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]
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| 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.
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