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Direct composite restorations—The ugly duckling classic
journal of dentistry 41s (2013) e1–e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden
Editorial
Direct composite restorations—The ugly duckling classic Dental composite resins have undergone such impressive evolution since their development in the early 1960s that Ray Bowen himself might not have predicted the direction the materials were headed. In the 1970s, composites were used only for simple conservative adhesive procedures. However, as clinicians began to perceive a wider scope of applications, calling for the use of direct composites in the posterior segment and in larger, more extensive anterior procedures, improvements in physical, mechanical and color/optical properties were made to suit their aesthetic expectations. Until the mid- to late 1980s, composites were generally available in only few shades and a single opacity, which sometimes made color matching elusive. The launching of systems that provided dentin and enamel shades inspired a more creative approach and restorations began to look better and more life-like than ever before. VITA-based shades were then introduced in an attempt to make the shade selection process easier and user-friendlier. It is impossible not to associate the evolution of the way composites are used today with the contributions of progressive leaders and superb clinicians such as Gerald Denehy, William (Buddy) Mopper, Norman Feigembaum, Ronald Goldstein, Ronald Jordan, Richard Simonsen, Jim Dunn, and Cary Behle, among others. These key opinion leaders have set the standard for quality dental care with an expanded approach for the use of composites. They have changed paradigms and helped make the dental community believe that composites were no longer interim materials but rather effective tools for creating superior restorations in the hands of skilled and knowledgeable clinicians. It was in the mid-1990s that a major shift occurred in the way composites were used, especially for the restoration of anterior teeth. Clinical and laboratory research led to the concomitant publication of papers describing layering techniques that are still the foundation for most techniques that are taught and used today. Dietschi and Vanini described, in separate papers based on their individual work, similar techniques substantiated by the replication the optical and color characteristics of natural dentin and enamel, which was termed ‘‘natural layering’’. Based on their research data, the industry introduced composite restoratives with dentin shades of a single hue and a wide chroma range. The enamels presented non-VITA based hues (also called value or achromatic enamels) with varying
degrees of color and value to be used according to the patients’ age. In this technique, the final color is achieved by the chroma and value modulation of the enamels that are layered over the dentin. Almost simultaneously, Fahl introduced a ‘‘polychromatic layering’’ concept, which supported the use of both VITA and non-VITA enamel and dentin shades. In this technique, the final hue and chroma of a restoration is achieved via the use of VITA-based enamels while non-VITA enamels are used to create translucency, opalescence and value effects. Both ‘‘natural layering’’ and ‘‘polychromatic layering’’ techniques are effective in the hands of one who is knowledgeable about anatomy, materials science, and color. Any single layering technique can be as simple or as complex as each clinical case demands, ranging from two-layer to multi-layer approaches. Ultimately, we want materials that are color-stable, color compatible, and that blend in with the tooth tissues. Unfortunately, not all composites are made the same, regardless of their filler type and monomer composition. Many factors influence the aesthetics of a composite restoration, including refractive index, opacity, translucency and thickness. No layering technique alone will determine clinical success; it is eventually the restorative dentist’s task to understand and master each one, and the materials involved therein, in view of current literature. Direct composite restorations are not only time- and costeffective, but they also are ultimately a high-quality, longlasting treatment of choice. State-of-the-art composites exhibit excellent physical, mechanical, and optical properties – a classical ugly duckling story compared to the beginnings of direct composites in the 1960s. Only the future will be able to tell the level of improvement that lies ahead. However, it is highly likely that composite resins will continue to progress not only when it comes to their properties but, first and foremost, in their indication for minimally invasive procedures. As improvements in adhesive and composite resin technology continue to evolve, a new generation of researchers and talented clinicians will have an opportunity to take this fascinating field of dentistry to yet unattained levels of excellence. Composite resins also represent a very attractive research topic. Several papers in this issue of Journal of Color and Appearance in Dentistry (JCAD) are related to composites, while
e2
journal of dentistry 41s (2013) e1–e2
other topics include whitening research, research on ceramic veneers, color stability of hard dental tissues, bonding-dependent enamel discoloration, masking of white spot lesions, and fabrication of soft tissue prostheses. We thank Dr. Christopher D. Lynch, Editor-in-Chief of the Journal of Dentistry, Jane Ryley, the publisher, and the Elsevier editorial office for their support. We are very grateful to our peer reviewers for invaluable help in producing this issue: Sercan Akyalcin, Mark Beatty, Juliana Branco Da Costa, Magda Eldiwany, Razvan Ghinea, William M. Johnston, Evren Kilinc, So Ran Kwon, Karl Martin Lehmann, Joe C. Ontiveros, John M. Powers, H. Ralph Rawls, Richard D. Trushkowsky, Alvin Wee, and Nigel Young. JCAD is the official publication of the Society for Color and Appearance in Dentistry (SCAD, www.scadent.org). SCAD VITA Award for Excellence in Research Related to Color and Appearance in Esthetic Dentistry has been established in 2011 and had first recipients in 2012. In 2013 we had 19 applicants from three continents, and we are pleased to announce the 2013 recipients in all three categories: James Oei (pre-doctoral students), Aram Kim (graduate students), and Razvan Ghinea (non-tenured junior faculty). SCAD covered the registration fees and three nights lodging for the 2013 Annual Meeting for each recipient, and each of them received a $1000 stipend at the annual meeting. We anticipate new applications for the 2014 SCAD VITA Award with excitement.
