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  • 42 | February 2009Irish Dentist | www.IrishDentist.ie

    21st century practice

    Trends in 21st century dental restoration favour a more conservative approach. This type of treatment can be more beneficial for both the patient and the dentist.

    Well-established techniques using composite materials allow the clinician to mimic natural tooth structure. A logical sequence of reproducible steps gives rise to greater predictability.

    The evolution of modern resin composites has led to significant improvements in their physiochemical properties, aesthetic qualities and colour stability. Additionally, simplified layering techniques have been developed, using opaque dentine colours with enamel shades and effect materials. The direct restoration treatment option has therefore become more widely accepted.

    Venus Diamond (Heraeus Kulzer) The dental restoration market already offers many composite materials, so the introduction of another new resin has to provide significant benefits for users to be willing to accept the steep learning curve required to master it.

    Venus Diamond has a firm consistency, which allows for ease of placement and adaptability. This provides for precise anatomy to be recreated without the material slumping. For restorations in the anterior zone, the final layer of composite can be warmed prior to placement, if desired, to allow for easy spreading and finishing with a soft bristle brush.

    The material offers the following specific advantages: • Improved biocompatibility, free of Bisphenol A • Special urethane monomer-based nano hybrid with improved cross linking

    • Easy-to-handle material with a stiff consistency similar to Venus micro hybrid composite, making it simpler to pack, adapt and shape without slumping • Optimal wear resistance and mechanical load capacity • Very low shrinkage, of approximately 1.5% • Very low shrinkage force, which is paramount during the setting phase of the material • Easy to polish to a high lustre, which is important for the aesthetic zone • Shading concept for natural aesthetics, with a choice of four opaque dentine shades, 15 enamel shades and four incisal opalescent shades • Longer working time – over two minutes in ambient light, thus giving ample time to place each increment with precision.

    In addition to the above, the material offers significant radiopacity.

    The colours of the material are easily understood and applied. Usually, only one enamel shade is required for posterior teeth restorations. However, to optimise the aesthetics further, in the author’s opinion a final surface layer of one of the incisal shades can be used.

    The Venus Diamond shade guide provides a good starting point for shade selection. However, in the author’s opinion, it is always best to assess the shade further, by placing some of the material, unbonded, onto the tooth directly and light curing it. This enables a more accurate analysis of the shade of the selected composite in vivo.

    The following case reports demonstrate the aesthetic potential of Venus Diamond. It is the author’s opinion that Venus Diamond’s new chemistry illustrates these clinical advantages, while still meeting the high-aesthetic prerequisites.

    FFiigguurree 55:: FFiinnaall vviieeww ooff tthhee ffiinniisshheedd rreessttoorraattiioonn

    Twenty-first century restorative aesthetics with low shrinkage composite

    By Sanjay Sethi Posterior case reportThe posterior case presented illustrates the restoration of the lower right first molar occlusal-buccal composite. The restoration could have been completed using one enamel shade. However, by using a final layer of clear composite the aesthetics are further enhanced.

    FFiigguurree 11:: PPrree--ooppeerraattiivvee vviieeww ooff ttooootthh 66||

    FFiigguurree 22:: VViieeww ooff oocccclluussoo-- bbuuccccaall pprreeppaarraattiioonn ooff ttooootthh 66||

    FFiigguurree 33:: TThhee ccaavviittyy wwaass bboonnddeedd uussiinngg aa ccllaassssiicc tthhrreeee-- sstteepp tteecchhnniiqquuee.. TThhiiss wwaass ffoolllloowweedd bbyy aa vveerryy tthhiinn llaayyeerr ooff VVeennuuss FFllooww.. VVeennuuss DDiiaammoonndd AA22 eennaammeell sshhaaddee ccoouulldd nnooww bbee llaayyeerreedd iinnccrreemmeennttaallllyy

    FFiigguurree 44:: TThhee ffiinnaall aannaattoommyy wwaass ccrreeaatteedd bbyy uussiinngg aa llaayyeerr ooff VVeennuuss DDiiaammoonndd CCLL ((CClleeaarr)) ttoo aadddd ddeepptthh ttoo tthhee rreessttoorraattiioonn.. TThhee pphhoottooggrraapphh sshhoowwss tthhee sshhaappiinngg aacchhiieevveedd aafftteerr tthhee ffiinnaall llaayyeerr hhaass bbeeeenn lliigghhtt ccuurreedd bbuutt pprriioorr ttoo aannyy ffiinniisshhiinngg aanndd ppoolliisshhiinngg

    FFiigguurree 66:: FFiinnaall vviieeww ffrroomm tthhee bbuuccccaall aassppeecctt

    For more information about Heraeus Kulzer Venus Diamond, contact Ryan Maguire: telephone: +44 (0) 7825 343920; email: ryan.maguire@heraeus.com

    42-43 IR Feb focus Sethi.qxd 21/1/09 14:40 Page 1

  • | 43February 2009 | Irish Dentistwww.IrishDentist.ie

    Anterior case report The anterior case presented illustrates the restoration of two very heavily restored upper central incisor teeth. The patient requested composite direct restorations to improve their aesthetics. Due to the extent of the cavities, the patient was informed that indirect restorations such as crowns would be more appropriate. The challenge in this case was to increase the dominance of the central incisors while maintaining symmetry of form using a freehand bonding technique.

