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42 | February 2009 Irish 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. Figure 5: Final view of the finished restoration Twenty-first century restorative aesthetics with low shrinkage composite By Sanjay Sethi Posterior case report The 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. Figure 1: Pre-operative view of tooth 6| Figure 2: View of occluso- buccal preparation of tooth 6| Figure 3: The cavity was bonded using a classic three- step technique. This was followed by a very thin layer of Venus Flow. Venus Diamond A2 enamel shade could now be layered incrementally Figure 4: The final anatomy was created by using a layer of Venus Diamond CL (Clear) to add depth to the restoration. The photograph shows the shaping achieved after the final layer has been light cured but prior to any finishing and polishing Figure 6: Final view from the buccal aspect For more information about Heraeus Kulzer Venus Diamond, contact Ryan Maguire: telephone: +44 (0) 7825 343920; email: r yan.maguir [email protected] 42-43 IR Feb focus Sethi.qxd 21/1/09 14:40 Page 1

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Page 1: 21st century practice Twenty-first century restorative ... › resources › Twenty-first-century... · and aesthetic aspects of dentistry. Dr Sethi runs hands-on composite courses

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

21st century practice

Trends in 21st century dentalrestoration favour a moreconservative approach. This typeof treatment can be more beneficialfor both the patient and thedentist.

Well-established techniquesusing composite materials allowthe clinician to mimic naturaltooth structure. A logical sequenceof reproducible steps gives rise togreater predictability.

The evolution of modern resincomposites has led to significantimprovements in theirphysiochemical properties,aesthetic qualities and colourstability. Additionally, simplifiedlayering techniques have beendeveloped, using opaque dentinecolours with enamel shades andeffect materials. The directrestoration treatment option hastherefore become more widelyaccepted.

Venus Diamond (Heraeus Kulzer)The dental restoration marketalready offers many compositematerials, so the introduction ofanother new resin has to providesignificant benefits for users to bewilling to accept the steep learningcurve required to master it.

Venus Diamond has a firmconsistency, which allows for easeof placement and adaptability. Thisprovides for precise anatomy to berecreated without the materialslumping. For restorations in theanterior zone, the final layer ofcomposite can be warmed prior toplacement, if desired, to allow foreasy spreading and finishing with asoft bristle brush.

The material offers thefollowing specific advantages:• Improved biocompatibility, freeof Bisphenol A• Special urethane monomer-basednano hybrid with improved crosslinking

• Easy-to-handle material with astiff consistency similar to Venusmicro hybrid composite, makingit simpler to pack, adapt andshape without slumping• Optimal wear resistance andmechanical load capacity • Very low shrinkage, ofapproximately 1.5%• Very low shrinkage force, whichis paramount during the settingphase of the material• Easy to polish to a high lustre,which is important for theaesthetic zone• Shading concept for naturalaesthetics, with a choice of fouropaque dentine shades, 15 enamelshades and four incisal opalescentshades• Longer working time – over twominutes in ambient light, thusgiving ample time to place eachincrement with precision.

In addition to the above, thematerial offers significantradiopacity.

The colours of the material areeasily understood and applied.Usually, only one enamel shade isrequired for posterior teethrestorations. However, to optimisethe aesthetics further, in theauthor’s opinion a final surfacelayer of one of the incisal shadescan be used.

The Venus Diamond shadeguide provides a good startingpoint for shade selection.However, in the author’s opinion,it is always best to assess theshade further, by placing some ofthe material, unbonded, onto thetooth directly and light curing it.This enables a more accurateanalysis of the shade of theselected composite in vivo.

The following case reportsdemonstrate the aestheticpotential of Venus Diamond. It isthe author’s opinion that VenusDiamond’s new chemistryillustrates these clinicaladvantages, while still meeting thehigh-aesthetic prerequisites.

