The dark side of composite bonding

With a rise in demand for composite bonding, this month Manrina Rhode discusses the complications every patient needs to be aware of.

My name’s Dr Manrina Rhode and I am the aesthetic dentistry expert for dentistry.co uk.

Today we’re talking about the dark side of cosmetic dentistry.

There’s a couple of topics I want to cover, and the first one I want talk about is composite bonding.

I feel like we’re in the middle of a composite bonding pandemic. There’s all these young people going out and getting their teeth covered in composite and thinking that it’s going to last forever. But unfortunately it doesn’t.

We know, as dentists, that composite tends to last for about five years. And in that time it’s prone to staining and chipping. Composite is made up of small balls that wear away with time, and they wear away at a different rate depending on how you’re eating and drinking.

You get differential wear of your composite, which can be more prone to stain than, for example, a natural tooth or a porcelain veneer.

Are your patients informed on the complications?

So what are these patients going to do?

They’ve got their 10, 20 teeth covered in big chunks of composite which are difficult to clean. Hopefully they’re done perfectly and so they can floss nicely between the teeth.

If they’re not, then they’re more prone to gum disease if they are difficult to clean at the gum margin.

I know there’s some dentists popping bonding on and leaving the teeth stuck together so patients can’t even floss. Those are all issues in themselves.

But let’s assume the patient has had a perfect job by a brilliant dentist and had these composite veneers placed and they’ve got great margins and they’re able to clean. Are they aware that this composite is going to need to be replaced in five years time?

And if they’re starting their composite bonding journey in their twenties, then how many five years are they going to live through? Assuming people are living to 100 now. I think a lot of them are having it done thinking that it’s removable, that it’s not a permanent procedure.

But how is any dentist going to remove composite bonding without removing enamel? At those five year intervals, how much tooth are they going to lose? What’s going to happen through their restorative spiral or through their tooth’s lifespan to these teeth underneath?

Is that all being discussed with these young people? If it is and they’re still going ahead with it, are they going ahead with their eyes wide open? Later on, are we going to see the repercussion of their actions? I think that’s what’s going to happen.

Moving to porcelain

So I think we need to assume that work’s being done well. And I think we need to assume that that patients are being informed of the complications and that patients are still going ahead with these treatments for cosmetic reasons.

But I think long term is where we’re going to see what complications have arisen from that. So I think that’s food for thought and something we should all be thinking about and, as dentists, be getting ready for as time progresses in the next five, 10, 15 years.

These patients will come back with their now worn stained composite deciding what we’re going to do for them. At what point are we going to move them over to porcelain and when we do move them over to porcelain? How well trained are you to do minimally invasive preparations of porcelain?

We’re not taught how to do porcelain veneers at university. It’s something that, if you have an interest in, you decide to learn when you graduate. You can learn from me on my Designing Smiles course. And obviously there are other courses out there that you can go on and learn.

But the key to doing beautiful porcelain work is re-alignment. Align your teeth so you’re not having to prep them, get lovely margins. Don’t just do a one size fits all approach or cut every tooth down to a peg so they’re not veneers at all. You’re taking them so far down a restorative spiral by doing that.

The restorative spiral

When a patient comes in to us and they have a virgin tooth with a small amount of decay in that tooth, we decide to fill it. Over time, you can get decay underneath that filling because it’s composite, it’s going to wear.

Depending on your diet and your oral hygiene habits, you could get decay underneath that filling and you end up needing a bigger filling. So you end up with a bigger filling and then that fitting could turn into an inlay, or your decay could get close to your nerve and the tooth could eventually require a root canal treatment.

So then the patient’s got this tooth with an onlay on it, and then a root canal. Then, at some point, that root canal may fail and then they may have a re-root canal. And then they’ve had a re-root canal and then potentially that fails and some of the tooth breaks off. Then they’ve got a post and a new abscess.

And then maybe they need a bursectomy. Maybe at that point you’re then like, ‘okay, enough’, and then they lose the tooth. And then what do you do? You’ve got leave the gap, denture, bridge, implant.

But by then they’ve come all the way down this restorative spiral right to the bottom of it.

Your responsibility as a dentist

It’s our responsibility as dentists to try and keep patients with their own God-made teeth for as long as possible. We don’t want to get to a point where they lose their teeth and then there’s not really many other options.

You can place an implant, but then if that implant fails, what are you going to do? You really want to postpone that for as long as possible through their age.

I do a massive amount of porcelain veneers. I’ve done over 13,000 in my career. But whenever someone embarks on that journey with me, I sit very carefully and say: ‘Okay, my porcelain veneers will probably last you 15 years. So in 15 years, how old are you going to be?’

And then in 15 years, I assume with technological advancements, it will probably be 20 years. So then if they’re going to last you 20 years, how many times will the work have to be replaced in their lifespan?

That’s an important conversation to have with any work that we do with our patients.

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Visit Manrina’s website here: www.drmrlondon.co.uk.