Direct_Fill-TipsTricks.pdf

?
Tips and tricks
for direct restorative procedures

Contents
2
Before and after the treatment
1 What do I do if my patient does not open wide enough? �� 4
2 What do I do if I have only one hand free whilst I am treating my patient? �� 4
3 What do I do if I want to prevent impression material from getting stuck in the facial hair
of a bearded patient? �� 6
4 What do I do if I need to use polishing strips that may hurt the corner of my patient's mouth? ��6
5 What do I do if I have to deal with a non-compliant child? �� 8
Adhesives
6 What do I do if I am not sure if the dentin is wet enough for bonding? �� 10
7 What do I do if I want to prevent postoperative sensitivities? �� 12
8 What do I do if I am not sure which etching technique is best suited for the case at hand? �� 14
Posterior restorations
9 What do I do if my composite resin sticks to my instrument whilst I am placing a filling? �� 16
10 What do I do if I want to provide my composite filling with an esthetic proximal margin? �� 16
11 What do I do if I want to provide my fissures with a well-defined contour? �� 16
12 What do I do if I want to mask severely stained dentin? �� 18
13 What do I do if I want to restore deep cavities as efficiently and esthetically as possible? ��20

3
Anterior restorations
14 What do I do if I have selected the correct shade but the shade looks nonetheless too bright or
too dark? �� 22
15 What do I do if I want to create mamelons on anterior teeth? �� 24
16 What do I do if I want to build up the palatal surface of my anterior restoration with a 45° incline? �� 24
17 What do I do if I want to contour the proximal wall of an anterior restoration? �� 24
18
What do I do if I want to build up a Class IV lesion using dentin and enamel materials
and achieve an optimum result? �� 26
19 What do I do if I want to add special effects and characterizations to my Class IV restorations? �� 28
Light-curing
20 What do I do if I have my doubts that my curing light cures my fillings completely? �� 30
21
What do I do if the composite in particularly bright fillings (e.g. bleach shades)
does not cure properly? �� 32
22 What do I do if I place a large restoration and want to make sure that all its surfaces
are cured properly without having to light-cure several times? ��32
Finishing and polishing
23 What do I do if I am left with little time to do the polishing but I nonetheless would like to achieve
an excellent result?�� 34
24 What do I do if I am not sure which finisher I should use?�� 36
25 What do I do if I am not sure which polishing tip I should use? �� 38

What do I do if…
... my patient does not open wide enough?
A lip and cheek retractor made of soft, flexible material such as OptraGate®
is handy for establishing full access
to the oral cavity. The lip and cheek retractor is comfortable to wear and adapts to the natural movements of the
patient. Because of its elasticity, OptraGate retracts the soft tissues gently and assists patients in keeping their
mouth open. In particular patients experiencing severe tension of the masticatory musculature as a result of e.g.
bruxism may feel that the lip and cheek retractor alleviates their pain and helps them to relax. The lip and cheek
retractor is therefore a valuable aid for both the patient and clinician.
... I have only one hand free whilst I am treating my patient?
A flexible lip and cheek retractor, e.g. OptraGate, is the ideal auxiliary for impression-taking, bleaching, cleaning
and polishing procedures. It considerably facilitates relative isolation with cotton rolls, parotid pads and saliva
ejectors and creates access to a much larger work space. The need for additional retraction of the lips and cheeks
with an oral mirror is eliminated.
2
1
4

With the OptraGate®
in place,
the mouth stays open.
As OptraGate retracts the lips and cheeks around
the circumference of the mouth, both hands are free
to administer the treatment.
Before
and
after
the
treatment
5

... I want to prevent impression material from getting stuck in the facial hair
of a bearded patient?
It easily happens that impression material gets caught in the facial hair of bearded patients when taking an
impression for e.g. making a diagnostic cast. Removing the material from the patient's face is not only time-
consuming but also unpleasant. A soft lip and cheek retractor (e.g. OptraGate) comes in handy here, too. It
encloses the lips and cheeks and covers facial hair extensively.
... I need to use polishing strips that may hurt the corner of my patient's mouth?
Use a soft lip and cheek retractor (e.g. OptraGate) to protect your patient.
This lip and cheek retractor covers the lips and corners of the mouth and provides gentle protection against injuries
to the lips, corners of the mouth and cheeks.
3
4
What do I do if…
6