FFiigguurree 55:: FFiinnaall vviieeww ooff tthheeffiinniisshheedd rreessttoorraattiioonn

Twenty-first century restorative aestheticswith low shrinkage composite

By Sanjay Sethi Posterior case reportThe posterior case presented illustrates the restoration of the lowerright first molar occlusal-buccal composite. The restoration couldhave been completed using one enamel shade. However, by using afinal layer of clear composite the aesthetics are further enhanced.

FFiigguurree 11:: PPrree--ooppeerraattiivvee vviieeww ooffttooootthh 66||

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

FFiigguurree 33:: TThhee ccaavviittyy wwaassbboonnddeedd uussiinngg aa ccllaassssiicc tthhrreeee--sstteepp tteecchhnniiqquuee.. TThhiiss wwaassffoolllloowweedd bbyy aa vveerryy tthhiinn llaayyeerr ooffVVeennuuss FFllooww.. VVeennuuss DDiiaammoonndd AA22eennaammeell sshhaaddee ccoouulldd nnooww bbeellaayyeerreedd iinnccrreemmeennttaallllyy

FFiigguurree 44:: TThhee ffiinnaall aannaattoommyy wwaassccrreeaatteedd bbyy uussiinngg aa llaayyeerr ooffVVeennuuss DDiiaammoonndd CCLL ((CClleeaarr)) ttoo aaddddddeepptthh ttoo tthhee rreessttoorraattiioonn.. TThheepphhoottooggrraapphh sshhoowwss tthhee sshhaappiinnggaacchhiieevveedd aafftteerr tthhee ffiinnaall llaayyeerr hhaassbbeeeenn lliigghhtt ccuurreedd bbuutt pprriioorr ttoo aannyyffiinniisshhiinngg aanndd ppoolliisshhiinngg

FFiigguurree 66:: FFiinnaall vviieeww ffrroomm tthheebbuuccccaall aassppeecctt

For more information about Heraeus Kulzer Venus Diamond,contact Ryan Maguire: telephone: +44 (0) 7825 343920; email: [email protected]

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

Page 2: 21st century practice Twenty-first century restorative ... › resources › Twenty-first-century... · and aesthetic aspects of dentistry. Dr Sethi runs hands-on composite courses

| 43February 2009 | Irish Dentistwww.IrishDentist.ie

Anterior case reportThe anterior case presented illustrates the restoration of two veryheavily restored upper central incisor teeth. The patient requestedcomposite direct restorations to improve their aesthetics. Due to theextent of the cavities, the patient was informed that indirectrestorations such as crowns would be more appropriate. Thechallenge in this case was to increase the dominance of the centralincisors while maintaining symmetry of form using a freehandbonding technique.

FFiigguurree 11:: PPrree--ooppeerraattiivvee ssmmiilleevviieeww

FFiigguurree 22:: PPrree--ooppeerraattiivvee vviieeww ooffhheeaavviillyy rreessttoorreedd tteeeetthh 11||11

FFiigguurree 33:: PPrree--ooppeerraattiivvee vviieeww ttooaasssseessss tthhee ttooootthh hhuuee,, vvaalluuee aannddcchhrroommaa iinn mmoorree ddeettaaiill.. TThhee ffoorrmm,,ssuurrffaaccee tteexxttuurree aanndd lluussttrree ccaannaallssoo bbee eevvaalluuaatteedd aatt tthhiiss ssttaaggee..BBootthh uuppppeerr cceennttrraall iinncciissoorrss ggaavveeaa ppoossiittiivvee rreessppoonnssee ttoo vviittaalliittyytteessttiinngg aanndd hhaadd nnoo ssiiggnnss ooff rroooottpprroobblleemmss uuppoonn rraaddiiooggrraapphhiicceexxaammiinnaattiioonn.. IItt wwaass nnootteedd tthhaatt ||11wwaass 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 ffiinnaalliinncciissaall lleennggtthhss,, ppaallaattaall ffoorrmmss aannddtthhee bbaassiicc ccoolloouurr.. TThhee pprree--sseelleecctteedd sshhaaddee wwaass aaddaapptteedd aannddlliigghhtt ccuurreedd,, bbuutt nnoott bboonnddeedd ttoo tthheettooootthh.. TThhee ppaallaattaall ffoorrmm ccoouullddtthheenn bbee rreeffiinneedd aanndd tthhee oocccclluussiioonnaaddjjuusstteedd

