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Why TakE This CoursE?Composite resins are theprimary restorative material oranterior teeth. Patients haveexpectations that when a tooth-colored restoration is placedthat it will be invisible to thoseseeing their smile. Learn thetechniques or fnishing and pol-ishing anterior composite resinsto achieve a highly aestheticresult or your patients.
PaTiEnT CarEThe trend isto simpliy fnishing and polishing
composite restorations. Patientsneed to value the attention to de-tail that is required to place highlyaesthetic restorations.
ConvEniEnCEContinueyour education without traveling,taking time away rom work andamily or paying high tuition, reg-istration and material costs.
CE CrEdiTsSuccessulcompletion o this course earnsyou 2 Continuing Dental Edu-cation Units.
high QualiTyAuthored ordental proessionals, by dentalproessionals, Dental U con-tinuing education courses areengaging, concise, anduser riendly.
Who should TakE ThisCoursE?Dentists, Dental Assistants, andDental Hygienists.
Tese courses have been designed specifcally tomeet the needs o busy proessionals like yoursel,who demand eciency, convenience and value.Begin your Benco educational experience withthis course today, and watch the mail or live CEevents in your area.
ACCEPTED NATIONAL PROGRAMPROVIDER FAGD/MAGD CREDIT
Cet Ccept f Pate Cmpte re
2 CONTINUING EDUCATION CREDITS
Howard E. Strassler, DMD, FADM, FAGD, Professor
Division of Operative Dentistry
Department of Endodontics, Prosthodontics, and Operative Dentistry
University of Maryland Dental School
650 West Baltimore Street, Baltimore, Maryland 21201
410-706-7551
Email: [email protected]
suPErvisEd sElF-sTudy CoursEs FroM BEnCo dEnTal
CoursE oBjECTivEs
At the completion o this program the partici-pant will be able to: Describe the choices in composite resin re-
storative materials Describe the principles o polishing com-
posite resins List and describe instruments used or n-
ishing and polishing composite resins List the step-by-step procedure or nish-
ing and polishing composite resins
CoursE sPonsorBenco Dental is the course sponsor. BencosADA/CERP recognition runs rom Novem-
ber 2009 through December 2013. Pleasedirect all course questions to the direc-tor: Dr. Rick Adelstein, 3401 RichmondRd., Suite 210, Beachwood, OH 44122. Fax:(216) 595-9300. Phone: (216) 591-1161.email: [email protected]
sCoring & CrEdiTsUpon completion o the course, each partici-pant scoring 80% or better (correctly answer-ing 16 o the 20 questions) will receive a certi-cate o completion veriying two ContinuingDental Education Units. Te ormal continu-ing education program o this sponsor is ac-
cepted by the AGD or FAGD/MAGD credit.erm o acceptance: November 2009 throughDecember 2013. Continuing education creditsissued or participation in this CE activity maynot apply toward license renewal in all states. Itis the responsibility o participants to veriy therequirements o their licensing boards.
CoursE FEE/rEFundsTe ee or this course is $54.00. I youare not completely satised with thiscourse, you may obtain a ull reund
by contacting Benco Dental in writing:
Benco Dental, Attn: Education Department,295 CenterPoint Boulevard, Pittston, PA 18640.
ParTiCiPanT CoMMEnTsAny participant wishing to contact the authorwith eedback regarding this course may doso through the course director: Dr. Rick Adel-stein, 3401 Richmond Rd., Suite 210, Beach-wood, OH 44122. Fax: (216) 595-9300. Phone:(216) 591-1161. email: [email protected]
rECord kEEPingo obtain a report detailing your continuingeducation credits, mail your written requestto: Dr. Rick Adelstein, 3401 Richmond Rd.,Suite 210, Beachwood, OH 44122. Fax: (216)595-9300. Phone: (216) 591-1161. email:[email protected]
iMPorTanT inForMaTionAny and all statements regarding the ecacyor value o products or companies mentionedin the course text are strictly the opinion othe authors and do not necessarily reectthose o Benco Dental. Tis course is not in-tended to be a single, comprehensive sourceo inormation on the given topic. Rather, it is
designed to be taken as part o a wide-rang-ing combination o courses and clinical ex-perience with the objective being to developbroad-based knowledge o, and expertise in,the subject matter.
CoursE assEssMEnTYour eedback is important to us. Please com-plete the brie Course Evaluation survey at theend o your booklet. Your response will helpus to better understand your needs so we cantailor uture courses accordingly.
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Cet Ccept f P ate Cmpte re
Te aesthetic appearance o composite resin is based
upon shape, color and gloss o the restoration achieved by
nishing and polishing. When composite resins were rst
introduced in the late 1950s and early 1960s, they were sel-
cured and macrolled with large ller particles in the 25-50 micrometer range. In most cases the ller was made o
quartz. Tese composite resins, once contoured, had little
surace gloss and the patient sensed they were rough when
their tongue touched the restoration. Te introduction in
the late 1970s o visible light-cured composite resins with
smaller ller particles made rom synthetic, soer glasses
made composites more polishable with improved tooth-
like translucency. Tese restoratives allowed the clinician
the ability to provide patients with more natural and es-
thetic tooth-like restorations in the anterior region. Visible
light-cured composite resins had changes in the polymer-ization chemistry that improved the color stability. Light
activation in most cases was initiated when a blue wave-
length light with a peak o 460-480 nm was absorbed by a
photoinitiator usually camphoroquinone (CQ). Te use o
CQ combined with an organic amine allowed the chemical
reaction to progress so the composite resin hardened. Tis
light-activated reaction eliminated the need or tertiary
amines that contributed to unaesthetic color changes o the
earlier sel-cured composite resins.
In the last decade and a hal, manuacturers have in-
troduced a wide variety o composite resins with varied
applications in both the anterior and posterior region. Foranterior restorations microlled composites and hybrid
composite resins have become accepted as the standard.
