Title
Full-Arch Adhesive Rehabilitation Using Direct Composite Resin: A Biomimetic, Minimally Invasive Approach
Abstract
This case demonstrates full-arch rehabilitation using direct composite restorations in a severely compromised dentition. The treatment philosophy focused on caries control, preservation of remaining tooth structure, biologic respect of soft tissues, and functional and esthetic rehabilitation using modern adhesive protocols. Rubber dam isolation, selective caries removal, deep margin management, incremental composite layering, and occlusal refinement were the core principles guiding treatment. The final outcome achieved functional stability, esthetic integration, and patient satisfaction without resorting to aggressive prosthodontic intervention.
Initial Assessment and Diagnosis
Clinical examination revealed:
- Generalized caries activity with extensive cervical and interproximal involvement
- Multiple teeth with significant structural loss but maintainable periodontal support
- Inflamed gingival tissues due to plaque retention and defective restorations
- Collapsed occlusal vertical dimension in the anterior segment
- Esthetic compromise affecting patient confidence
Radiographic and clinical findings indicated that a conservative adhesive approach was feasible, prioritizing tooth preservation over extraction or full-coverage restorations.
Treatment Planning
The treatment plan was based on the following principles:
- Maximum tooth preservation
- Caries control before esthetics
- Adhesive rehabilitation instead of crowns
- Segmental treatment under absolute isolation
- Functional and esthetic re-establishment using direct composite
Direct composite was selected due to its reparability, biomimetic behavior, and ability to preserve remaining tooth structure.
Clinical Procedure (Step-by-Step)
1. Disease Control Phase
- Removal of gross caries and unsupported enamel
- Selective caries removal to firm dentin in deep areas
- Disinfection of cavities using chlorhexidine where indicated
- Temporary stabilization where needed to control sensitivity and inflammation
This phase aimed to reduce bacterial load and prepare the dentition for definitive adhesive rehabilitation.
2. Isolation Protocol
- Full rubber dam isolation using clamps and retraction accessories
- Additional soft-tissue protection to prevent contamination
- Absolute isolation maintained throughout adhesive procedures
Isolation was critical to ensure predictable bonding and long-term restoration survival.
3. Tooth Preparation Philosophy
- No mechanical retention created
- Rounded internal line angles
- Enamel margins preserved wherever possible
- Cervical margins carefully finished to respect biologic width
This preparation followed biomimetic principles, avoiding unnecessary removal of sound tissue.
4. Adhesive Strategy
- Selective enamel etching with phosphoric acid
- Application of a high-performance adhesive system
- Careful air thinning and complete polymerization
This approach ensured optimal enamel bond strength while reducing dentin sensitivity and degradation.
5. Deep Margin and Cervical Management
- Cervical defects restored using controlled composite layering
- Careful margin adaptation to avoid overhangs
- Attention to emergence profile to promote gingival healing
Direct composite allowed precise control of cervical contours without surgical crown lengthening.
6. Incremental Composite Build-Up
- Incremental layering to reduce polymerization stress
- Dentin replacement layers followed by enamel characterization
- Use of anatomical buildup techniques to recreate natural morphology
Composite was sculpted to restore cusp anatomy, proximal contacts, and facial contours.
7. Occlusal Rehabilitation
- Occlusion assessed intra-operatively
- Light centric contacts ensured
- No premature excursive interferences
- Functional harmony established without increasing stress on weakened teeth
This step was essential to protect restorations and remaining tooth structure.
8. Finishing and Polishing
- Sequential finishing discs and polishing systems used
- Margins refined under magnification
- High-gloss finish achieved to reduce plaque adhesion
Proper finishing significantly influences longevity and periodontal response.
Final Outcome
- Significant improvement in esthetics and smile harmony
- Stable gingival response with reduced inflammation
- Restored function and patient comfort
- Preservation of natural dentition without crowns or extractions
The patient reported improved confidence and comfort immediately after treatment.
Discussion
This case highlights how direct composite restorations, when performed using strict adhesive protocols, can successfully rehabilitate even severely compromised dentitions. Compared to full-coverage restorations, this approach:
- Preserves maximum tooth structure
- Is repairable and modifiable
- Reduces biological and financial cost
- Aligns with modern minimally invasive dentistry
Such cases emphasize that advanced adhesive dentistry is not inferior to prosthodontics when applied correctly.
Conclusion
Direct composite restorations remain a powerful tool for full-arch rehabilitation when guided by biomimetic principles, proper isolation, and sound occlusal planning. This case reinforces that conservative dentistry can deliver long-term functional and esthetic success without aggressive intervention.
References
- Magne P, Belser UC. Adhesive restorations, centric relation, and the biomimetic principle. Quintessence Int.
- Van Meerbeek B et al. Adhesive dentistry: Current status and future challenges. Oper Dent.
- Dietschi D, Argente A. A comprehensive and conservative approach for restoration of severely compromised teeth. Pract Periodontics Aesthet Dent.
- Opdam NJ et al. Longevity of posterior composite restorations: A systematic review. J Dent Res.
- Ferracane JL. Resin composite—State of the art. Dent Mater.
- Bazos P, Magne P. Bio-emulation: Biomimetically restoring teeth. Eur J Esthet Dent.
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