    FFiigguurree 11:: PPrree--ooppeerraattiivvee ssmmiillee vviieeww

    FFiigguurree 22:: PPrree--ooppeerraattiivvee vviieeww ooff hheeaavviillyy rreessttoorreedd tteeeetthh 11||11

    FFiigguurree 33:: PPrree--ooppeerraattiivvee vviieeww ttoo aasssseessss tthhee ttooootthh hhuuee,, vvaalluuee aanndd cchhrroommaa iinn mmoorree ddeettaaiill.. TThhee ffoorrmm,, ssuurrffaaccee tteexxttuurree aanndd lluussttrree ccaann aallssoo bbee eevvaalluuaatteedd aatt tthhiiss ssttaaggee.. BBootthh uuppppeerr cceennttrraall iinncciissoorrss ggaavvee aa ppoossiittiivvee rreessppoonnssee ttoo vviittaalliittyy tteessttiinngg aanndd hhaadd nnoo ssiiggnnss ooff rroooott pprroobblleemmss uuppoonn rraaddiiooggrraapphhiicc eexxaammiinnaattiioonn.. IItt wwaass nnootteedd tthhaatt ||11 wwaass ddaarrkkeerr iinn ccoolloouurr tthhaann 11||

    FFiigguurree 44:: UUssiinngg tthhee bbaassiicc pprree-- sseelleecctteedd sshhaaddee ooff VVeennuuss DDiiaammoonndd ((iinn tthhiiss ccaassee AA22)),, aa ddiirreecctt iinnttrraa-- oorraall mmoocckk--uupp ccoonnffiirrmmeedd tthhee ffiinnaall iinncciissaall lleennggtthhss,, ppaallaattaall ffoorrmmss aanndd tthhee bbaassiicc ccoolloouurr.. TThhee pprree-- sseelleecctteedd sshhaaddee wwaass aaddaapptteedd aanndd lliigghhtt ccuurreedd,, bbuutt nnoott bboonnddeedd ttoo tthhee ttooootthh.. TThhee ppaallaattaall ffoorrmm ccoouulldd tthheenn bbee rreeffiinneedd aanndd tthhee oocccclluussiioonn aaddjjuusstteedd

    FFiigguurree 55:: TThhee aaeesstthheettiicc ppaarraammeetteerrss ooff tthhee mmoocckk--uupp sshhoouulldd bbee aasssseesssseedd aatt tthhiiss ssttaaggee.. AAfftteerr ffiinnaalliissiinngg tthhee mmoocckk--uupp,, aa ssiilliiccoonnee ppuuttttyy iinnddeexx ccaann bbee mmaaddee cchhaaiirrssiiddee

    FFiigguurree 66:: IInnddeexx iinn ssiittuu,, pprriioorr ttoo bbeeiinngg ttrriimmmmeedd

    FFiigguurree 77:: TThhee ccoommppoossiitteess wweerree rreemmoovveedd aanndd aa vveerryy ffiinnee ffaacciiaall rreedduuccttiioonn wwaass ppeerrffoorrmmeedd oonn 11|| aanndd ||11

    FFiigguurree 88:: OOcccclluussaall vviieeww ooff tthhee pprreeppaarreedd tteeeetthh

    FFiigguurree 99:: TThhee iinnddeexx iinn ssiittuu gguuiiddeess tthhee ffiirrsstt llaayyeerr ooff VVeennuuss DDiiaammoonndd CCLL ((cclleeaarr)) ttoo ffoorrmm tthhee ppaallaattaall wwaallll.. MMeettaall mmaattrriixx ssttrriippss pprreevveenntt tthhee rreessttoorraattiioonnss bbeeiinngg sspplliinntteedd ttooggeetthheerr.. ||11 aallssoo hhaadd aa tthhiinn llaayyeerr ooff ooppaaqquuee mmeeddiiuumm ddeennttiinnee aapppplliieedd,, VVeennuuss DDiiaammoonndd OOMM,, ttoo rreeiinnffoorrccee tthhee wweeaakk ppaallaattaall sshheellll ooff ccoommppoossiittee

    FFiigguurree 1100:: VViieeww aafftteerr tthhee ppaallaattaall sshheellll hhaass bbeeeenn mmaaddee wwiitthhoouutt tthhee iinnddeexx iinn ssiittuu

    FFiigguurree 1111:: VVeennuuss DDiiaammoonndd OOMM wwaass uusseedd ttoo rreepplliiccaattee tthhee mmaammeelloonn aannaattoommyy aanndd mmaasskk tthhee ttooootthh aanndd ccoommppoossiittee iinntteerrffaaccee.. TThhee nneexxtt llaayyeerr wwaass VVeennuuss DDiiaammoonndd AA22,, aann eennaammeell sshhaaddee,, nnoott ppllaacceedd ttoo ffuullll ffaacciiaall tthhiicckknneessss ssoo tthhaatt eeffffeecctt sshhaaddeess ccoouulldd bbee aaddddeedd.. TThheenn aa tthhiinn llaayyeerr ooff VVeennuuss DDiiaammoonndd CCLL wwaass aapppplliieedd ttoo tthhee ffaacciiaall ssuurrffaaccee,, ttoo aadddd ddeepptthh

    FFiigguurree 1122:: FFiinnaall rreessttoorraattiioonn aatt ffoouurr wweeeekkss ppoosstt--ooppeerraattiivvee rreevviieeww

    FFiigguurree 1133:: CClloossee--uupp ppoosstt-- ooppeerraattiivvee vviieeww aatt ffoouurr wweeeekkss

    FFiigguurree 1144:: VViieeww ooff tthhee ppaattiieenntt’’ss ssmmiillee iilllluussttrraatteess bbaallaannccee ooff ffoorrmm aanndd hhaarrmmoonnyy

    Dr Sanjay Sethi owns a private practice in London and has special interests in the re

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