What types of dental veneers are there: what are they made of and what materials to choose

Many dental clinics offer fillings using several different filling materials. Price lists (including those posted on websites) are also often replete with various commercial names of fillings: Filtek, Spectrum, Aesthetics, Charisma (Karizma), Vines (Venus), Gradia, Estelite, Herculite, Point, Tetrik, Admira, Brilliant, Enamel Plus and others. Patients are asked to make a choice, but this requires dental-level knowledge, which most people, of course, do not possess.

Popular articles on the Internet for the following queries: “which filling is better?”, “which filling material is the best?”, “which filling is better to put?” and so on. – do little to clarify the situation. Most articles (often written by anonymous authors or copywriters) discuss only classes of filling materials: cements, amalgams, glass ionomers, chemical and light-curing composites. After a detailed description of materials that went out of use several decades ago (apparently to give more volume to the text), the conclusion is made that light-curing composites are the best, and if a person has the financial means, then it is advisable to install fillings from them. Either nothing is mentioned about specific brands of heliocomposites, or it is stated that they are all approximately equally good. Or “the latest generation nanocomposites” begin to be advertised.

What fillings do not need to be placed?

The first and most important thing that every patient should understand is that light-curing fillings (photopolymers, heliocomposites) are the only reasonable choice in the 21st century. Even for people on a budget. Other materials are not 10 or 20 percent, but many times worse. Discussing the advantages or price/quality ratio of cement fillings in our time is as stupid as looking for advantages, for example, in reel-to-reel tape recorders. For a long time now, no one has been producing or buying cassette and video recorders, but for some reason some individuals allow themselves to install a 19th-century seal.

Plastic fillings are completely beyond reason. Acrylic oxide and similar anachronisms should have been banned for use a quarter of a century ago, since they are not only unable to stop the further spread of caries, but also provoke its progression. A plastic filling on a tooth is a direct road to pulpitis and periodontitis. You have to hate yourself with a fierce hatred to allow this to happen to you. And clinics that currently use such materials will be deprived of their license.

Amalgam fillings are famous for their durability, but due to toxicity (not for the patient, but for the environment and medical staff), dentists themselves refuse them.

Chemical composites are moderately bad - if a person lives from hand to mouth, then, of course, you can install them (it’s still better than nothing). But for most other people who do not experience urgent need every day, this will not be a justifiable choice. It may happen that such a filling will last for many years, but more often the opposite happens. After 3-5 years (or earlier), caries will develop under the “chemical” filling, and it can either reach pulpitis, or the amount of destruction will become so great that instead of re-installing the filling, the manufacture of an inlay or onlay will be required. As a result, the cost of repeated intervention increases by an order of magnitude due to the savings of thousands of rubles the first time (the approximate difference with the cost of a light-curing composite).

Light-curing fillings are not uniform

Glass ionomer cements with a light-initiated curing mechanism are available. For example, Fuji 2 (Fuji II LC). Compomers (a hybrid material between composites and glass ionomers) are also cured using a lamp. Their most famous representative is Dyract XP. These materials are more reliable than some heliocomposites, but are still significantly inferior to their best representatives. Due to the misconception about the toxicity of composites, some doctors recommend these materials for filling for children. For pediatric dentistry, Fuji and Direct are acceptable options, but composites are still preferable.

Dental composite materials are divided into universal (suitable for filling any cavities), aesthetic for anterior teeth (excellently convey all the nuances of the color of natural teeth) and packable for chewing teeth (have low shrinkage and abrasion, but also low aesthetic characteristics). There is another class of composites – flowable. Previously, they were recommended for filling wedge-shaped defects due to their high elasticity, however, according to modern data, universal composites give better results even with non-carious lesions.1 Therefore, current composites currently have only an auxiliary value: they are used together with other classes of materials, but the main one the volume of the filling does not make up.

Universal heliocomposites are the most widely used type of filling materials in the world. The commercial names of fillings offered to the patient to choose from mostly refer to these materials. They also differ in quality. The percentage of inorganic filler, its chemical composition and the shape of the granules determine the mechanical properties of the filling: polymerization shrinkage, mechanical strength, hardness and wear resistance, polishability and surface smoothness. Some of these parameters antagonize each other. For example, for good polishability, the granules of non-limiting filler (oxides of silicon, zirconium, aluminum, etc.) should be as small as possible, and to increase strength, on the contrary, as large as possible. Therefore, materials advertised as “nanocomposites” cause a wry smile among professionals - the prefix “nano-” attracts illiterate dentists and patients who blindly associate it with high technology. However, for the sake of fairness, quite good material can be presented. For example, Filtek Ultimate.

How to navigate the names

When choosing records, first of all look at:

• material – ceramics, zirconium, plastic, composite;
• thickness – the method of preparing a dental unit depends on it; the thinner the model, the less turning;
• manufacturer - give preference to a well-known brand whose products are reliable, safe, and time-tested.

In most cases, onlays are placed in the smile area - on the incisors, canines, and premolars. But they can also be fixed to molars. If the tooth is severely damaged, the standard option is not suitable. In this case, the product is installed 180° or 360°, covering the crown on all sides.