We have high expectations for the 2014 meeting in Chicago (Oct 2–4). The meeting theme, ‘‘Synergy for Success,’’ will allow us to epitomize our goals related to clinical dentistry, dental technology, research and education. To achieve this, we recruited a very diverse group of presenters, tightly connected with a single word – excellence. We hope that many colleagues will join us at SCAD 2014. Dr. Newton Fahl Jr. Visconde do Rio Branco, 1335 – suite 12 80420-210 – Curitiba, PR, Brazil Rade D. Paravina* Houston Center for Biomaterials and Biomimetics (HCBB), Department of Restorative Dentistry and Prosthodontics, University of Texas, School of Dentistry, 7500 Cambridge St., Ste. 5350, Houston, TX 77054, USA *Corresponding author. Tel.: +1 713 500 4477; fax: +1 713 500 4372 E-mail address: [email protected] (R.D. Paravina) 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.09.009
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden
Editorial
Direct composite restorations—The ugly duckling classic Dental composite resins have undergone such impressive evolution since their development in the early 1960s that Ray Bowen himself might not have predicted the direction the materials were headed. In the 1970s, composites were used only for simple conservative adhesive procedures. However, as clinicians began to perceive a wider scope of applications, calling for the use of direct composites in the posterior segment and in larger, more extensive anterior procedures, improvements in physical, mechanical and color/optical properties were made to suit their aesthetic expectations. Until the mid- to late 1980s, composites were generally available in only few shades and a single opacity, which sometimes made color matching elusive. The launching of systems that provided dentin and enamel shades inspired a more creative approach and restorations began to look better and more life-like than ever before. VITA-based shades were then introduced in an attempt to make the shade selection process easier and user-friendlier. It is impossible not to associate the evolution of the way composites are used today with the contributions of progressive leaders and superb clinicians such as Gerald Denehy, William (Buddy) Mopper, Norman Feigembaum, Ronald Goldstein, Ronald Jordan, Richard Simonsen, Jim Dunn, and Cary Behle, among others. These key opinion leaders have set the standard for quality dental care with an expanded approach for the use of composites. They have changed paradigms and helped make the dental community believe that composites were no longer interim materials but rather effective tools for creating superior restorations in the hands of skilled and knowledgeable clinicians. It was in the mid-1990s that a major shift occurred in the way composites were used, especially for the restoration of anterior teeth. Clinical and laboratory research led to the concomitant publication of papers describing layering techniques that are still the foundation for most techniques that are taught and used today. Dietschi and Vanini described, in separate papers based on their individual work, similar techniques substantiated by the replication the optical and color characteristics of natural dentin and enamel, which was termed ‘‘natural layering’’. Based on their research data, the industry introduced composite restoratives with dentin shades of a single hue and a wide chroma range. The enamels presented non-VITA based hues (also called value or achromatic enamels) with varying
degrees of color and value to be used according to the patients’ age. In this technique, the final color is achieved by the chroma and value modulation of the enamels that are layered over the dentin. Almost simultaneously, Fahl introduced a ‘‘polychromatic layering’’ concept, which supported the use of both VITA and non-VITA enamel and dentin shades. In this technique, the final hue and chroma of a restoration is achieved via the use of VITA-based enamels while non-VITA enamels are used to create translucency, opalescence and value effects. Both ‘‘natural layering’’ and ‘‘polychromatic layering’’ techniques are effective in the hands of one who is knowledgeable about