It's quite common for people to chip their front teeth, but the good news is that fixing them doesn't take long. Most people don't want to wait when they chip a front tooth, so I make sure to fit them in as soon as possible to ease their worries. Unfortunately, there's more to the story. Allow me to elaborate.

Composite Restorative Material

In the 1960s, tooth-colored materials called composites were created. By the late '70s, they became the norm after adding microfillers to make them look realistic and glossy. If someone breaks an anterior tooth, they can be restored to their original appearance by using this material, which comes in various colors and levels of transparency. This helps dentists match the color of the existing tooth. Additionally, they are light-cured, which facilitates their application and shaping because the material satays pliable until a bright blue light is shone on it.

Bonding

Composite restoration is often called bonding, but this term describes making the composite material stick to the tooth. An acid solution is briefly applied to the tooth, roughening its surface to achieve this. A bonding agent is then painted onto the tooth, mechanically adhering to the roughened surface. The composite material chemically bonds to the bonding agent, which has evolved to become stronger than ever.

Occlusal Force

The force produced by biting is known as occlusal force. Surprisingly, the human bite can generate up to 162 pounds per square inch, which is more force than a shark can create. However, dentists know that continuous chewing can cause substantial damage over time. Hence, they require stronger materials for certain purposes. The back molars produce more force than the front teeth, so that they may need stronger materials.

Furthermore, fillings are not intended to cover teeth. The term "filling" refers to something that goes inside another object. In contrast, a covering is the opposite. Materials that cover teeth must be more resilient. Crowns or veneers are the typical coverings used in dental procedures. They are usually made of porcelain and are very durable.

Anterior composites

It is common for people to develop cavities between their teeth, particularly in the front teeth. Dentists use tooth-colored composites to fill these cavities, which are not noticeable due to their properties. These composites are supported and protected by the natural tooth structure surrounding them, making them highly durable.

In cases where a person breaks an anterior tooth, such as a severe fracture where half of the incisal edge of the tooth is gone, a composite can be placed quickly by a dentist. This helps the patient to look and feel normal. However, the 162 pounds of pressure concentrated on the edge of a front tooth during chewing can exceed the bond strength of composites. Therefore, composites that replace the biting edges of anterior teeth often fail.

As a dentist, I always warn patients that these composites may last for only ten minutes or ten years. A large composite can be placed in an emergency, but I always recommend that the patient return for a more durable restoration, like a veneer or crown.

It is important to note that everyone is different. Nail biters are likely to break their incisal edge composite restorations, while patients with thin, worn teeth may experience more frequent failures. Those who grind their teeth also increase their odds of composite failure due to the repeated forces generated.

The conundrum

In some cases, patients may have a small fracture that can be fixed with a composite. While the cost of a small composite is low, it may not be the most durable solution and may require frequent replacements. In such cases, a veneer or crown may be a better option, providing a stronger and more long-lasting restoration. However, these options are more costly and require reducing the tooth to make room for the porcelain. There is no middle ground between the two options. Repeatedly replacing a composite can add up over time and cost as much as a crown or veneer in the long run. Ultimately, it is up to the patient to decide which option to choose. In cases where a patient needs a composite replaced frequently, I help them understand the cost involved in constant maintenance versus a one-time fix.