Composite Bonding

Where it may be suitable

• Small chips or broken edges on front teeth
• Small and medium-sized gaps between teeth
• Teeth whose length or shape differs from their neighbours
• Front teeth with worn edges (the cause of the wear is assessed first)

Where another option should be considered first

• The overall colour of your teeth. If the concern is the colour of all your teeth, teeth whitening is done without adding anything to the tooth. Whitening does not lighten composite, crowns or veneers the way it lightens natural teeth², so whitening done after bonding can leave a colour mismatch.
• Crowded teeth, wide gaps or a bite problem. Bonding does not move teeth; it only changes their shape. Closing a wide gap with composite alone makes the teeth look wider than they are. In that case orthodontics or a combined plan is considered.
• Untreated decay or gum disease. These problems need to be treated¹ before veneers are placed.
• Extensive loss of tooth structure. If a large part of the tooth has been lost, composite may not be enough; a partial restoration or a crown is discussed.

Where extra care is needed

• Clenching or grinding, or a deep bite. In these cases veneers may not be a suitable option¹. A two-year randomised study comparing composite with ceramic did not include³ patients who clench their teeth, so its results cannot be applied to them. Your dentist may recommend a night guard.
• Worn teeth. Before composite is added, the cause of the wear is assessed, such as clenching or acidic drinks. For example, in a laboratory test every flavoured sparkling water examined showed an erosive effect similar to or greater than orange juice⁴.
• Root-filled teeth. At a university clinic, 196 direct composite veneers were followed for an average of 3.5 years. In this retrospective study the yearly failure rate was about 5 in every 100 veneers on living teeth and about 10 on root-filled teeth⁵. The main cause was fracture of the veneer. This does not mean that a root-filled tooth cannot be bonded.

The right option is decided at an examination, with X-rays assessed where needed.

• Doing nothing. If a small chipped edge or gap does not bother you and there is no underlying disease, leaving it alone is a valid option.
• Teeth whitening. If the only concern is colour, it is done without adding anything to the tooth surface. Its effect is not permanent⁶; the colour partly returns over time. See the teeth whitening page for details.
• Orthodontics. It does not change the shape of the teeth; it moves them to correct their position and the bite. It is used for gaps, crowding and bite problems. It takes months, and afterwards retainers are needed for a long time to hold the teeth in place. A small retrospective study followed 30 patients whose gap between the two upper front teeth had been closed with orthodontics. On average 5 to 6 years after the patients stopped wearing retainers, the gap had reopened in 60% of patients⁷; this rate does not apply to every gap between teeth.
• Bonding or a composite veneer. The composite is shaped in the mouth, directly on the tooth. It can correct a chip, the shape and a gap at the same time.
• Porcelain (ceramic) veneer. It is made in a laboratory and usually needs more than one appointment. Enamel is removed from the tooth for the veneer, and this cannot be undone⁸. See the laminate veneer page for details.
• Laboratory-made (indirect) composite veneer. The composite is shaped in a laboratory rather than in the mouth and then bonded to the tooth. In a ten-year randomised study these veneers failed more often than ceramic ones: survival was 75% for indirect composite and 100% for ceramic⁹. This result does not apply to bonding done in the mouth.

The options can also be combined: for example, after the teeth have been aligned with orthodontics, their shape can be completed with bonding.

The steps below are for bonding done directly in the mouth. A small repair can be completed in one appointment¹; the more teeth are treated, the longer it takes. Your dentist decides whether a local anaesthetic is needed, depending on the extent of the work.

Shade selection is one of the steps that determine the result. Choosing a shade by eye is subjective. In two meta-analyses, selection with digital photography came closer to the target shade¹⁰ than selection by eye. For spectrophotometers (devices that measure tooth colour) the two disagreed: one found an advantage, the other did not¹¹; the studies are few and small.

Risks and disadvantages

• It is not fully reversible. The tooth surface is treated so the composite can hold, and sometimes a small amount of tissue is reshaped. Veneers are not designed to be removed¹. Composite may require less enamel to be removed⁸ than porcelain; even so, tissue removed from the tooth does not grow back, and the procedure does not count as reversible without a trace.
• Staining and wear. Composite resists staining and wear less well⁸ than porcelain. Staining can appear at the edges over time.
• Chipping and debonding. Composite or porcelain, any veneer can chip, crack or come off¹² over time. It then needs to be rebonded, repaired or replaced. In a review of 17 studies on composite restorations in front teeth, the most common reason for failure was fracture of the tooth or the restoration¹³. Nail biting and biting on hard objects increase the risk.
• Appearance problems. In the same review, failures due to colour, shape and surface staining were more common in restorations done for cosmetic reasons. The colour of a veneer cannot be changed¹ once it has been bonded. If the colour of the surrounding natural teeth changes over time, the match may be lost.
• Sensitivity. If enamel has been reshaped, the tooth may be more sensitive.
• Gums and decay. If the edge of the composite near the gum is not cleaned well, gum inflammation or new decay at the edge can develop.

