Tips and tricks for direct restorative procedures

Transcription

1 ? Tips and tricks for direct restorative procedures

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

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? What do I do if I want to create mamelons on anterior teeth? What do I do if I want to build up the palatal surface of my anterior restoration with a 45 incline? What do I do if I want to contour the proximal wall of an anterior restoration? What do I do if I want to build up a Class IV lesion using dentin and enamel materials and achieve an optimum result? What do I do if I want to add special effects and characterizations to my Class IV restorations? Light-curing 20 What do I do if I have my doubts that my curing light cures my fillings completely? What do I do if the composite in particularly bright fillings (e.g. bleach shades) does not cure properly? 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? 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? What do I do if I am not sure which finisher I should use? What do I do if I am not sure which polishing tip I should use?

4 Before and after the treatment 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. 4

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

6 Before and after the treatment What do I do if 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 timeconsuming 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. 6

7 Before and after the treatment 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. With an OptraGate in place, the area around the mouth stays clean. The facial hair is free of impression material after impression taking and does not need to be cleaned. Polishing strips can easily hurt the lips and corners of the mouth. The lip and cheek retractor covers these areas and protects them. 7

8 Before and after the treatment What do I do if 5... 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. Noncompliant 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: 8

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

10 Adhesives What do I do if 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 Tetric N-Bond 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. 10

11 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 Tetric N-Bond Universal moistens collapsed collagen fibres evenly. 11

12 Adhesives What do I do if 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. Tetric N-Bond 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. 12

13 Adhesives Hot Cold Tetric N-Bond Universal Resin tags Dentinal fluid Dentin Reduction of the fluid flow in the dentin tubules after application of Tetric N-Bond Universal Brännström M et al.: The hydrodynamic theory of dentinal pain, 1967 Odontoblast 13

14 Adhesives What do I do if 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. Tetric N-Bond 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. 14

15 Adhesives Self-etch technique Selective-enamel-etch technique Total-etch (etch & rinse) technique R&D, Ivoclar Vivadent AG, Schaan,

16 Posterior restorations What do I do if... 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. 16

17 Fig. 1: Adapting the material with a conventional metal instrument. Stickiness tends to occur with the first layer of composite resin in particular. Fig. 2: Composite material can be easily adapted using the ball-shaped non-stick OptraSculpt tip. Posterior restorations 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. 4: Efficient contouring of fissures and cusps using the point attachment of the OptraSculpt instrument. 17

18 Posterior restorations What do I do if 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 N-Flow 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

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

20 Posterior restorations What do I do if 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 N-Flow Bulk Fill or Tetric N-Ceram Bulk Fill, which can be applied and light-cured in increments of up to 4 mm. Tetric N-Ceram 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 N-Flow 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 N-Ceram Bulk Fill or a conventional composite, e.g. Tetric N-Ceram. Do I have to compromise on esthetics if I want to use the bulk-fill technique? Not at all. Tetric N-Flow 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 N-Ceram, which is available in 10 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

21 Single-layer technique Two-layer technique Posterior restorations < 4 mm 1 1 < 4 mm < 6 mm Tetric N-Ceram Bulk Fill 2 Tetric < 4 mm Tetric N-Ceram N-Flow Bulk Fill 21

22 Anterior restorations What do I do if 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

23 Fig. 5: Vertical grooves on the tooth surface are responsible for reflecting light. Anterior restorations 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). 23

24 Anterior restorations What do I do if 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 %). 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 N-Flow, 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). 24

25 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 N-Flow) 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

26 Anterior restorations What do I do if 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 N-Ceram) 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). 26 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 N-Ceram). 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).

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

28 Anterior restorations What do I do if 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 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

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

30 Light-curing What do I do if 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/cm 2, 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

31 Light curing 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. The digital display is activated automatically when the curing light is switched on. 31

32 Light curing What do I do if... 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 ( nm), such as the Bluephase N 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 N, 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

33 Fig. 14: Wavelength range of various curing lights* Fig. 15: Large diameter for single-step light-curing procedures Light curing Bluephase N Valo (Ultradent) Smartlite Max (Dentsply Sirona) Smartlite Focus (Dentsply Sirona) Elipar S10 (3M) Elipar Deep Cure (3M) Demi Plus (Kerr) Demi Ultra (Kerr) S.P.E.C. 3 (Coltene) nm nm nm nm nm nm nm nm nm nm Lucirin TPO, PPD 320 nm 420 nm Ivocerin 370 nm 460 nm Camphorquinone nm 10-mm light guide Single-step light curing 8-mm light guide Multiple-step light curing Wavelength [nm] * according to the manufacturers' information Source: Ivoclar Vivadent, 2016 Bluephase N M, Bluephase N, Bluephase N MC 33

34 Finishing and polishing 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? 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

35 grit Surface roughness (µm) 10 s 20 s 30 s 40 s 50 s * Surface roughness (gloss units) 320 grit 10 s 20 s 30 s 40 s 50 s Finishing Polishing OptraPol 3-step system OptraPol 3-step system Figs 16 and 17: Comparison of the polishing results achieved with a 1-step polishing and a 3-step polishing system Sources: In-vitro test of competitive polishing systems; composite: Tetric N-Ceram Bulk Fill, Dr S. Heintze, Ivoclar Vivadent, Schaan, * 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),

36 Finishing and polishing What do I do if 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 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

37 Rough: 8 blades Fine: 32 blades Finishing Polishing 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. Fig. 22: Polishing discs are suitable for polishing areas that are difficult to access. Fig. 23: Polishing strips are designed for interdental applications. 37

38 Finishing and polishing What do I do if 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

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

40 Direct Restoratives 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. OptraGate Tetric N-Bond Universal Tetric N-Ceram Bluephase N OptraPol Fluor Protector N PREPARE BOND FILL CURE FINISH MAINTAIN THESE ARE FURTHER PRODUCTS OF THIS CATEGORY: Bluephase N The curing light Tetric N-Bond Universal The tolerant universal adhesive LED for all curing needs All light-curing materials due to Polywave -LED All indications due to continuous operation All the time due to Click & Cure Universal for direct and indirect bonding procedures Universal application for all bonding procedures and etching techniques Predictable results high bond strength on wet or over-dried dentin Universal delivery available in bottles and the convenient VivaPen 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 for more information. Ivoclar Vivadent AG Bendererstr Schaan Liechtenstein Tel Fax Descriptions and data constitute no warranty of attributes. Ivoclar Vivadent AG, Schaan/Liechtenstein / /EN