FFiigguurree 55:: TThhee aaeesstthheettiiccppaarraammeetteerrss ooff tthhee mmoocckk--uuppsshhoouulldd bbee aasssseesssseedd aatt tthhiissssttaaggee.. AAfftteerr ffiinnaalliissiinngg tthheemmoocckk--uupp,, aa ssiilliiccoonnee ppuuttttyy iinnddeexxccaann bbee mmaaddee cchhaaiirrssiiddee

FFiigguurree 66:: IInnddeexx iinn ssiittuu,, pprriioorr ttoobbeeiinngg ttrriimmmmeedd

FFiigguurree 77:: TThhee ccoommppoossiitteess wweerreerreemmoovveedd aanndd aa vveerryy ffiinnee ffaacciiaallrreedduuccttiioonn wwaass ppeerrffoorrmmeedd oonn 11||aanndd ||11

FFiigguurree 88:: OOcccclluussaall vviieeww ooff tthheepprreeppaarreedd tteeeetthh

FFiigguurree 99:: TThhee iinnddeexx iinn ssiittuugguuiiddeess tthhee ffiirrsstt llaayyeerr ooff VVeennuussDDiiaammoonndd CCLL ((cclleeaarr)) ttoo ffoorrmm tthheeppaallaattaall wwaallll.. MMeettaall mmaattrriixx ssttrriippsspprreevveenntt tthhee rreessttoorraattiioonnss bbeeiinnggsspplliinntteedd ttooggeetthheerr.. ||11 aallssoo hhaadd aatthhiinn llaayyeerr ooff ooppaaqquuee mmeeddiiuummddeennttiinnee aapppplliieedd,, VVeennuuss DDiiaammoonnddOOMM,, ttoo rreeiinnffoorrccee tthhee wweeaakkppaallaattaall sshheellll ooff ccoommppoossiittee

FFiigguurree 1100:: VViieeww aafftteerr tthheeppaallaattaall sshheellll hhaass bbeeeenn mmaaddeewwiitthhoouutt tthhee iinnddeexx iinn ssiittuu

FFiigguurree 1111:: VVeennuuss DDiiaammoonndd OOMMwwaass uusseedd ttoo rreepplliiccaattee tthheemmaammeelloonn aannaattoommyy aanndd mmaasskk tthheettooootthh aanndd ccoommppoossiittee iinntteerrffaaccee..TThhee nneexxtt llaayyeerr wwaass VVeennuussDDiiaammoonndd AA22,, aann eennaammeell sshhaaddee,,nnoott ppllaacceedd ttoo ffuullll ffaacciiaall tthhiicckknneessssssoo tthhaatt eeffffeecctt sshhaaddeess ccoouulldd bbeeaaddddeedd.. TThheenn aa tthhiinn llaayyeerr ooff VVeennuussDDiiaammoonndd CCLL wwaass aapppplliieedd ttoo tthheeffaacciiaall ssuurrffaaccee,, ttoo aadddd ddeepptthh

FFiigguurree 1122:: FFiinnaall rreessttoorraattiioonn aattffoouurr wweeeekkss ppoosstt--ooppeerraattiivveerreevviieeww

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

FFiigguurree 1144:: VViieeww ooff tthhee ppaattiieenntt’’ssssmmiillee iilllluussttrraatteess bbaallaannccee ooffffoorrmm aanndd hhaarrmmoonnyy

Dr Sanjay Sethi owns a private practice in London and has special interests in the restorativeand aesthetic aspects of dentistry. Dr Sethi runs hands-on composite courses and lectures onimplant dentistry and crown and bridgework internationally. Sanjay founded and co-ordinatesthe Dentology Study Club and is Secretary of the British Academy of Aesthetic Dentistry.

43 redo IR Feb focus Sethi.qxd 22/1/09 12:18 Page 2


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