With an OptraGate®
in place, the area around the mouth
stays clean.
A common problem when taking an impression: Impression
material gets stuck in the facial hair of bearded patients and
can only be removed with difficulty.
The facial hair is free of impression material after impression
taking and does not need to be cleaned.
Before
and
after
the
treatment
Polishing strips can easily hurt the lips and corners of the mouth. The lip and cheek retractor covers these areas and protects them.
7

... I have to deal with a non-compliant child?
In this case in particular, we recommend using a soft, flexible lip and cheek retractor (e.g. OptraGate). It retracts
the lips and cheeks gently and completely, enabling you to carry out the treatment quickly and effectively. Non-
compliant children are often scared and suspicious. You can use the lip and cheek retractor to get the child actively
involved in the treatment and build a relationship of trust. OptraGate in the new colour versions is designed to add
a touch of fun to a situation that is normally fraught with anxiety.
Already the fact that they are allowed to select their preferred colour will give your young patients the feeling that
their views count and their needs and wishes are respected. As OptraGate is made of a flexible material, it can be
squeezed into different shapes; e.g. it can be made to look like a fish mouth. These funny shapes can be used as
props to tell a short story whilst placing the lip and cheek retractor in the child's mouth. This strengthens the trust
between you and your young patient and makes the subsequent treatment easier.
OptraGate in blue and pink is part of the i-Kids program aimed at making the visit to the dentist a positive
experience for children. Certificates of bravery and small give-aways as a reward to take home after the treatment
have already proven to be popular with young patients.
For further information on our i-Kids program, please visit: www.ivoclarvivadent.com/ikids-en
5
What do I do if…
8

Non-compliant children can be involved in the
treatment in a playful manner.
Before
and
after
the
treatment
9
Dr med dent Niklas Bartling, Switzerland; Photo: Ivoclar Vivadent AG

6 ... I am not sure if the dentin is wet enough for bonding?
After the etching procedure, the exposed collagen fibres on the dentin surface should be encapsulated by a
homogeneous and thin layer of adhesive to achieve a stable bond to the tooth. For this to happen, the tooth
surface must not be overly dry. Otherwise, the collagen fibres may collapse. Collagen collapse is a phenomenon
that may occur after phosphoric acid etching as the collagen fibres are exposed. The collagen fibres cannot be
seen by the naked eye. It is therefore difficult to evaluate if or when the dentin surface has become too dry. Some
adhesives fail to infiltrate overdried collagen fibres properly and this may lead to a significant reduction in bond
strength.
Against this background, adhesives such as Adhese®
Universal are based on a combination of water and ethanol as
the solvent to restore moisture to collagen fibres that have collapsed because of desiccation.
This type of adhesives is suitable for both wet and dry bonding techniques.
Adhesives
What do I do if…
10

Adhesives
Collagen fibres are in a vertical position if an adequate
degree of moisture is present on the dentin surface.
Collagen fibres collapse if the dentin has
become excessively dry.
The universal adhesive Adhese®
Universal
moistens collapsed collagen fibres evenly.
11

7 ... I want to prevent postoperative sensitivities?
Postoperative sensitivities can have any of a number of causes. They often occur if the dentin tubules and collagen
network are exposed because they are not properly covered with adhesive. In these cases, external stimuli may
result in movement of fluid within the dentin tubules and cause hypersensitivity. This phenomenon is known as
microleakage and can be avoided.
One way of preventing it is to use an adhesive (e.g. Adhese Universal) that comprises hydrophilic solvents and
methacrylate monomers that can wet and infiltrate the dentin tubules in moist and dry conditions. In addition, the
acidic compounds in the dentin precipitate as insoluble calcium salts, facilitating the mechanical blocking and
sealing of the dentin tubules. This integrated desensitizing effect prevents the fluid flow within the dentin
tubules and reduces the risk for microleakage and postoperative sensitivities.
Using the adhesive in conjunction with the self-etch technique may be an additional measure to prevent
hypersensitivity.
Adhesives
What do I do if…
12

SEM image (1000x magnification) of the dentin tubules after application
of Adhese ®
Universal using the total-etch technique on wet and dry
dentin
Lopes M, University of Lisbon, 2013
Wet dentin Dry dentin
Adhesive layer
Resin tags
Dentin
Odontoblast
Dentinal fluid
Resin tags
Adhese®
Universal
Hot Cold
Reduction of the fluid flow in the dentin tubules
after application of Adhese®
Universal
Brännström M et al.: The hydrodynamic theory of dentinal
pain, 1967
Adhesives
13

