Composite Restorations vs. Ceramic Restorations

Imagine that this patient presented to your office for the treatment of the left central and lateral that were fractured in a biking accident. What would be your restorative material of choice – composite or ceramic? Would your decision change if the patient said that she wanted it to match perfectly? Or would your material of choice change if these were your teeth?

Although both treatment options can be utilized to achieve the patient's treatment goals, it’s interesting to stop and think about how we make our clinical decisions. Many variables must be taken into consideration to help us make our choice. And given our individual clinical experiences, some variables may be weighted more heavily than others.

What Does the Literature Say About Ceramic and Composite?

Of course, clinical longevity must always be taken into consideration. The literature is fairly consistent on veneer success rates (7 percent failure over 10 to 15 years). ^1,2  The literature regarding success rates of composite restorations is more difficult to ascertain. What we do know from the literature is that when evaluating surface staining, surface degradation, color change, marginal staining and breakdown and overall longevity 60 to 80 percent of the Class III and Class V restorations remain clinically acceptable after five years. It is also known that Class IV restorations tend to not last as long because they are subjected to a higher amount of stress with functional load. ^{3, 4}

Can Composite Look as Good As Ceramic?

The financial cost of the treatment is often a major component in the patient's decision making process, as the cost of a direct composite restoration in general is significantly lower than the cost of a ceramic veneer fabricated by a technician. However from a clinical standpoint, if the patient wants the restorations to match perfectly, can composite look as good as ceramic? The first thing that needs to be understood is that the answer to this question is not based on the material – it’s based on the clinical experience and skill level of the ceramist and the clinician. With more composite materials on the market than ever before and with the ability of today’s composites to have opacious dentin, body, colored enamels and translucent enamels, composite can look every bit as good as ceramic. In addition, composite has the added benefit of being significantly more conservative by removing far less tooth structure.

In my practice, composite is often the first choice of treatment in many clinical situations - because that is what I would choose if it were my teeth.

References:

1. A 15-year review of veneer failure: A clinician’s perspective. Friedman MJ  Compendium 1998;19(6):625-636
2. A prospective 10-year clinical trial of porcelain veneers. Peaumans M, Van Meerbeek B, et al.  J Adhesive Dent 2004;6(1):65-76
3. Clinical evaluation of four anterior composite resins over five years. Smales RJ, Gerke DC.  Dent Mater 1992;8:246-51
4. Effects of enamel bonding, type of restoration, patient age and operator on the longevity of anterior composite resins. Smales RJ  Am J Dent 1991;4:130-3