Microlled composites oer high polishability with tooth-
like translucency, but unortunately are radiolucent. Te
high polishability and the ability to maintain their luster o
microlled composites is due to the use o a 0.04 microm-
eter colloidal silica particles that can be within the polymer
matrix (homogenous microll) or mixed with the polymer
matrix, light cured and crushed to make a prepolymer ller
that is loaded as an organic ller within the microlled
composite (heterogenous microll). Te small llers andresin-rich surace allow or high polishability. Microlled
composites are generally loaded to 32-50% by volume, have
greater polymerization shrinkage, higher water sorption
and a higher coecient o thermal expansion and contrac-
tion than hybrid composites.(1)
Hybrid composite resins combine microller particles
(0.04 micrometer umed silica) with microne glass llers
with an average particle size diameter o less than 2 microm-
eters. ypically these composites are loaded to 58-75% by
volume and are radiopaque. Tis mixture o llers accounts
or the excellent physical properties with high polishability
when compared to macrolled composites.(2)
Regrettably,
one problem with hybrid composite resins is their inabil-
ity to maintain their gloss when exposed to toothbrushing
with toothpaste and prophylaxis pastes.(3-6)Although microlled composites maintained their
gloss, in high stress-bearing areas, microlled composites
they were more susceptible to racture.(7)
Tere was a need
or a highly polishable composite resin with optimal physi-
cal properties or use in the anterior and posterior regions.
Recently, a new generation o hybrid composite
resin has been introduced. Tese composites have been
categorized as nanolled with ller particles with a di-
ameter ranging rom 0.005-0.1 micrometers. Te in-
troduction o nanollers allows manuacturers to cre-
ate hybrid composite resins with physical propertiesequivalent to the original hybrid composite resins, good
handling characteristics and higher polishability.(8-12)
Tese nanolled composites oer an alternative to mi-
crolled composites in their ability to be highly polish-
able with toothlike translucency.(10-13)
Many nanolled
hybrid composite resins have not only the basic shade
selection, but oer an extended range o opacities,
translucencies with dentin, enamel, incisal shades to
allow or building and stratiying a restoration to have
a more toothlike appearance. With the current genera-
tion o nanolled composites or anterior and posterior
restorations, the clinician can expect good color stabil-ity, stain resistance, low wear, excellent polishability and
luster retention.(2,8 10-12, 15)
With the introduction o these composites, manu-
acturers have also introduced specialized shade guides
and recipes to help the clinician choose the mix o
shades to use in specialized circumstances like the
building on Class IV incisal edge ractures rom the in-
side out and stratied building o completed acial ve-
neers or esthetic bonding. Tese stratied composite
resin placements, using the recipe consisting o the den-
tin, enamel body shades and incisal shades can be usedto restore anterior and posterior teeth. Examples o this
philosophy o adhesive bonded composite resin resto-
ration include Filtek Supreme PLUS (3M-ESPE) which
includes a comprehensive shade selection wheel that is
used once the basic shade is selected rom a Classic Vita
Shade Guide (Vident) classical shade guide; IPS Em-
press Direct (Ivoclar-Vivadent) which utilizes rue-to-
Nature shades with ve dierent levels o translucency
and natural uorescence to mimic a natural tooth in ap-
pearance. Shades are selected using the IPS Empress Di-
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rect autoclavable shade guide. Esthet-X HD (Dentsply
Caulk) uses a similar approach by providing the clini-
cian with a comprehensive shade guide with expanded
shades (bleaching shades and some darker shades than
the traditional Classic Vita guide) and receipes on theback o the shade guide to select enamel, dentin and
incisal shades. Nanohybrid composites are the current
state-o-the-art universal anterior and posterior com-
posite resins. Tese advanced composite resins have
been ormulated to be more sculptable with minimal
slump and very little tackiness or ease o placement.
Te nal esthetic appearance o any composite resin
will be based upon the artistic abilities o the clinician in
choosing the correct shade or shades o composite resin
to mimic the color and appearance o the teeth and in
shaping and contouring the restoration. Te restorationsability to imitate in appearance the tooth and/or adjacent
teeth will be based upon the proper use o abrasives to
nish and polish the restorative to its highest luster. Re-
search has shown that the technique or polishing com-
posite resin to its optimal smoothness and gloss is prod-
uct specic and composite resin specic.(10-27)
Regardless
o composite type, using discs sequentially rom coarsest
to smoothest produced the smoothest suraces.
Te principles governing the polishing o compos-
ite resins are similar to those o dental metals. Unlike
metals that have homogeneous alloyed suraces with
a uniorm hardness, composite resins have a variablecomposition o resin matrix and ller particles. In some
cases the resin matrix and llers have dierent hard-
nesses. Metals, due to hardness and composition use
dierent abrasive systems and while composite resin
nishing systems can be used on metals, metal nishers
and polishers should not be used or composites in or-
der to avoid undesirable staining and discoloration. Te
abrasive particles used to polish composites are material
specic. Similar to metal polishing, the sequence o pol-
ishing or composite resin progresses rom the coarsest
abrasive to the smoothest. Finishing and polishing de-vices and instruments can be classied as:
1. coated abrasives, e.g., abrasive nishing disks and strips;
2. rotary cutting devices, e.g., carbide nishing burs;
3. rotary submicron particle diamond nishing abrasives;
4. reciprocating abrasive tips, e.g., laminated abrasive at
paddles
5. rubberized embedded abrasives, e.g., rubber or silicone
rotary points;
6. hand instruments;
7. abrasives suspended in a polishing paste.
No matter which abrasives are selected, the rule o
coarsest to smoothest and then physically debriding the
surace with a moist cotton roll between abrasives must be
ollowed. For a complete listing o the wide variety o n-
ishing and polishing burs, diamonds, abrasives, strips andpastes or composite resin reer to the Benco Dentist Desk
Reerence as your resource or these instruments.
Te goal or placement o any composite resin is mini-
mal nishing and polishing. While this is not dicult with
routine anterior restorations (Class IIIs and Class Vs) or
larger more involved restorations (Class IVs and complete
acial veneering especially or multiple teeth) there will be
signicantly more contouring and nishing involved. ypi-
cally or these larger restorations, the sequence or nish-
ing and polishing involves gross contouring, shaping with
nishing burs and submicron nishing diamonds witha high-speed handpiece ollowed by additional nishing
with abrasive discs and/or rubber points. For long incisal-
gingival restorations, narrow, long nishing burs or dia-
monds with sae-tipped ends aord the ability to establish
esthetic orm to curved suraces. While nishing burs and
diamonds can be used either wet or dry, these authors pre-
er using them dry with the dental assistant suctioning the
composite dust during the procedure. Working with a dry
eld and a light touch allows me or better visualization o
shape and contour o the composite resin surace. Judicious
use o coarse and medium grit nishing disks using only
small sections o the disk allows the same level o control.Most disks today have smaller metal hubs to avoid marring
the composite surace by accidentally hitting the compos-
ite with the metal hubs o the disk. Some manuacturers
(Shou and Brasseler) have placed their disks on silicone
sheaths that slip over the metal mandrel, totally eliminating
the potential o marring the composite resin surace. Ad-
ditional nishing o acial and lingual suraces can be ac-
complished with specialized rubberized polishers in ame,
disk and cup shapes. Tese shapes provide access to the
varied contours o the tooth. Tese are used on a latch-type
contra-angle handpiece. It is important whenever usingabrasive systems that the surace o the composite resin be
physically debrided o composite debris and abrasive de-
bris with a damp cotton roll or gauze. I only an air-water
spray is used, some o the abrasive debris will remain on
the restoration surace and interere with attaining the
smoothest polish nest abrasive grit with the next step-
down instrument.
Interproximal nishing and polishing is accom-
plished with gapped nishing and polishing strips cov-
ered with aluminum oxide abrasive particles or metal
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Fe 1a: Smile
view o discol-
ored maxillary
anterior teeth
due to enamel
demineralizationoccurring dur-
ing orthodontic
trewatment.
Fe 1B:
Retracted view o
maxiallary anterior
teeth.
Fe 2: Long,
thin composite
resin fnishing bur
(Brasseler) trim-
ming the acial
surace
Fig. 1a
Fig. 1B
Fig. 2
strips covered with submicron diamond particles. Oc-
casionally, even with the use o a matrix strip, the resto-
ration may bond to the adjacent teeth, literally splinting
them together. In these cases, there are specialized acces-
sories that allow the clinician to separate the teeth with-
out damaging the restoration. One can saw the teeth apart
using an ultra-thin stainless steel saw blade mounted in
a handle (Cerisaw, Den-Mat). Tis mini-hacksaw and
handle allows or total control o the instrument while
gently sawing through the interproximal resin. When us-
ing a saw, a gingival wooden wedge should be placed to
protect the gingival papilla when sawing through. Axis
Dental combines a gapped diamond containing metal
nishing strip with saw teeth on the strip. Den-Mat uses
the same concept as the CeriSaw by placing saesideddiamond strips in their CeriSaw handle to nish resin
and ceramic veneer interproximal suraces. Another
useul aid to help get through interproximal contacts or
access with placement o matrix strips or gapped nish-
ing strips is the Contact Disc (Centrix). Tis thin, rigid
disk can be inserted rom the incisal, occlusal or acial
suraces to orce the teeth apart with rapid tooth separa-
tion. I there is excess composite resin present, the disk
will create space to place a matrix strip or restoration
without taking the risk o causing bleeding that a gingival
wooden wedge would cause to perorm the same task. In
the presence o excess composite resin interproximally,
the disk will break away excess resin without damaging
the restoration. Premier Dental Products has developed
a diamond-impregnated thin disk, CompDisk, that not
only creates space with rapid separation but can also be
used or interproximal nishing or cleaning interproxi-
mal suraces beore the bonding procedure.
Tere are times aer placement o the composite res-
toration, that margination is best accomplished with a
hand instrument or by using a specialized reciprocating
handpiece with a at abrasive paddle. Carbide-tipped hand
instruments (Brasseler), restorative knives (Hu-Friedy) or
scalpel blades with shapes that allow or access to the res-
toration margin allow the clinician to remove overhangingrestorative material in a more controlled way than with ro-
tary burs or diamonds.(17, 28)
Carbide carvers are especially
useul or marginating composite resin restorations where
slight excesses exist. In hard-to-reach areas such as the
interproximal surace at the gingival margin, specialized
instruments and devices, e.g., a reciprocating handpiece,
Pron (Dentatus) with a at Lamineer abrasive tip can
be used.(28, 29)
Lamineer tips come in a variety o submicron
abrasives or nishing and polishing cervical margins o the
restoration. Te at tips can also be used to nish and shape
acial suraces and incisal embrasures.
Final polish o the composite resin surace to itsmost lustrous nish can accomplished using disks with
the nest aluminum oxide abrasive. Using a disk will
not only smooth the resin surace, but it also heats the
surace creating a high luster. Tis heating o the surace
causes the polymer matrix to reach its glass transition
temperature. Tis phenomenon gives the composite
resin a glassy appearance. Also, a composite resin can
be polished with specialized composite resin polishing
pastes which contain either very ne aluminum oxide
abrasive particles or diamond particles. Tis is best ac-
complished with with oam cups, elt mounted on disksor ne goats hair brushes. I the surace o the restora-
tion is smooth with no acial lobular orm, disks work
well. For acial suraces o composite resins that have
anatomic variation o lobular orm or striations, com-
posite polishing pastes work best.
CasE rEPorT:
A 18-year-old emale presented with concerns about
the appearance o her maxillary anterior teeth. She had
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completed orthodontic treatment to align her permanent
dentition. Unortunately, during treatment, the diculty
in cleaning adjacent to the bonded brackets resulted in de-
mineralization. Although remineralization therapy with a
prescription uorides (Prevident 5000 Plus, Colgate) andthe use o a casein phosphopeptides-amorphous calcium
phosphate paste (CCP-ACP, MiPaste, GC America, Alsip,
IL) was eective, the discolorations on the acial suraces o
#6-11 were aesthetically unacceptable to the patient and her
mother.(Figure 1)
During the restorative treatment consultation the pa-
tient was presented with two minimally invasive treatment
choicesporcelain veneers or direct placement composite
resin. Based upon the age o the patient, the recommenda-
tion or minimally invasive porcelain veneers was discour-
aged because o the potential or the anterior teeth to haveadditional eruption and changes in the height o the ree
marginal gingiva due to the patients age. Te patient and
her parents ollowed this clinicans recommendation or
direct bonded composite resin veneers or #6-11. A diag-
nostic wax-up was not needed because the tooth align-
ment and tooth shapes were aesthetically acceptable or the
patient. In other cases where the patient desires to change
tooth shape and position adhesive bonding with composite
resin and ceramic veneers can be used as a successul alter-
native treatment or esthetic correction o the tooth malpo-
sition in the anterior area.(30, 31)
When the patient accepted
treatment, she was scheduled or restoration with a directplacement optimized particle nano-hybrid composite resin
(NDurance, Septodont) to aesthetically veneer the maxil-
lary incisors and canines.
Te choice or NDurance was based upon this clini-
cians experience with patients that have mouth breath-
ing and leave the surace o the composite resin dry dur-
ing their normal activities. Te desire to have a high luster
when the restoration was dry and good polish retention is
oered by the unique monomer chemistry o NDurance
based upon dimer acid monomers that signicantly reduce
polymerization shrinkage, shrinkage stresses and increasedthe initial double bond concentration o the monomer and
the degree o double bond conversion achieved during po-
lymerization.(32, 33)
With NDurance, the use o optimized
nano-llers o Ytterbium Fluoride, Barium glass and silica
make this composite easy to distinguish in radiographs and
provide or wear resistance similar to existing nano-lled
composites.(34-36)
With this signicantly lower volumetric
shrinkage and non-stick ormulation with NDurance,
well-adapted composite resin restorations are more eas-
ily achievable. Side benets o this new chemistry include
extremely low water sorption and solubility which contrib-
utes to color stability (no color shiing), marginal integrity
and stain resistance o the composite. A clinical research
study evaluating the NDurance to restore anterior teeth
demonstrated excellent clinical results in all the categoriesevaluated at one year.
(37)
CliniCal ProCEdurE
Beore tooth isolation, a shade was selected with a Clas-
sic Vitapan shade guide (Vident, Brea, CA). Te patient
wanted the teeth to be slightly lighter in appearance. Shade
selection nalization was achieved by placing an increment
o composite resin in the lighter shade on the right central
incisor, shaping it and light curing that increment. Like
many o the new generation o nano-lled composite res-
ins, NDurance has shade choices o regular shades, trans-lucent shades and bleaching shades. Although NDurance
has very little color shi when light cured, some com-
posite resins change their shade signicantly when light
cured. Tis color shi occurs during light curing due to the
chemistry o the polymerization process. By exposing the
composite resin to the light source, a bleaching out o the
orange-yellow colored photoinitiator, camphoroquinone,
occurs and the material reaches its nal shade. Accurate
shade selection is a critical step when placing anterior com-
posite resins. Te patient was pleased with the lighter shade
and was ready or treatment.
Te teeth were isolated using lip retractors. Sincethe tooth shape and alignment were acceptable, as well
as, a minimally translucent shade o NDurance was
selected to block out the enamel discolorations, only a
minimally invasive preparation o the acial suraces o
#6-11 was needed. Te teeth were minimally prepared
leaving enamel to a depth o 0.3 mm using the a me-
dium grit ame shaped diamond (Revelation 653-016,
SS White Burs) on a high-speed handpiece with water
spray. Since there was no need or incisal edge length
changes, the incisal edges were not changed.
While there are many dierent techniques to restore #6-11 with direct composite veneers, I have ound that the ol-
lowing sequence gives me excellent control o the compos-
ite shape and widths during reehand sculpting. Te teeth
were restored, two teeth at a time to control tooth shape and
contour. Te sequence o restoration was the maxillary cen-
tral incisors, the right maxillary lateral incisor and canine,
and then the le maxillary lateral incisor and canine. Be-
ore acid etching, dead so stainless steel metal matrix,
thickness 0.001 inch thick (Pulpdent) was placed as a
matrix. For the maxillary central incisors, my experi-
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Fe 3: Coarse XT Soex disk (3M-ESPE) shaping incisal edge. Fe 4: Coarse XT Soex disk (3M-ESPE) shaping incisal
embrasure. Fe 5: For another case Vision Flex disk (Brasseler) shaping acial and incisal embrasures.Fe 6: For another
case Profn with S type Lamineer tip (Dentatus) shaping acial embrasure.Fe 7: For another case sae sided Lamineer tip
on Profn reciprocating handpiece, shaping gingival interproximal embrasure.Fe 8: Enhance (Dentsply Caulk) fnishing cup
smoothing acial surace o composite resin.
Fig. 3
Fig. 6
Fig. 4
Fig. 7
Fig. 5
Fig. 8
ence has been that using aofemire stainless steel rigid
matrix (0.002 inch thick) cut into a small rectangular
strip placed between the central incisors provides or
the correct orientation o the midline to the interpupil-
lary plane. Following the plan or restoration two teeth
at a time, the acial tooth suraces and slightly over the
incisal edge were etched or 15 seconds with a 32 per-
cent phosphoric acid etchant and then rinsed with an
air-water spray or 15 seconds. Te etched tooth surac-
es were dried, leaving a slightly rosty appearance to the
enamel. A 5th-generation adhesive (Septobond, Sep-
todont) was painted on the acial surace o the etched
enamel and then light cured or 10 seconds with a high
intensity LED curing light (BluePhase 20i, Ivoclar-Viva-
dent). Te nano-hybrid composite resin (NDurance)
was placed on the acial suraces o both central incisorsand sculpted with a thin, broad plastic lling instru-
ment (PFIAB1, HuFriedy). Tis instrument allows or
smooth shaping o the broad acial areas o incisors. Te
instrument was lightly wetted with a coating o adhesive
resin to prevent the composite resin rom sticking to the
instrument and pulling away rom the enamel surace.
Te composite resin was light-cured or 20 seconds. A-
ter placement o the composite resin on the central inci-
sors, the other teeth were were restored ollowing the
sequence described and the same protocol.
Finishing and Polishing:
Many manuacturers provide kits containing nishing
burs, diamond abrasives, rubberized abrasives and disks
that provide the clinician with an orderly arrangement o
nishing and polishing instruments. In these authors ex-
periences all these kits have merit. Tere is certainly no
one way to nish and polish composite resin but no matter
what set o instruments are selected the operator does need
to ollow the order o coarsest to nest to attain the best
nish and polish or composites. For this case, the acial
suraces were contoured using a long, narrow, sae-ended,
multiuted nishing bur (E-9F, Brasseler) (Figure 2) but
a submicron diamond abrasive with a similar shape could
also be used. Te gingival margin was contoured and mar-
ginated with a shorter, thin, needle-shaped nishing bur.
Other popular choices or shaping acial suraces o veneersand Class IVs are the Sae-ended series o nishing burs
rom SS White Burs and nishing burs rom Axis Dental.
Te choice o nishing bur and diamond abrasive is usually
a decision made by the practitioner based upon his or her
ability to control the instrument without notching the res-
toration. Finishing burs can have as ew as 8 and 12 blades
or gross reduction. For ner nishing, 16-bladed and
30-bladed nishing burs are available. Diamond composite
nishers usually have diamond particle sizes o approxi-
mately 30-40 microns or ne grit, 15 microns or extra-ne
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Fe 9: Egg-
shaped fnishing
bur (SSWhite Burs)
marginating and
shaping lingual
surace o composite
restoration.
Fe 10: Goat's
hair polishing brush
(Ultradent) with
composite polishing
paste bringing the
composite resin to
a highly polished
surace.
Fe 11: Complet-
ed restorations smile
view (N'Durance
Dimer Nano-hybrid,
Septodont)
Fig. 9
Fig. 10
Fig. 11
grit and 8 microns or ultra-ne grit. A thin, brand-new n-
ishing bur can cut too aggressively into a acial surace. I
have ound that a composite resin nishing bur dulls appro-
priately aer two sequences o autoclaving, thus enhancing
control. o urther marginate and nish the gingival mar-
gin a ame-shaped ne nishing diamond (862-016, SS
White Burs) was used because it allows or better access to
the gingival margin without marring the root surace o the
tooth. Te acial surace was also shaped with a coarse X
Soex disk (#2381C , 3M-ESPE).
Te incisal edge was shaped and the length determined
using a pop-on mandrel with a coarse disk (Soex X disk,
3M-ESPE)(Figure 3). Te best technique or shaping the
incisal edge is to have the patient seated in an upright posi-
tion that mimics how the incisal edges are visualized. Te
disk should be oriented with a slight lingual inclinationollowing the chisel shape o the incisal edge o an intact
incisor. Te incisal embrasures and acial embrasures were
established using a the same disk. (Figure 4) Tin, exible
diamond disks can also be used, e.g., the Vision Flex Disc,
Brasseler) (Figure 5) Tese areas can also be shaped with
a reciprocating handpiece, Pron, and an S series knie
edge Lamineer tip (Figure 6). Once shaped the areas were
nished using successively smoother disks rom a medium
to ne and to nest grit.
One o the most dicult areas to access when nish-
ing any aesthetic restoration is the gingival interproxi-
mal margin. Finishing strips do not work well due to thediculty o attempting to access these margins. In this
case, the Pron with a Lamineer tip was used in the
gingival interproximal areas because it aorded a ne
control that the reciprocating handpiece allows with its
back and orth motion to saely nish and polish the
root suraces without ear o notching. (Figure 7) Fin-
ishing burs on a high-speed handpiece, i not used cor-
rectly, can easily notch a root surace. Even the thinnest
o nishing burs or submicron diamonds are rounded
and can notch root suraces. Te Lamineer tips are sae
sided and come in decreasing diamond abrasive grits tonish and then polish the gingivoproximal suraces.
Tere are times when a rotary instrument or even
a reciprocating instrument does not have complete
access to the interproximal surace. For these special
situations, a hand instrument allows or ne control,
precision placement and eective removal o excess
composite resin. Hand instruments or this use include
carbide-tipped composite instruments (with specialized
shapes to access dierent tooth suraces), composite
carving knives and a #12 scalpel blade.(28)
Te nishing and polishing o the interproximal sur-
aces o composite resin restorations require the same
attention given to accessible suraces. Care should be
taken not to aggressively nish interproximal suraces
by removing excessive composite resin, resulting in an
open proximal contact. Interproximal strips can be used
to shape and contour the interproximal contact thus
maintaining the proximal contact. When using nish-
ing strips, always proceed rom medium abrasive grit to
ne grit to the nest grit strips. Gapped nishing strips
work best as they allow the operator ease o placement
between the teeth. I there is diculty getting the strip
through the contact, this can be accomplished using a
plastic lling instrument to rapidly separate the teeth
and then sliding the nishing strip below the interproxi-
mal contact area. I the operator wants to use a diamond-abrasive gapped strip, (e.g.,Open centered lightening
strips, Miltex), additional care must be taken to not re-
move tooth structure when nishing the interproximal
areas. Tese diamond impregnated strips work well in
removing stain on interproximal tooth suraces beore
the bonding procedure.
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Intermediate nishing o the acial surace was ac-
complished with a cup-shaped, rubber nisher, e.g,
Astropol, Ivoclar-Vivadent; Jazz, SS White Burs, and
Enhance, Dentsply-Caulk. For this case, a cup shape
(Enhance) aords access to the gingival acial margin
and contours to the acial surace.(Figure 8) I lobularacial orm is desired in the restoration, this can be ac-
complished once the acial surace has been smoothed
by using a disk-shaped rubberized abrasive. Te lingual
surace was nished with an egg-shaped nishing bur (SS
White Burs)(Figure 9). Te surace was then smoothed
with a ame shaped point (Jazz, SS White Burs). Occlu-
sion was checked beore the nal polish was completed.
Te nal polish was accomplished with a composite
resin polishing paste (Sparkle, Pulpdent) using a goats
hair polishing wheel (Jiy Goat Brush, Ultradent) (Fig-
ure 10). Foam cups (Luminescence, Premier Dental
Products and Enhance oam cups, Dentsply-Caulk) can
also be used eectively with composite resin polishing
pastes. Another technique or attaining a smooth, high
luster is using the nest grit aluminum oxide disk avail-
able or the nest grit o rubber polishing point. Running
the nest abrasive disk or rubber point above 18,000
RPM creates a highly lustrous surace. Tis is due to
both the polishing eect o the disk and the act that the
disk heats the resin surace, creating a glassy appearance.
Interproxmal areas can be urther polished with small
width gapped ne abrasive nishing strips or composite
resin polishing paste on a Lamineer plastic polishing tip(Dentatus) with the reciprocating handpiece. Te patient
was pleased with the nal result. (Figure 11)
disCussion:
Te clinical success o nishing and polishing tech-
niques can best be seen during the recall appointments
o patients restorations. While the current generation
o composite resins is highly polishable, this may not
hold true or all cases. Te highly polished surace o
resin-rich microlls are still prone to staining(38)
. Te
potential staining o composite resin suraces is direct-
ly related to a patients oral habits including a patients
diet (coee, iced tea, wine and other alcoholic bever-
ages, cola beverages, tea), as well as other habits (smok-
ing, chew tobacco, and the use o alcohol-containing
mouth rinses). Te staining due to coee, tea and
smoking arises rom the deposition o stain rom the
oending agent. Alcoholic beverages and high percent-
age alcohol-containing mouth rinses cause composite
staining by soening the resin matrix o the composite
resin.(39-42)
Tis soened polymer matrix allows the pa-
tient to abrade away the matrix leaving exposed ller
particles and a slightly roughened composite resin sur-
ace susceptible to staining. It has also been demon-
strated that acidulated uorides can have an etching e-
ect on glass ller particles leaving composites rougheras well.
(43, 44)
Oral maintenance o restorations and oral health can
also have an impact on the appearance o composite res-
ins. As stated earlier, high concentration alcohol mouth
rinses can soen the resin matrix, leaving the compos-
ite susceptible to toothbrush with toothpaste abrasion.
Even without alcohol mouthrinses, toothpastes can a-
ect composite smoothness.(3-5)
For patients with signi-
cant staining, some hygienists use air powder abrasive
instruments to remove stain. Te sodium bicarbonate
abrasive powder used to remove tooth stains can sig-
nicantly roughen composite resin restorations.(45)
Care
must be taken when using these devices.
Te gloss o the composite resin contributes to the
overall aesthetic appearance o the restoration. It is
possible that even ollowing all the recommendations
or nishing and polishing composite resins to their
highest luster, that outside inuences can have deleteri-
ous eects on the smooth composite surace. Because
o these potential adverse eects, composite resin res-
torations need to be reassessed or repolishing at every
recall. Te dental hygienist needs to be aware o poten-
tially damaging eects o the pastes and stain removaldevices they use. Also, the dental hygienist should be
instructed with techniques or repolishing composite
resin restorations using ne abrasive aluminum oxide
composite resin polishing pastes and disks.
ConClusion:
During the last several years, more polishable nano-
lled composite resins have become available with the
physical properties o hybrid composite resins. With
these new composites have come new polishing sys-
tems to include rubberized abrasives. Many o the
instruments previously used to nish composite res-
ins are still very useul with the newer composites. In
order to attain the optimal nish or composite resins,
it is important to ollow manuacturers recommenda-
tions. Using a systematic technique rom nishing burs
and diamonds, abrasive disks, rubberized abrasives and
composite resin polishing paste, you should be able to
impart an enamel-like luster to your composite resins.
Care must be taken to reevaluate these restorations at
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RefeRences1. Powers JM. Composite restorative materials. In Restorative Dental Ma-
terials edited by Craig RG and Powers JM. Edition 11, Mosby Publish-
ing, 2002 ; p. 232-258.
2. Strassler HE, Polishing composite resins. J Esthet Dent, 1992; 4:177-179.
3. Strassler HE, Mott W. Te surace texture o composite resin aer pol-ishing with commercially available toothpastes. Compend Contin Educ
Dent 1988; 8:826-830.
4. Serio FG, Strassler HE, Litkowski L, et al. Te eect o polishing pastes
on composite resin suraces. J Periodont 1988; 59:838-840.
5. Roulet JF, Roulet-Mjehrens K. Te surace roughness o restorative
materials and dental tissues aer polishing with prophylaxis and polish-
ing pastes. J Periodont 1982; 53:257-266.
6. Neme AL, Frazier KB, Roeder LB, Debner L. Eect o prophylactic
polishing protocols on the surace roughness o esthetic restorative ma-
terials. Oper Dent 2002; 27:50-58.
7. Goldman M. Fracture properties o composite and glass ionomer dental
restorative materials. J Biomed Mater Res, 1985; 19:771-783.
8. CRA Newsletter 2003; 27(1):1-2.
9. Peyton JH. Direct restoration o anterior teeth: review o clinical
technique and case presentation. Pract Proced Aesthet Dent 2002;
14(3):203-210.10. Senawongse P, Pongprueksa P. Surace roughness o nanol and nana-
hybrid resin composites aer polishing and brushing. J Esthet Restor
Dent. 2007; 19:265-73.
11. Almeida GS, Poskus L, Guimaraes JG, da Silva EM.
12. Sensi LG, Strassler HE, Webley W. Clinical materials review: direct com-
posite resins. Inside Dent. 2007; 3(7):76-79.
13. Stanord WB, Fan PL, Wozniak W, Stanord JW. Eect o nishing on
color and gloss o composites with dierent llers. J Am Dent Assoc
1985; 110:211-213.
14. Da Costa J, Ferracane J, Paravina RD, et al. Te eect o dierent polish-
ing systems on surace roughness and gloss o various resin composites.
J Esthet Restor Dent. 2007; 19:214-24.
15. Korkmaz Y, Ozel E, Attar N, Aksoy G. Te inuence o one-step polish-
ing systems on the surace roughness and microhardness o nanocom-
posites. Oper Dent. 2008; 33:44-50.
16. Barghi N. Surace polishing o new composite resins. Compend Cont
Educ Dent 2001; 22:918-924.
17. Duke ES. Finishing and polishing techniques or composite resins.
Compend Cont Educ Dent 2001; 22:392-396.
18. Barghi N. A guide to polishing direct composite resin restorations.
Compend Cont Educ Dent 2000; 21:138-144.
19. Ozgunaltay G, Yazici AR, Gorucu J. Eect o nishing and polishing
procedures on the surace roughness o new tooth-coloured restor-
atives. J Oral Rehabil 2003; 30:218-224.
20. Reis AF, Giannini M, Lovadino JR, dos Santos Dias C. Te eect o six
polishing systems on the surace roughness o two packable resin-based
composites. Am J Dent 2002; 15:193-197.
21. Pratten DH, Johnson GH. An evaluation o nishing instruments or an
anterior and a posterior composite. J Prosthet Dent 1988; 60:154-158.
22. Jeeries SR, Barkmeier WW, Gwinnett AJ. Tree composite nishing
systems: a multisite in vitro evaluation. J Esthet Dent 1992; 4:181-185.
23. Barkmeier WW, Cooley RL. Evaluation o surace nish o microlled
resins. J Esthet Dent 1989; 1:139-143.24. Hoelscher DC, Neme AM, Pink FE, Hughes PJ. Te eect o three nishing
systems on our esthetic restorative materials. Oper Dent 1998; 23:36-42.
25. Setcos JC, arim B, Suzuki S. Surace nish produced on resin compos-
ites by new polishing systems. Quintessence Int 1999; 30:169-173.
26. Botta AC, Duarte Junior S, Paulin Filho PI, Gheno SM, Powers JM. Sur-
ace roughness o enamel and our resin composites. Am J Dent. 2009;
22:252-4.27. de Maraies RR, Goncalves L de S, Lancellotti AC, et al. Nanohybrid
resin composites: nanoller loaded materials or traditional microhybrid
resins. Oper Dent. 2009; 34:551-7.
28. Strassler HE. Interproximal nishing o esthetic restorations. MSDA
Journal 1997; 40(3):105-107.
29. Strassler HE, Brown C. Periodontal splinting with a thin high-modulus
polyethylene ribbon. Compend Contin Educ Dent 2001; 22:696-702.
30. Helvey GA. Using pressable ceramics to achieve orthodontic correction.
Pract Period and Aesthet Dent 2002; 14:223-227.
31. Lowe RA. Instant orthodontics: an alternative esthetic option. Dent
Prod Report 2002; 36(7):50-52.
32. Ge J, Lemon M, Lu H, Stansbury JW. Dimer acid-der ived dimethac-
rylates as diluents monomers in restorative resins. J Dent Res (Special
Issue A); 2005; 84: abstract no. 1470.
33. Lu H, Newman SM, Bowman CN, Stansbury JW. Dimer acid derived
dimethacrylate or ternary dental restorative resins. J Dent Res (SpecialIssue A). 2006; 85:abstract no. 32.
34. Bracho-roconis C, Rudolph S, Boulden J, Wong N, et al. Characteriza-
tion o a new dimer acid based resin nano-hybrid composite. J Dent Res
(Special Issue A). 2008; 87: abstract no. 81.
35. Bracho-roconis C, Rudolph S, Garnhart A, Boulden J. New low-
shrinkage dimer acid based microhybrid composite physical properties.
J Dent Res (Special Issue A). 2007; 86: abstract no. 1290.
36. Burgess J. Comparison polishing o nanolled composites. Compend
Contin Dent Educ (Supplement). 2010; 31(2):9-11.
37. Ritter H, Lee SS. Clinical evaluation o NDurance nano-dimer con-
version technology dental composite J Dent Res. 2009; 89(Special Issue
IADR Abstracts): Abstract 1006.
38. Luce MS, Campbell CE. Stain potential o our microlled composites. J
Prosthet Dent 1988; 60:151-154.
39. McKinney JE, Wu W. Chemical soening and wear o dental compos-
ites. J Dent Res 1985; 64:1326-1331.
40. Settembrini L, Penugonda B, Scherer W, Strassler H, Hittelman E. Al-
cohol containing mouthwashes: eect on composite color. Oper Dent
1995; 20:14-17.
41. Penugonda B, Settembrini L, Scherer W, Hittelman E, Strassler H. Alco-
hol-containing mouthwashes: eect on composite hardness. J Clin Dent
1994; 5:60-62.
42. Almeida GS, Poskus L, Guimaraes JG, Da Silva EM. Te eect o
mouthrinses on salivary absorption, solubility and surace degradation
o a nanolled and a hybrid resin composite. Oper Dent. 2010; 35:105-
11.
43. Kula K, Nelson S, Kula , Tompson V. In vitro eect o acidulated
phosphate uoride gel on the surace o composite with dierent ller
particles. J Prosthet Dent 1986; 56:161-167.
44. Soeno K, Matsumura H, Atsuta M, Kawasaki K. Inuence o acidulated
phosphate uoride agent and eectiveness o subsequent polishing on
composite material suraces. Oper Dent 2002; 27:305-310.
45. Cooley RL, Lubow RM, Patrissi GA. Te eect o an air-powder abrasiveinstrument on composite resin. J Am Dent Assoc 1986; 112:362-364.
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ConTinuing EduCaTion TEsT QuEsTions
test questions
1. Usully h phiii us lih-cucpsis is
a. silane
b. glass llersc. camphoroquinoned. Bis-GMA
2. micll cpsis f hih plishbiliywih h-lik sluccy, bu uuly iluc. T hih plishbiliy hbiliy ii hi lus icllcpsis is u h us cllil silicpicls h c b wihi h ply ix(hus icll) ix wih hply ix, lih cu, cush k pply ll h is l s
ic ll wihi h icll cpsi(hus icll). T ll picl siz h cllil silic picls is
a. 0.04 micrometersb. 0.4-0.9 micrometersc. 1-3 micrometersd. 5-15 micrometers
3. a w clss ll cpsi sisf h cliici cbii ipvphysicl ppis
a. better ow to adapt to marginsb. higher polishabilityc. expanded shades or improved shade selection
and the ability to match incisal, enamel anddentin shades.
d. b and c
4. nll cpsis hv ll picls wih i i
a. 0.005-0.1 micrometersb. 0.5-5 micrometersc. 5-10 micrometersb. 20-50 micrometers
5. all h llwi ll cpsi
sis eXCePt:a. IPS Empress Directb. Esthet-X HDc. NDuranced. Smoothy
6. T sis biliy ii i ppch h / jc h will b bsup h pp us bsivs ish
plish h siv is hihs lus.rsch hs shw h h chiqu plishi cpsi si is pilshss lss is puc spcic cpsi si spcic.
a. Both statements are trueb. Te rst statement is true, the second statement is
alsec. Both statements are alsed. Te rst statement is alse, the second statement is
true
7. all h llwi isus
vics ish plish cpsisis eXCePt:a. coated abrasives, e.g, abrasive nishing disks and
stripsb. ultrasonic scaling tipsc. carbide nishing bursd. submicron diamond abrasives
8. gss ishi cui c sily bccplish wih
a. nishing bursb. submicron nishing diamondsc. coarse and medium grit disksd. all the above
9. T is wh plci icpsi si h xcss h iivlipxil i s b v. Tisxcss c b v usi
a. a Pron reciprocating handpiece with a Lamineertip abrasive tip
b. a nishing diskc. #12 scalpel bladed. a and c
10. iishi ipxil sucs s
scib i his icl iclu ll hllwi eXCePt:
a. gapped nishing and polishing strips covered withaluminum oxide abrasive particles
b. metal strips with submicron diamondsc. dental oss with zirconia abrasive
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ConTinuing EduCaTion TEsT QuEsTion
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11. occsilly, wh plci ipxilsis wih cpsi sis, h jch y b h. a chiqu scib i
h icl sp h h usi ila. jackhammerb. routerc. sawd. hammer
12. t chiv h hihs lus cpsisi, h h l sp plishiwul b
a. nishing burb. submicron nishing diamondc. composite resin polishing pasted. air abrasion
13. il plish h cpsi si suc iss lusus ish c ccplish usi iskswih h s luiu xi bsiv. Usi isk will ly sh h si suc, bu ils hs h suc ci hih lus. Tishi h suc cuss h ply ix ch is_______________________________.Tis ph ivs h cpsi si lssy ppc.
a. waxed smoothnessb. glass transition temperaturec. ller mosaic polishd. polymer matrix interstitial exure
14. T pi wih ic shic bi ihis icl h h iscli u
a. tetracycline stainingb. demineralization due to bacterial plaque retained by
orthodontic bracketsc. endodontic stainingd. hypoplastic white spots
15. T chic cpsi si s hi h h pi i h cs pis lw shik cpsi wih hih
ubl b cvsi h hs uiqucpsi chisy bs up
a. dimer acid monomersb. glyomonersc. resinomersd. pleobisphenol dimethacrylate
16. T ii piiz lls wh ypk nduc cpsi si sy isiuishi iphs pvi w sisc.
a. Ytterbium uorideb. barium glassc. silicad. all the above
17. T pil sii cpsi si sucs isicly l pis l hbis iclui pis i (cf, ic , wi h lchlicbvs, cl bvs, ), s wll s h hbis(ski, chw bcc, h us lchlcii uh iss). T sii u cf, ski iss h psii si h fi .
a. Both statements are trueb. Te rst statement is true, the second statement is alsec. Both statements are alsed. Te rst statement is alse, the second statement is true
18. alchlic bvs hih c lchl-cii uhiss c k cpsi sisuscpibl sii bcus hy
a. cause loss o ller particles through chemicaldissolution
b. soen the polymer matrix o the composite resinmaking them more susceptible to wear and suraceroughening
c. cause microractures in the composite resin suraced. cause a change in chemical polarity o the composite
surace making it more susceptible to attract stain
19. dui l pphylxis ppis, h lhyiis c uh cpsi si sucski h suscpibl sii by
a. using prophylaxis pastes with a prophylaxis cupb. using an air-powder (sodium bicarbonate abrasive
particle) abrasion to remove surace stainsc. using an acidulated uoride that can etch glass ller
particlesd. all the above
20. T l hyiis c hlp ii h lus plish cpsi sis by
a. polishing the surace with prophylaxis pastes.b. polishing the composite restorations with ne abrasive
aluminum oxide composite resin pastes and disks.c. cleaning the composites with diamond air abrasion
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Cet Ccept f P ate Cmpte re
ansWEr kEy Course Order Number [4235-169]
name: _________________________________________________________________
title: (circleone) dds dmd rdh cdh rda cda efda
address: ______________________________________________________________
city:__________________________state: _________zip: ______________________
telephone: home ( )________________office ( ) _______________________
Mailing insTruCTions:When you fnish reading the course text, use the orm to submit your an-swers to the sel test. Fill in the correct box or each question indicating your answer. Pen or pencil may beused. There should be only one correct answer or each question. Upon completion o the course, mail theanswer sheet to: Benco Dental, Attn: Education Department, 295 CenterPoint Boulevard, Pittston, PA 18640
noTE: We recommend that you photocopy your answers beore mailing this course. This will ensurethat you have a record o your course completion in case o loss due to postal system error.
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The course provided clear inormation about the topic. 1 2 3 4
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Overall rating 1 2 3 4
The course evaluated my understanding o the topic 1 2 3 4through the post-course questions.
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On a scale o 1-5 (5=Excellent, 0=Poor), please rate the ollowing:
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Was the course clearly written and easy to understand? o Yes o No
I no, please describe: _______________________________________________________
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Please direct all questions or requests or additional inormation pertaining to this course to:Dr. Rick Adelstein, 3401 Richmond Rd., Suite 210, Beachwood, OH 44122. This examination isgraded manually. Upon completion o this course, a certifcate will be mailed within 2-3 weeks oreceipt o payment and completed examination.
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