color and materials, most clinicians can achieve beautiful results. Delivering direct resin restorations greatly improves a clinician’s understanding of tooth contour and form as well. The more I place direct resin restorations, the more I understand natural tooth anatomy and how line angles affect contours and light reflection. It makes sense that the more I practice, the better I get at placing direct bonded restorations, and the more I enjoy doing it.