8 ... I am not sure which etching technique is best suited for the case at hand?
Etch-and-rinse systems which etch both the enamel and dentin (total-etch technique) usually achieve a better bond
strength because the phosphoric acid contained in the etchant results in a deeper and more pronounced retention
pattern on the enamel. For this reason, these bonding systems are often preferred for indirect restorations that
involve large enamel surfaces (e.g. veneers).
Self-etch systems are faster and easier to apply than total-etch systems. They result in a favourable and predictable
shear bond strength on dentin. As they provide a similar bond strength as other systems but can be applied more
efficiently, they are recommended for direct composite restorations in particular. This is particularly true if most of
the bonding surface is located in the dentin. As genuine self-etch systems do not normally involve a separate
application of phosphoric acid, the bond to the enamel may be reduced in comparison with etch rinse systems.
The more recently introduced universal adhesive systems, e.g. Adhese Universal, have the advantage that they
allow you to freely select your etching technique. These systems are capable of sealing both etched and unetched
dentin. For this reason, you can decide for yourself if you want to etch the dentin along with the enamel or not.
They allow you to choose freely between total-etch (enamel and dentin etching), selective-etch (only enamel
etching) or self-etch (neither enamel nor dentin etching) techniques.
Adhesives
What do I do if…
14

Selective-enamel-etch technique
Self-etch technique Total-etch (etch rinse) technique
Dr A. Peschke, Ivoclar Vivadent AG, Schaan, 2013
Adhesives
15

9
10
... my composite resin sticks to my instrument whilst I am placing a filling?
In this case, use an instrument with a specially coated tip, e.g. OptraSculpt Next Generation (Fig. 2). The innovative
2-component attachments come with a non-stick coating that enables you to adapt and shape composite resins
without being hampered by excessive stickiness. Additionally, the soft quality of the tips reduces the likelihood of
leaving instrument marks on the material. This allows you to achieve a homogeneous and smooth surface
already during contouring.
Even demanding areas, such as fissures and proximal margins can be quickly and easily shaped thanks to the three
attachments available.
... I want to provide my composite filling with an esthetic proximal margin?
The chisel-shaped attachment of the OptraSculpt Next Generation modelling instrument is especially designed
for contouring esthetic proximal margins (Fig. 3). The thin end fits exactly between the matrix band and material,
allowing the marginal ridge to be given a suitably contoured, rounded shape.
... I want to provide my fissures with a well-defined contour?
OptraSculpt Next Generation with the point attachment is of valuable assistance here (Fig. 4).
This modelling tip allows you to create clearly defined esthetic fissures using a small dabbing motion.
What do I do if…
11
16

Posterior
restorations
Fig. 1: Adapting the material with a conventional metal
instrument. Stickiness tends to occur with the first layer of
composite resin in particular.
Fig. 3: Contouring the proximal margin is made easy with the
chisel attachment, which fits precisely between the matrix band
and tooth. The natural curvature of the marginal ridge can be
easily replicated.
Fig. 2: Composite material can be easily adapted
using the ball-shaped non-stick OptraSculpt tip.
Fig. 4: Efficient contouring of fissures and cusps
using the point attachment of the
OptraSculpt instrument.
17

What do I do if…
12 ... I want to mask severely stained dentin?
Severe discolourations can only be concealed by using an opaque material. Please note: The higher the opacity,
the higher the masking effect will be. However, the natural tooth, in particular the enamel, exhibits a certain
measure of translucency (approx. 15%) and this means that an opaque filling may look artificial.
We therefore recommend applying a thin coating (lining) of a flowable opaque material such as IPS Empress Direct
Opaque (translucency: approx. 1%) or Tetric EvoFlow Dentin (translucency: approx. 6%) before applying the actual
filling material. Depending on how much efficiency you are looking for and on how deep the cavity is, you may
either use a bulk-fill material or a conventional composite resin.
18

Then pack and shape the cavity with a sculptable composite,
e.g. Tetric EvoCeram®
using your customary method.
The restoration will reflect the translucency
of the natural tooth.
Cover discoloured dentin by first applying a thin
coating of a flowable opaque composite, such as
Tetric EvoFlow®
Dentin.
Posterior
restorations
19

What do I do if…
13 ... I want to restore deep cavities as efficiently and esthetically as possible?
For deep cavities, we recommend using a bulk-fill material, e.g. Tetric EvoFlow Bulk Fill or Tetric EvoCeram Bulk
Fill, which can be applied and light-cured in increments of up to 4 mm. Tetric EvoCeram Bulk Fill has a sculptable
consistency and can be applied in a single increment in many cases. This allows you to save time and increase your
efficiency.
Another possibility is to use Tetric EvoFlow Bulk Fill. This material provides a flowable and self-levelling viscosity,
which allows it to flow into difficult to reach areas especially easily. For the capping layer, you can choose between
the sculptable Tetric EvoCeram Bulk Fill or a conventional composite, e.g. Tetric EvoCeram.
Do I have to compromise on esthetics if I want to use the bulk-fill technique?
Not at all. Tetric EvoFlow Bulk Fill becomes less translucent (i.e. more opaque) as it polymerizes due to the
innovative Aessencio technology incorporated into the material. As a result, discoloured dentin can be effectively
concealed. To apply a capping layer, you may use a sculptable composite such as Tetric EvoCeram, which is
available in 14 enamel shades. Using this method, you will be able to match the shade of your restoration
closely to your patient's individual tooth shade so that the esthetic result can be hardly told from the esthetic
result achieved with a conventional layering technique.
20

1
Single-layer
technique
Tetric EvoCeram®
Bulk Fill
Two-layer
technique
1
2 Tetric EvoFlow®
Bulk Fill
Tetric EvoCeram®
4 mm
–
4 mm
–
4 mm
–
6 mm
–
Posterior
restorations
21

What do I do if…
14 ... I have selected the correct shade but the shade looks nonetheless too bright or
too dark?
The human eye perceives intensely reflected light as bright and non-reflected light as dark. The surface of a
tooth is not smooth but instead it is textured, consisting of horizontal growth lines, vertical grooves and subtle
concavities and convexities. The scattered light reflected from the surface creates the light reflection that we
perceive as bright. This means: The more light is reflected, the brighter the tooth and/or restoration appears.
If less light is reflected, the tooth/restoration appears to be darker.
Hence, it is important to provide the restoration surface with a morphologically correct texture because the texture
directly affects the brightness of the restoration. Besides the anatomical shape, the surface texture has a
determining effect on the esthetic properties of a restoration. As a rule of thumb, shape comes before shade!.
When contouring the shape of a restoration, particular care should be taken to replicate the small areas of
concavity and convexity found on the surface of natural teeth (Fig. 5).
The bevel, or the transition from the restoration to the tooth, also plays an important part in the perception of
brightness because the natural tooth structure refracts light differently than the restorative material. Because
of this, horizontal lines should be avoided and vertical lines preferred (Fig. 6). This can be achieved by preparing a
wide wave-shaped bevel, or a wave bevel.
22

Anterior
restorations
23
Fig. 6: Straight-line bevels
should be avoided (left).
A wave-shaped line (wave bevel)
results in an optically integrated
transition between the restoration
and natural tooth (right).
Fig. 5: Vertical grooves on the tooth surface
are responsible for reflecting light.

What do I do if…
15 ... I want to create mamelons on anterior teeth?
OptraSculpt Next Generation with the point attachment is particularly suitable for this indication (Fig. 7). With its
round sides and fine tapered tip, it enables you to place mamelons in the composite material in an ideal width with
ease.
You may additionally accentuate the resulting mamelons by overcoating them with a highly translucent Effect
composite (e.g. IPS Empress®
Direct Effect Trans Opal; translucency: approx. 20–30%). This will add special
emphasis to them.
... I want to build up the palatal surface of my anterior restoration with a 45° incline?
If you use a high-viscosity sculptable composite on an incline, you will run the risk of creating undercuts. It can also
happen that the composite cannot be adapted adequately. For these cases, we recommend using a flowable
composite, e.g. Tetric EvoFlow, which is applied only to the margin (Fig. 8).
... I want to contour the proximal wall of an anterior restoration?
The chisel attachment of the OptraSculpt Next Generation modelling instrument allows you to contour the
proximal wall along the enamel layer from the cervical to the incisal, enabling you to achieve a well adapted
proximal surface. After light curing, the proximal surface requires hardly any finishing (Fig. 9).
16
17
24

Anterior
restorations
Fig. 7: Mamelons can be easily contoured
with the help of the pointed OptraSculpt
modelling tip.
Fig. 8: A thin layer of flowable composite (e.g. Tetric EvoFlow®
) is
applied to enhance the adaptation of the material to the palatal
bevel.
Fig. 9: The chisel-shaped OptraSculpt modelling tip
facilitates the contouring of the proximal margin of
anterior teeth.
25

What do I do if…
18 ... I want to build up a Class IV lesion using dentin and enamel materials and achieve an
optimum result?
If the incisal edge is still intact before the tooth is cut, we recommend taking a preliminary impression using a
kneadable impression material. The impression is then cut at the height of the incisal edge in such a way that the
palatal wall and approx. 2/3 of the incisal edge remain preserved. This method will allow you to achieve the original
proportions of the tooth more easily when you build up the restoration.
To obtain a harmonious transition between the composite and tooth structure, a wave-shaped bevel should be
prepared on the vestibular side, using a pear-shaped diamond bur (Fig. 10).
Once the tooth is prepared, appropriately isolated and the dentin and enamel are conditioned, the palatal wall is
reconstructed by applying a very thin increment of enamel material (e.g. IPS Empress Direct or Tetric EvoCeram)
using the preliminary impression as an aid. This layer is then light-cured (Fig. 11).
Next, the dentin body and the mamelons are built up in increments. It is advisable to apply the dentin material in
such a thickness that approx. 1/3 of the bevel is covered by it. The pointed modelling tip of the OptraSculpt Next
Generation instrument facilitates the contouring of the mamelons (Fig. 12).
Once the dentin layer is cured, the reconstruction is given its final shape by applying a layer of enamel material
(e.g. IPS Empress Direct or Tetric EvoCeram). The OptraSculpt Pad instrument is particularly suitable for applying
and contouring this layer. The soft and large attachment pads have a non-stick effect to enable efficient contouring
of smooth surfaces, resulting in restoration surfaces that require hardly any finishing (Fig. 13).
26

Fig. 11: Completed palatal enamel
shell, reconstructed with the help
of a silicone key
Fig. 10: Wave-shaped bevel to
obtain enhanced transitions
Fig. 13: Efficient contouring of
the final enamel layer using
an OptraSculpt Pad
Anterior
restorations
27
Fig. 12: Dentin layering and mamelon
contouring with the help of the pointed
OptraSculpt modelling tip

What do I do if…
19 ... I want to add special effects and characterizations to my Class IV restorations?
Characterizations or natural effects, e.g. hypocalcifications, discolourations etc. can be replicated using
a composite resin system, such as IPS Empress®
Direct. The special effect materials (e.g. IPS Empress Direct Color,
Effect Trans 30 or Trans Opal) are applied in a very thin layer (approx. 0.1– 0.5 mm) under the enamel or incisal
layer to prevent them from fading out over time.
The shade selected depends on the indication (see Table).
28

Effect Indication Shade
Enamel cracks Not discoloured / slightly discoloured
Severely discoloured
White / Honey
Ochre
Hypocalcifications Bright tooth
Dark / yellow tooth
White / Effect Bleach XL
Honey
Discolourations Mottled enamel
Masking dark areas
Discoloured fissures
Tea / nicotine staining
Severely discoloured fissures
White / Honey
Opaque
Ochre / Brown
Grey / Brown
Incisal third Young patients
Middle-aged patients
Older patients
Adding / increasing translucency
Trans Opal*/Trans 30*
Trans Opal*/Trans 20
Trans 20
Blue / Violet
Mamelons Accentuating the interspaces between
dentin trabeculae (emphasising the
mamelons)
Effect Trans Opal
Blue / Violet
HALO effect Opaque incisal edge in young patients in
particular
Effect Bleach XL
White
Cervical areas A and B shades
C and D shades
Ochre
Brown
Worn surfaces Worn and slightly discoloured
Worn and severely discoloured
Ochre
Brown
Anterior
restorations
29
*
Available in a flowable and sculptable version

Light-curing
What do I do if…
20 ... I have my doubts that my curing light cures my fillings completely?
An insufficient light cure can have two possible causes:
a) The light intensity emitted by the curing light is inadequate (e.g. because of a technical defect).
Solution: Check the light intensity regularly using a reliable measuring device (radiometer) such as a Bluephase
Meter II to be sure that you are getting the correct amount of light. As the light intensity is always measured in
relation to the light emission window, the diameter of the light guide should first be determined and then entered
into the radiometer. If the curing light emits a light intensity of less than 400 mW/cm2
, we recommend buying a
new one.
b) The initiator system of the filling material responds to a different wavelength range than the one covered by
your curing light. Solution: See Question 21
Note: Fillings that are not properly cured may cause postoperative sensitivities.
We therefore recommend that you should measure the light intensity of your curing device at least twice a year
because you will not be able to see, with the naked eye, if the light intensity of your curing device is too low.
30

Light
curing
The digital display is activated
automatically when the curing
light is switched on.
The template on the rear
of the radiometer assists in
determining the diameter of
circular light guides.
The size of the diameter is
then entered into the
radiometer.
31

Light curing
What do I do if…
21
22
... the composite in particularly bright fillings (e.g. bleach shades) does not cure properly?
You should make sure that the emission spectrum of your curing light matches the relevant wavelength range of
the product you are using. Universal curing lights covering a broad wavelength range (385–515 nm), such as the
Bluephase Style with integrated polywave technology, are especially useful here (Fig. 14).
... I place a large restoration and want to make sure that all its surfaces
are cured properly without having to light-cure several times?
A light guide with a large diameter, such as the 10-mm light guide of the Bluephase Style, is especially suitable for
these cases (Fig. 15).
You should hold the light guide as upright as possible and at close distance to the restoration.
32

Light
curing
385 – 515 nm
Bluephase®
Valo®
(Ultradent)
Smartlite®
Max (Dentsply Sirona)
Smartlite®
Focus (Dentsply Sirona)
Elipar S10 (3M)
EliparDeep Cure (3M)
DemiPlus (Kerr)
DemiUltra (Kerr)
S.P.E.C. 3(Coltene)
395 – 480 nm
377 – 490 nm
430 – 480 nm
450 – 470 nm
450 – 470 nm
460 – 490 nm
430 – 480 nm
375 515 nm
Lucirin TPO, PPD 320 nm – 420 nm
Ivocerin®
370 nm – 460 nm
Camphorquinone 410 – 500 nm
430 – 490 nm
390 400 410 420 430 440 450 460 470 480 490 500
Wavelength [nm]
Fig. 14: Wavelength range of various curing lights*
* according to the manufacturers' information
Source: Ivoclar Vivadent, 2016
Fig. 15: Large diameter for single-step light-curing procedures
10-mm light guide
Single-step light curing
8-mm light guide
Multiple-step light curing
33

What do I do if…
23 ... I am left with little time to do the polishing but I nonetheless would like to achieve an
excellent result?
In this case, you may want to use a single-step polishing system after you have finished the restoration with
tungsten carbide finishers. The polishing level is controlled by alternating the pressure being applied (coarse or
fine). We recommend beginning the polishing procedure by applying a contact pressure of approx. 2 N
(corresponds to a weight of approx. 200 g). For high-gloss polishing, a contact pressure of approx 1 N (corresponds
to a weight of 100 g) will be adequate.
The polishing result obtained in this way is comparable with the result achieved with a 3-step polishing system
(Figs 16 and 17).
34

Finishing
|
Polishing
100
80
60
40
20
0
0 10 s 20 s 30 s 40 s 50 s
Surface roughness (gloss units)
OptraPol®
3-step system
1,2
1
0.8
0.6
0.4
0.2
0
0 10 s 20 s 30 s 40 s 50 s
Surface roughness (µm)
OptraPol®
3-step system
*
Sources:
In-vitro-Test konkurrierender Poliersysteme; Composite:Tetric EvoCeram®
(Dr S. Heintze, Ivoclar Vivadent, Schaan, 2009)
*Bollen, C. M., Lambrechts, P. Quirynen, M. (1997). Comparison of surface roughness of oral hard materials to the threshold surface roughness
for bacterial plaque retention: a review of the literature. Dent Mater, 13(4), 258-269.
35
Figs 16 and 17: Comparison of the polishing results achieved with a 1-step polishing and a 3-step polishing system

What do I do if…
24 ... I am not sure which finisher I should use?
The term finishing refers to both removing excess material and obtaining a smooth surface on
restorations. What matters is which end you want to achieve and what material you are working on.
Finishing systems are available in a large variety, which can be confusing (Figs 18 – 23).
Recommendation: It is advisable to use a tungsten carbide finisher with a low number of blades (e.g.
colour coding: red ring; Fig. 20) to remove gross excess on composite restorations.
Subsequently, a tungsten carbide finisher with a large number of blades (up to 32 blades) is used to
smooth the surface. Tungsten carbide finishers are a available in different degrees of abrasiveness
(8–32 blades). In general, the more blades the carbide bur has, the less material it will remove and the
smoother the surface will be. Alternatively, diamond finishers with a grit size between 15–40 µm can be
used (Fig. 21). The smaller the grit size, the finer the diamond will be. Diamond and tungsten carbide burs
involve different mechanisms to remove material: Tungsten carbide finishers involve a cutting operation,
while diamond finishers use a grinding/milling operation. For this reason, tungsten carbide finishers can be
used on composite materials but are unsuitable for use on ceramic materials.
36

Fig. 18: Rubber finishers
will remove only very little
material and are therefore
suitable for the pre-polishing
of surfaces.
Fig. 19: Arkansas stones
also remove relatively little
material.
Fig. 20: Tungsten carbide
finishers are available in
different degrees of
abrasiveness. They involve a
cutting mechanism to remove
material and are therefore
ideally suited for finishing
composite materials. However,
they should not be used on
ceramics.
Fig. 21: Diamond finishers are
available in different grit sizes.
They involve a milling
operation to remove material
and are therefore especially
suited for ceramic materials.
They can also be used on
composite resins.
Fine: 32 blades
Rough: 8 blades
Fig. 22: Polishing discs are
suitable for polishing areas
that are difficult to access.
Fig. 23: Polishing strips are
designed for interdental
applications.
Finishing
|
Polishing
37

What do I do if…
25 ... I am not sure which polishing tip I should use?
Polishing tips are commonly available in the following four shapes: small flame, large flame, cup and lens.
The small flame is particularly suitable for polishing delicate structures, such as fissures. However, it wears
out quickly because of its fine tapered end. The large flame is the all-rounder among the polishing tips.
Generally, it allows all surfaces to be reached effortlessly. Cusps and cusp slopes can be easily polished
using a polishing cup as the cup often fits around the cusps and its concave shape is particularly conducive
to establishing an effective contact with the convex structures on the tooth surface. The lens is used for
polishing proximal marginal ridges and exposed proximal areas in partially edentulous dentitions and
broadly spaced teeth.
38

Polishing the fissures using an OptraPol flame. Polishing the interdental spaces using an OptraPol lens. Polishing the cusp slopes using an OptraPol cup.
Finishing
|
Polishing
39

Ivoclar Vivadent AG
Bendererstr. 2
FL-9494 Schaan
Liechtenstein
Tel. +423 235 35 35
Fax +423 235 33 60
www.ivoclarvivadent.com
The above products form a part of the Direct Restoratives product category. The products of this category cover the procedure involved in the direct restoration of teeth –
from preparation to restoration care. The products are optimally coordinated with each other and enable successful processing and application.
Would you like to know more about the products of the “Direct Restoratives” category?
Simply get in touch with your contact person at Ivoclar Vivadent or visit www.ivoclarvivadent.com for more information.
PREPARE BOND FILL CURE FINISH MAINTAIN
Fluor Protector S
Tetric EvoCeram®
OptraGate®
Adhese®
Universal OptraPol®
Bluephase®
THESE ARE FURTHER PRODUCTS OF THIS CATEGORY:
Direct Restoratives
High-performance posterior composite
Tetric EvoCeram®
Bulk Fill Tetric EvoFlow®
Bulk Fill
•
Increment thickness of up to 4 mm due to the highly reactive light initiator Ivocerin®
• Dentin or enamel-like volume replacement
• 10 seconds (≥1,000 mW/cm2
)
• 47% less time required than with the conventional technique*
* compared to Tetric EvoFlow®
and Tetric EvoCeram®
. Data available on request.
The efficient posterior composite!
P
A
T
ENTIERTER
L
ICHTINITIA
T
O
R
Ivocerin
®
Universal adhesion with advanced delivery
• Efficient delivery – up to 190 single-tooth applications per 2 ml VivaPen®
• Universal application – for all bonding and etching techniques
• Predictable results – high bond strength on dentin and enamel
Adhese®
Universal
The universal adhesive
687262/EN/2016-11

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