Benefits

• It can be done with very little tissue removed from the tooth, or with no drilling at all.
• No laboratory is needed; small procedures are often finished in a single appointment.
• When damaged, it is easier to repair⁸ than porcelain. Small chips can be repaired; sometimes a new veneer is needed¹².

Recovery time after bonding is usually short. If you had a local anaesthetic, do not eat until it has worn off. If your bite feels high in the first few days, tell your dentist; it can be adjusted.

Day-to-day care

• Brush your teeth twice a day with a fluoride toothpaste; clean between your teeth every day with floss or an interdental brush.
• Do not bite hard things such as nails, pens or very hard foods with your front teeth; cut hard foods into small pieces.
• Tea, coffee and tobacco can increase staining of composite.
• If you clench or grind your teeth, tell your dentist; they may recommend a night guard.
• Come for regular check-ups.

In short: most composite veneers stay in place for several years, but they need repair or replacement more often than porcelain. No single number of years can be given. Studies measure "lasting" in different ways; we state next to each rate what it counts. A rate of veneers staying in place does not mean that there were no problems or no repairs during that time. The research is mostly on composite veneers that cover the whole front surface of the tooth. Our sources give no separate rate for small edge repairs, so we do not give a figure for them.

Composite veneers. A meta-analysis that looked at composite laminate veneers made both in the mouth and in the laboratory pooled the results of randomised studies. Over an average follow-up of between 2 and 8 years, about 88 in every 100 veneers stayed in place¹⁴. The problems reported most often were surface roughness, colour mismatch and staining at the edges.

Composite or porcelain? A two-year randomised study included selected patients with gaps between several teeth. In an assessment that also counted chips as failures, about 93 in every 100 composite veneers and 95 in every 100 ceramic veneers³ were rated successful; the difference was not significant. In the composite group, 4 veneers needed repair³, and staining at the edges was more common with composite.

In a retrospective study of 1,459 veneers at a single dental practice, followed for up to 10 years, composite needed repair or replacement more often. Counting repaired and replaced veneers together, the yearly rate over ten years was about 10 in every 100 veneers for composite and about 3 for ceramic¹⁵. Counting replaced veneers only, the rates were about 4 against 1. Because this study was not randomised, it does not show that the difference comes from the material alone.

In both comparisons we have, the numbers favour porcelain; in the two-year randomised study the difference was not significant, and the ten-year data come from a single non-randomised study. So it has been shown neither that composite lasts as long as porcelain nor that porcelain lasts longer for every patient. Porcelain veneers are not problem-free either. A meta-analysis pooled 29 studies of ceramic veneers. At an average follow-up of 10.4 years, 4.3% of ceramic veneers cracked, 3.5% had a small piece chip off, 2.5% fractured completely¹⁶ and 2.2% came off; the results varied widely between the studies.

Worn front teeth. A meta-analysis pooled 6 studies (141 patients, follow-up from 5 months to 10 years) on repairing worn front teeth with composite placed in the mouth or made in the laboratory. Over 2 to 10 years of follow-up, 88 in every 100 restorations stayed in place, and 68 met the researchers' stricter success criterion¹⁷. The differences between the studies are very large. The authors recommend telling patients that these restorations will need monitoring, repair or replacement in the long term.

Repair or replace? Studies comparing the repair of defective direct fillings with their replacement found no significant difference¹⁸ in the risk of failure. However, there are only 3 studies on this, their reliability is low, and the result is not specific to veneers.

Contact your dentist if any of the following happens:

• A chip or break in the composite, or a sharp edge that catches your tongue
• The composite coming off (keep the piece and do not try to stick it back yourself)
• A high feeling when you bite, or tiredness in your jaw
• Sensitivity that lasts more than a few weeks or keeps getting worse
• Staining or roughness at the edge of the composite, or bleeding from the gum around it
• Pain that starts on its own or wakes you at night

If you have had a knock to your front teeth, or a tooth has broken or moved, see a dentist without waiting.

Emergencies. Severe pain, facial swelling or a fever are not an expected result of bonding; see a dentist the same day. If a swelling makes it hard to breathe or swallow, or spreads to your neck, do not wait for a dental appointment: go to an emergency department or call 112.

This page does not give prices. A treatment plan is prepared for you after an examination. The main factors that affect the plan are:

• How many teeth receive composite, and how much of each tooth: a small edge repair or the whole front surface
• Any treatment needed first: decay, gum treatment, whitening or orthodontics
• A night guard, if needed
• Polishing, repair or replacement that may be needed over time

Ask for the plan in writing, including what is covered and how any future repairs will be handled.