What is a classic veneer

This is the name for plates that are fixed only at the front. To attach them, the tooth is ground down, removing the enamel and part of the dentin (hard tissue). This is explained by the fact that:

• The structure of the enamel prevents high-quality adhesion, so it must be removed.
• Dentin needs to be prepared if the thickness of the plate is more than 0.5 mm. Otherwise, the bite will be disrupted, the shape of the face will change, and the patient will feel discomfort.

When you don’t want to sharpen your incisors, canines and molars too much, take lumineers. To fix them, only the enamel is removed.

The best filling materials (as of 2022)

In the dental world, the greatest authority in the assessment of restorative materials currently belongs to the American publication The Dental Advisor. For the last 12 years (from 2010 to 2022), the highest award in the “universal composites” category has been awarded to the Japanese filling material Estelite Sigma Quick. Selection criteria: percentage of inorganic filler, amount of shrinkage, correspondence of shades to the natural color of the tooth, ease of use, radiopacity, polishability. A survey of dentists showed that they switch to Estelite more often than to other filling materials. Clinical success of Estelite is 99%.2

Among aesthetic composites in 2015, 2016, 2022, according to the same publication, the filling material from Germany, Venus Pearl, took the highest position. Its clinical effectiveness is 91%.3 In 2021, it received the title of “preferred product”. It can also be used for chewing teeth.

In 2022 and 2022, first place in the category of aesthetic composites was taken by the Harmonize material of the American manufacturer Kerr Restorative.4

Other good quality filling materials should also be mentioned. These include those who received awards in 2016-2019: Omnichroma, Brilliant EverGlow, Admira Fusion, Filtek Supreme Plus and Filtek Supreme Ultra.

Indications and contraindications

Due to its versatility, this composite can be used in quite a few procedures for the prevention and treatment of dental diseases. Estelite can be used:

• for carrying out the restoration procedure of the frontal zone of the jaw row;
• to eliminate minor external defects from the tooth surface;
• as a base layer;
• in treatment processes using the indirect restoration method;
• to restore artificial tooth fragments;
• as a material for eliminating cracks and diastemas;
• as a component of composite veneers;
• for the prevention and treatment of caries.

The presence of methacrylic monomers in Estelite suggests contraindications for those patients who have an individual intolerance to these substances.

Therefore, before use, you must make sure that this drug will not cause an allergic reaction.

Preparation for use

The process of preparing the oral cavity for appropriate procedures is a necessary and important part of a positive result. Tooth preparation is carried out only in the specified order and includes the following medical procedures:

1. Enamel cleaning

   – the entire surface of the teeth must be cleaned using a special fluoride-free mass that fits in a rubber container, and then rinsed with water.

2. Selecting a color shade

   – there is a special shade scale, but to choose the optimal color it is recommended to wait a little, because dry teeth have the same color, while wet teeth are slightly different.

To correctly choose the optimal color option, you should choose the most intense one from those selected.

Attention!

Under no circumstances should professional teeth whitening be performed before these procedures. Otherwise, it may happen that the shade will be quite different after some time. It is also not recommended to use eugenol and its derivatives for protective functions, since then the polymerization process of the presented composite is much worse.

Restoration process step by step

It is recommended to use unidoses in the manner described in the instructions. Before use, an ounce of material is placed in the dispenser, then the cap is removed, which does not allow the material to flow out. The composite is filled directly into the indicated cavity or prepared for application on a special tablet, bringing it to the desired state.

When using a syringe, the following manipulations are performed:

• you need to remove the protective cap;
• turn the handle clockwise;
• place a small amount of mass on a special tablet;
• knead the paste.

Once the material reaches the desired level of consistency, filling and restoration work can be carried out. The paste should be applied in small doses, in layers, so as not to exceed the permissible depth. To guide the dosage, the creators of Estelite have developed a special table.

When the filling process is carried out using the Estelite composite mass, it is prohibited to use other preparations, since the possibility of voids increases and the polymerization process will not proceed properly.

Each layer is polymerized separately, the time specified by the manufacturer. And the surface treatment completes the procedure. The site for restoration work is cleaned and a small cosmetic polishing is carried out using burs with a fine-grained diamond cut.

In order to erase the boundaries between the tooth surface and the filling, the dentist performs a polishing procedure with a multifaceted carbide bur. This does not require water and rotation is minimized.

Palette of material shades

Estelite filling material is available in a very wide range of shades - A1, A2, A3, A3.5, A4, A5, B1, B2, B3, B4, C1, C2, C3, OA1, OA2, OA3, OPA2, BW (created for for filling whitened teeth), CE (for enamel types with increased transparency, cutting edge shade) and WE (white enamel).

The opalescent shades in the product line, which include OA1, OA2 and OA3, are distinguished by a fairly good level of opacity. Thanks to this, Estelite is 100% suitable for blocking the darkness of the oral cavity (this makes it possible to carry out restoration work on cavities of classes 3 and 4).

Opalescent shades are also actively used as dentin shades when restoration procedures are carried out with several different shades in several layers. Shades 4FA1, OA2 and BW are used during restoration work on primary teeth. However, they are practically not used in cases where it is necessary to perform a restoration in which pins and metal structures were used. As well as those teeth whose color has changed significantly. For example, tetracycline teeth.

OPA2 is a color used to hide small enamel stains. The Estelite material can also be used to restore the patient’s opaque teeth.

Rating of filling materials: