Nadeem Younis presents a confirmed step-by-step protocol for ending and sprucing direct composite resin restorations, with helpful outcomes for aesthetics, oral well being and long-term integrity.
Using direct composite resin restorations has elevated dramatically over the previous couple of years (Eltahlah et al, 2018).
Adjustments in sufferers’ expectations and rising aesthetic calls for can now be met by latest developments in composite resins, with their improved bodily and visible properties.
A natural-looking restoration that mimics the tooth construction will be achieved through the use of probably the most acceptable composite materials and layeringtechniques, and replica of the tooth anatomy, with skilful ending and sprucing of the composite restorations.
Ending includes contouring the restorations to acquire the specified anatomy and full any needed occlusal changes.
In the meantime, sprucing is the discount of floor irregularities created by the ending devices (Daud et al, 2018).
A easy floor and excessive gloss composite resin restoration is fascinating, not just for aesthetic causes, but in addition for oral well being and the restored dentition’s long-term integrity.
A tough floor impacts the restoration’s aesthetics (Barakah and Taher, 2014). It makes the composite inclined to staining and reduces the reflectance of the fabric which, in flip, impacts the perceived color of the composite resin. As well as, tough composite resin surfaces will lead to retention of microorganisms, resulting in sooner colonisation and maturation of dental plaque (Konishi et al, 2003; Montanaro et al, 2004).
Roughness of higher than two microns ends in steep will increase in biofilm formation. Lower than 0.2 microns is advisable to offer supreme surfaces for intraoral restorations.
Determine 1: Transitional line angles are marked on the restoration and adjoining tooth for reference
Figures 2a and 2b: The first anatomy is adjusted with a Kulzer pink ring tapered diamondbur (250 – 012F)
Determine 2b
Figures 3a and 3b: Labial adjustment will be carried out through the use of a bur or medium coarse Sof-Lex disc
Determine 3b
Determine 4: A quantity 12 scalpel blade can be utilized to take away extra composite or unbonded resin from the proximal space.
Indistinguishable from pure tooth enamel
From an aesthetic standpoint, a excessive gloss end will assist make the restoration indistinguishable from enamel as a result of the color of the mirrored gentle is extra predominant than the color of the composite resin materials.
Then again, a composite restoration with a diminished shiny end shall be extra apparent to the human eye, even when the shade match to the encircling pure tooth is correct (O’Brien et al, 1984).
There are a lot of components that may have an effect on the ultimate polish obtained with composite resin restorations. Filler particle measurement, resin matrix composition, the sprucing system used, moist or dry sprucing situations, in addition to the utilized power and the time taken, can affect the ultimate gloss achieved.
Ending and sprucing protocol for top gloss outcomes
The next describes the creator’s ending and sprucing protocol, which he has been making use of for greater than 15 years.
The step-by-step course of combines a lot of methods and finest apply adopted by a number of composite resin artistry consultants.
In Determine 1, the higher proper central incisor has been constructed up with a direct composite resin restoration. Thetransitional line angles are marked on the restoration and the adjoining tooth for reference.
A Kulzer pink ring tapered diamond bur is used to regulate the labial and interproximal surfaces and spherical off the transitional line angles (Figures 2a and 2b). The three ranges of the labial curvature will be adjusted with the identical bur, or through the use of a medium coarse Sof-Lex disc or any medium grit disc (Figures 3a and 3b).
A quantity 12 scalpel blade can be utilized to take away any extra composite or unbonded resin from the proximal space (Determine 4). The tremendous tip of the scalpel is the perfect instrument in circumstances the place the margin of the proximal field extends into an space the place the pure anatomy turns into concave.
Steel strips or diamond-impregnated sprucing strips, comparable to Epitex, will be employed the place the floor to be completed is convex or flat (Figures 5a and 5b).
As soon as the first anatomy has been established, developmental grooves could also be marked with a pencil (Determine 6).
The grooves are reproduced by making use of gentle, intermittent stress with a diamond bur held at an angle (Figures 7 and eight).
Determine 9 reveals the composite resin restoration on the central incisor the place the first and secondary anatomy have been outlined.
The composite restoration seems boring with ‘scratch’ marks evident from the usage of the diamond bur or the medium coarse Sof-Lex disc. This marks the top of the ending stage. To assist differentiate the composite restoration from the tooth construction, diamond burs can be utilized intermittently at low speeds with out water.
Care must be taken to keep away from heating the composite floor above 200oF, which can trigger degradation of the resin floor and jeopardise the marginal integrity of the restoration.
Figures 5a and 5b: Epitex sprucing stripsor steel interdental strips will be employed inareas the place the floor is convex or flat
Determine 5b
Determine 6: As soon as the first anatomy has been established, developmental grooves could also be marked with a pencil
Figures 7 and eight: The grooves are reproduced by making use of gentle, intermittent stress with a diamond bur held at an angle
Determine 8
Determine 9: The first and secondary anatomy are outlined
Figures 10A and 10B: Shofu Brownie polishers can be utilized to take away the scratch marks
Determine 10b
Determine 11a: Venus Supra pre-polisher
Determine 11b: Venus Supra sprucing burs
Determine 12: Venus Supra excessive gloss polishingsystem helps create a extremely aesthetic outcome
For gross composite elimination, a diamond bur with a water spray within the air rotor handpiece is advisable (Morgan, 2004).
With the intention to take away the scratch marks, the creator makes use of a Shofu Brownie polisher (Figures 10a and 10b) adopted by the Kulzer Venus Supra aluminaimpregnated silicone factors for a excessive gloss look and aesthetic outcome (Figures 11-12).
The sleek floor produced by aluminium oxide-containing discs and silicone factors is considered associated to their capability to chop the filler particles and resin matrix equally (Özgünaltay, Yazici and Görücü, 2003). Brownie polishers and the Venus Supra silicone factors are extremely efficient at eradicating or sprucing composites.
Nevertheless, eradicating pure tooth construction is more difficult. It’s advisable to make use of the sprucing programs with a water spray to maintain the warmth era to a minimal.
Figures 13 and 14: A superfine Sof-Lex disc is employed within the ultimate stage of the ending andpolishing protocol
Determine 14
Figures 15 and 16: Case one – the affected person introduced with unpleasant, discoloured anteriorcomposite restorations
Determine 16
Determine 17: Case one – the underlying toothstructure after current composite elimination
Determine 18: Case one – postoperativedentition restored with Kulzer Venus Pearl,adopted by ending and sprucing
Figures 19 and 20: Case one – on the one-week evaluation appointment, good integration with the present dentition was recorded and a excessive gloss look of the composite restorations had been achieved with ending and sprucing
Determine 20
Determine 21: Case two – the affected person presentedwith stained restorations and enamel defects inthe higher and decrease anterior tooth
Determine 22: Case two – the underlying toothstructure after composite elimination and toothpreparation
Determine 23: Case two – composite resinbuild-up
Determine 24: Case two – quick polishbefore rubber dam elimination
Determine 25: Case two – polish and evaluation atone-week postoperative appointment
Brownie silicone polishers are impregnated with high-quality abrasive brokers and are advisable for use at 5,000 to 7,000rpm. The Venus Supra sprucing factors are latex free and produced from artificial rubber impregnated with microfine diamond powder and color pigments. Out there in 5 completely different shapes for all restoration surfaces, the pre-polisher set (pink) is used first, adopted by the excessive gloss set (gray).
It is suggested to make use of every set with a water spray, ideally at 7,500rpm however not more than 10,000rpm.
To realize a high-quality gloss, a superfine Sof-Lex disc, or any superfine disc, is employed within the ultimate stage of the protocol. Fast motions should be utilized over the labial and approximal surfaces to minimise warmth era (Figures 13 and 14).
Enhanced CP
GDC anticipated end result: C
CPD hours: one
Subject: Aesthetic dentistry
Instructional goals and aims: To current a step-by-step protocol for ending and sprucing direct composite resin restorations
Clear anticipated outcomes: Accurately answering the questions on web page 102 will reveal the reader understands the advantages of following a protocol for ending and sprucing direct composite resin restorations.
Case research
The next circumstances illustrate how the creator’s ending and sprucing protocol has been adopted following direct composite resin restorations.
Case one
A affected person in her 50s introduced with discoloured anterior composite resin restorations (Figures 15 and 16).
Determine 17 reveals the underlying tooth construction after composite elimination. Determine 18 reveals the dentition after restoration with Kulzer Venus Pearl composite opaque dentine shade Opaque Gentle Chromatic (OLC) and Common shade B1, adopted by ending and sprucing.
On the one-week evaluation appointment, good integration with the present dentition was recorded. The excessive gloss look of the composite restoration had been achieved after ending and sprucing with a mixture of Kulzer tremendous diamond burs, Brownie and Venus Supra polishers and Sof- Lex discs (Figures 19 and 20).
Merchandise used
Brownie Shofu
Epitex GC
Venus Pearl Kulzer
Venus Supra Kulzer.
Case two
A younger affected person introduced with outdated, stained composite resin restorations and enamel defects within the higher and decrease anterior tooth (Determine 21).
Determine 22 reveals the underlying tooth construction after composite elimination and tooth preparation. Figures 23 and 24 reveal the tooth after build-up with Venus Pearl Opaque Medium Chromatic (OMC) and A1 shades, and the preliminary polish earlier than rubber dam elimination.
On the one-week evaluation appointment, a extremely shiny look has been completed by adopting the ending and sprucing protocol described above, restoring the affected person’s smile and confidence (Determine 25).
Conclusion
Spending extra time on the ending and sprucing of composite resin restorations might help to realize excellent aesthetics and contribute to oral well being and long-term tooth integrity.
The ending and sprucing protocol is a multistep course of that, when adopted methodologically utilizing acceptable devices and sprucing programs, can create restorations with a excessive gloss and lasting lustre, with a variety of composite resin supplies.
References
Barakah HM, Taher NM (2014) Impact of sprucing programs on stain susceptibility and floor roughness ofnanocomposite resin materials. J Prosthet Dent 112(3): 625-631
Daud A, Grey G, Lynch CD, Wilson NHF, Blum IR (2018) A randomised managed research on the usage of ending and sprucing programs on completely different resin composites utilizing 3D contact optical profilometry and scanning electron microscopy
J Dent 71: 25-30 Eltahlah D, Lynch CD, Chadwick BL, Blum IR, Wilson NHF (2018) An replace on the explanations for placement and alternative of direct restorations. J Dent 72: 1-7
Konishi N, Torii Y, Kurosaki A, Takatsuka T, Itota T, Yoshiyama M (2003) Confocal laser scanning microscopic evaluation of early plaque shaped on resin composite and human enamel. J Oral Rehabil 30(8): 790-5
Montanaro L, Campoccia D, Rizzi S, Donati ME, Breschi L, Prati C, Arciola CR (2004) Analysis of bacterial adhesion of streptococcus mutans on dental restorative supplies. Biomaterials 25(18): 4457-4463
Morgan M (2004) Ending and sprucing of direct posterior resin restorations. Pract ProcedAesthet Dent 16(3): 211-7
Özgünaltay G, Yazici AR, Görücü J (2003) Impact of ending and sprucing procedures on the floor roughness of latest tooth-coloured restoratives. J Oral Rehab 30(2): 218-224
O’Brien WJ, Johnston WM, Fanian F, Lambert S (1984) The floor roughness and gloss ofcomposites. J Dent Res 63(5): 685-8.
For extra data go to www.kulzer.com/en/en/merchandise/venus-pearl-art-shades.html.