Decisional factors supporting the use of direct or indirect techniques and related esthetic biomaterials

There are many options for restoring or improving a smile, including various tooth-colored biomaterials and clinical protocols. Some simple and limited tooth form or color corrections in young patients with healthy teeth logically call for a direct approach using composite resins, whereas more extensive smile rehabilitation in older patients with high esthetic demands should rationally be performed with ceramics. The various patient conditions that comprise these 'simple' examples, for which all practitioners may apply the same decision-making rationale, do not apply in increasingly complicated situations when more options appear feasible; this is exactly what the 'gray zone' in esthetic restorative dentistry is about. This introductory article presents and analyzes the multitude of factors to be considered in adopting a rational approach to this 'complex' situation faced daily by clinicians. The other articles in this publication develop first the arguments of the invited experts in favor of direct or indirect techniques and composite resin or ceramic materials, prior to a description of the state of the art in each treatment approach and restorative materials. This is followed by the conclusive outcome of a general discussion summarizing the recommendations of EAED's Active Members and conference moderators to select more rationally the most appropriate treatment modalities and biomaterials for excellence in esthetic restorative dentistry.