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Why composite bonding can be an excellent way to correct some common issues with your patients’ teeth.
Maybe it’s a small chip in the anterior. It could be a stain on the upper left canine. Perhaps your patient has a diastema. His or her teeth are otherwise healthy, so you might think “That must not bother them much because they never ask me to fix it.”
However, it could be because they don’t know how today’s composite resin materials make it possible to fix it effectively, efficiently and affordably.
Composite bonding can be an excellent way to correct some common issues with your patients’ teeth. Composite resin materials can be shaped and molded to the teeth to give patients a straighter or whiter smile at a fraction of the cost of some other cosmetic procedures.
Today’s composite resins can complete the following three cosmetic bonding procedures:
Dr. Michael Miyasaki is a private practice dentist in Sacramento, California, who has been practicing since 1987. He says offering any of these three cosmetic treatments to your patients is an excellent way to leverage your existing patient base and grow your revenue.
Dr. Miyasaki credits the materials for their improvements. The procedures are easier for clinicians to do, and the cost is reasonable for most patients.
“There's just a lot of work that we don't offer our patients,” Dr. Miyasaki says. “We don't value it like a full-mouth restoration case, but the value to the patients for treatments like these is invaluable.”
Dr. Miyasaki says you see it with kids who improve their smile. They feel more confident about how they look, so they smile more and their self-esteem goes up.
Dr. Miyasaki describes a case where a patient had a brown stain on his teeth. Dr. Miyasaki removed the stain using Opalustre™ from Ultradent, which he describes as hydrochloric acid in a slurry-like pumice. After Dr. Miyasaki polished, the brown stain was gone, and the patient was thrilled and felt more confident.
“There are simple things we can do that usually don't cost the patients a whole lot of money but can make a big impact in their lives,” he says.
Tips and tricks for cosmetic bonding procedures
Dr. Ed Kusek, a private practice dentist in Sioux Falls, South Dakota, who has been practicing for more than 35 years, describes these cosmetic composite treatments as simple to do, provided you have the correct composites. Because these three procedures are in the anterior, esthetics is paramount. He recommends using a microfill to give the restoration the proper luster.
“Some of the hybrid composites may not have as nice of a polish to them, so you need to have a material that will allow you to get more esthetic results,” Dr. Kusek says.
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You also want the material to handle appropriately for your bonding treatment. For example, on diastema closures, Dr. Miyasaki suggests warming the composite with composite warmers from AdDent or Vista Dental Products so that it flows better and creates the right contour.
Warming the material allows Dr. Miyasaki’s staff members to take their favorite regular, sculptable composites and inject them to create the shape of the tooth they want, almost like a flowable composite. He says warming also makes the composite more manageable and reduces the risk of voids or getting air incorporated into the material.
“The composite has better physical properties where we can shape it and then polish it. It turns out really nice,” Dr. Miyasaki says, adding that he warms the composite for his posterior restorations as well as the anterior ones.
Dr. Miyasaki also recommends using air abrasion to roughen the surface of the tooth to aid in bonding the material. He uses an air abrasion unit from Danville Materials. He says the air abrasion helps the chameleon effect, or the ability of the tooth to blend in with the surrounding teeth, making the restoration less noticeable.
“When I do air abrasion, that gives me a better etch pattern and it helps the composite stick to the teeth better, so we get a better bond,” Dr. Miyasaki says.
For diastema closings, Dr. Miyasaki uses Bioclear matrices to help shape the composite. He says when used with warmed composite, the forms help him to create a beautiful shape.
Dr. Miyasaki also likes Uveneer® by Ultadent, a direct composite template system that helps create direct composite veneers on the facial aspect of the tooth. He says the Uveneer process is fast, which means the clinician can make it affordable for the patient. First, you etch the tooth and fill the Uveneer form with composite. Then, you press that up against the facial of the tooth.
“They are clear forms, so we can cure the composite through that form. When you peel the form off, it has the whole facial veneer all done for you,” Dr. Miyasaki says.
Dr. Kusek agrees that manufacturers provide excellent shortcuts that can further simplify these bonding procedures. He also likes the forms for diastema closings.
“They are like little shields, and you can just change the shape of the composite very quickly,” Dr. Kusek says.
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Experience can help clinicians feel more confident suggesting these treatments to patients. Dr. Miyasaki encourages dentists with less experience working with composite in these ways to attend a course about it. In many cases, the course might be only a couple of hours, but it will save a dentist a lot of time in the long run.
“Once you see somebody do it and explain to you why they're doing it and what they're doing, it's a lot easier than going through all the trials and failures of trying to do it on your own,” Dr. Miyasaki says.
With stain removal or chip repair, Dr. Miyasaki reminds clinicians to ask if the patient is considering whitening his or her teeth. He learned that patients who have a cosmetic bonding treatment in the anterior are so happy with the improvement that they often want to whiten their smiles afterward.
However, whitening after the treatment could mean the composite material used for the bonding treatment might not match the newly whitened teeth. Dr. Miyasaki wants patients considering both treatments to whiten first instead.
“We're not trying to sell whitening, but we do want to make sure that they understand that they have that option to do it now,” Dr. Miyasaki says. “If we do it after, then there will be an additional cost to the patient, which we don't want to have.”
With stains, Dr. Kusek recommends taking out the stain and then putting an enamel stain over the top to make it more lifelike. When it comes to more involved cosmetic bonding procedures, he recommends using your lab to help you work efficiently and effectively.
“Some of the bigger things, like closing a diastema, I will always get a lab wax set up. Then, I have a putty stent, so I can use that stent to do my wax up. It makes things much easier and quicker for me to do,” Dr. Kusek explains.
No matter which cosmetic bonding treatment the patient is considering, Dr. Kusek says he always sets patient expectations before he proceeds. He advises clinicians to have the patient approve the treatment plan and anticipated outcome.
“We don't want to have their expectations so high that what we're trying to do won't match them or won’t work for them. We want to be at the same level as what the patient's expectations are,” Dr. Kusek says.
On the other hand, sometimes patients don’t know what to expect-and that can create some storybook outcomes. Dr. Miyasaki had a patient in her early 20s with peg laterals that he closed up for her. He told the patient that her life was going to change because she would smile more, she would appear happier and other people would be friendlier toward her. She didn’t believe him.
However, when he saw her six months later, she was engaged.
Dr. Miyasaki says he sees it all the time. Patients don’t understand what a difference fixing that minor cosmetic problem will affect how they feel about their smile. They also don’t always want to mention it to their dentist either because they don’t want to sound vain.
“They don’t want to say, ‘I don't like this space’ or ‘I don't like the staining here,’” Dr. Miyasaki says. “However, there are such conservative treatments that we can offer our patients. Once we do that, I have seen a lot of patients’ lives change.”