Cosmetic Bonding Watertown MA

Restoring Chipped, Cracked and Discolored Teeth

The application of a plastic tooth-colored material, formally called composite resin, to any or all of a tooth, is termed dental bonding,  composite filling, or white filling. All terms are equivalent.   It is a very versatile method, done daily in every office, and used as a single visit procedure for teeth that are chipped, cracked, discolored or misaligned.  When the entire front surface of the tooth is covered, the restoration is a composite veneer or direct veneer.  If just a small “chip” of tooth is restored, the restoration is called a composite filling or simply white filling. 

Composite, or “white” fillings

The above video  illustrates a composite resin restoration of a chipped tooth – note no anesthesia is necessary.  The tooth is lightly roughened, then the surface is specially prepared to facilitate adhesion.  A putty-like composite resin is applied and cured rigid with a high-intensity light. Once set, its sculpted into the desired shape by the dentist.  In the above case, only the side of the tooth was restored, but the filling can be extended to anywhere on the tooth surface. 

Direct vs. Porcelain Veneers

Full coverage of the entire front surface of a tooth with any material is termed a veneer.  In dentistry, two materials are used for veneers – composite resin, i.e. putty-like white filling material which is cured onto the tooth surface, and porcelain. When the material is a composite resin, it is termed a direct veneer or composite veneer.  These are termed direct because the putty-like material is applied right over the tooth surface in one visit. When the material is porcelain, it is termed a porcelain veneer,  sometimes indirect veneer, as the veneer is constructed in two visits. First the tooth is shaved, and an impression taken; then the impression is sent to an outside facility for porcelain veneer fabrication. On the second visit the porcelain veneer is bonded to the tooth. 

Direct veneers are overwhelmingly the best choice for patients seeking great cosmetic results. Advantages of direct veneers:

1. No enamel removal involved;  thus can often be completed in a single office visit, with no anesthesia.
2. Direct veneers are completely reversible, and can be removed at any point in the future; the original tooth structure underneath remains completely intact. Both porcelain and direct veneers often develop unsightly “stains around the edges” in 15-20 years with normal gum recession; margins that were hidden under the gums at age 40 are exposed at age 60.   Direct veneers can simply be removed, while porcelain veneers must be replaced.
3. Very unlikely to chip or completely fall off, as they are bonded directly to the tooth.
4. A fraction of the cost of porcelain veneers.
5. Fifth-generation composite resins, such as Cosmedent Renamel, https://www.cosmedent.com/shop-by-department/dental-composites/,  are indistinguishable from porcelain at normal 2-3 foot viewing range. (A patient once commented  “That is fine – I don’t care about people who can get within 6 inches. “)

Porcelain veneers are becoming a less recommended option due to the development of modern composite resins. Disadvantages of porcelain veneers:

1. 1-1.5 mm enamel removal of the entire front surface of the tooth is required, permanently compromising the tooth. Possibility of sensitivity, some chance of root canals.
2. Much more expensive, as they require long chair time for extensive tooth removal,  an outside facility for custom fabrication, then a second visit for cementation.
3. As they are a separate “fingernail” of porcelain cemented over the tooth, they are much more likely to chip or completely fall off, vs direct veneers.
4. Non-reversible; no option to remove if they fall off repeatedly or stain.  You will be forced to maintain them for your lifetime.