anatomy, materials science, and color. Any single layering technique can be as simple or as complex as each clinical case demands, ranging from two-layer to multi-layer approaches. Ultimately, we want materials that are color-stable, color compatible, and that blend in with the tooth tissues. Unfortunately, not all composites are made the same, regardless of their filler type and monomer composition. Many factors influence the aesthetics of a composite restoration, including refractive index, opacity, translucency and thickness. No layering technique alone will determine clinical success; it is eventually the restorative dentist’s task to understand and master each one, and the materials involved therein, in view of current literature. Direct composite restorations are not only time- and costeffective, but they also are ultimately a high-quality, longlasting treatment of choice. State-of-the-art composites exhibit excellent physical, mechanical, and optical properties – a classical ugly duckling story compared to the beginnings of direct composites in the 1960s. Only the future will be able to tell the level of improvement that lies ahead. However, it is highly likely that composite resins will continue to progress not only when it comes to their properties but, first and foremost, in their indication for minimally invasive procedures. As improvements in adhesive and composite resin technology continue to evolve, a new generation of researchers and talented clinicians will have an opportunity to take this fascinating field of dentistry to yet unattained levels of excellence. Composite resins also represent a very attractive research topic. Several papers in this issue of Journal of Color and Appearance in Dentistry (JCAD) are related to composites, while
e2
journal of dentistry 41s (2013) e1–e2
other topics include whitening research, research on ceramic veneers, color stability of hard dental tissues, bonding-dependent enamel discoloration, masking of white spot lesions, and fabrication of soft tissue prostheses. We thank Dr. Christopher D. Lynch, Editor-in-Chief of the Journal of Dentistry, Jane Ryley, the publisher, and the Elsevier editorial office for their support. We are very grateful to our peer reviewers for invaluable help in producing this issue: Sercan Akyalcin, Mark Beatty, Juliana Branco Da Costa, Magda Eldiwany, Razvan Ghinea, William M. Johnston, Evren Kilinc, So Ran Kwon, Karl Martin Lehmann, Joe C. Ontiveros, John M. Powers, H. Ralph Rawls, Richard D. Trushkowsky, Alvin Wee, and Nigel Young. JCAD is the official publication of the Society for Color and Appearance in Dentistry (SCAD, www.scadent.org). SCAD VITA Award for Excellence in Research Related to Color and Appearance in Esthetic Dentistry has been established in 2011 and had first recipients in 2012. In 2013 we had 19 applicants from three continents, and we are pleased to announce the 2013 recipients in all three categories: James Oei (pre-doctoral students), Aram Kim (graduate students), and Razvan Ghinea (non-tenured junior faculty). SCAD covered the registration fees and three nights lodging for the 2013 Annual Meeting for each recipient, and each of them received a $1000 stipend at the annual meeting. We anticipate new applications for the 2014 SCAD VITA Award with excitement.
We have high expectations for the 2014 meeting in Chicago (Oct 2–4). The meeting theme, ‘‘Synergy for Success,’’ will allow us to epitomize our goals related to clinical dentistry, dental technology, research and education. To achieve this, we recruited a very diverse group of presenters, tightly connected with a single word – excellence. We hope that many colleagues will join us at SCAD 2014. Dr. Newton Fahl Jr. Visconde do Rio Branco, 1335 – suite 12 80420-210 – Curitiba, PR, Brazil Rade D. Paravina* Houston Center for Biomaterials and Biomimetics (HCBB), Department of Restorative Dentistry and Prosthodontics, University of Texas, School of Dentistry, 7500 Cambridge St., Ste. 5350, Houston, TX 77054, USA *Corresponding author. Tel.: +1 713 500 4477; fax: +1 713 500 4372 E-mail address: [email protected] (R.D. Paravina) 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.09.009