Composite Resins and Bonded Porcelain: The Postamalgam Era?

The growing demand of patients for esthetic or metal-free restorations, together with the ongoing interest of the dental profession for tissue-preserving materials have led to the actual development of posterior adhesive restorations. It is now clearly established that a new biomimetic approach to restorative dentistry is possible through the structured use of "tooth-like" restorative materials (composite resins and porcelain) and the generation of a hard tissue bond (enamel and dentin bonding). Scientific studies and clinical experience have validated use of bonded tooth-colored restorations, and we may have entered the so-called "postamalgam era." These significant changes have already impacted daily general practice, including pediatric dentists in California, but it is now critical to assure that the corresponding evidencebased process is integrated to the predoctoral programs statewide and nationwide. This paper reviews the foundations of this evolution, based on maximum tissue preservation and sound biomechanics, the so-called "biomimetic principle." Using scientific evidence and clinical experience, a model for the adequate use of current restorative systems is presented. This work, illustrated with cases with up to 10 and 14 years' follow-up, sets the ground rules for the clinical performance of the posterior esthetic restoration. Important considerations about tooth preparation, matrix techniques, layering methods, immediate dentin sealing and base lining are presented. [ABSTRACT FROM AUTHOR]