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Establishing the Primary Outline


 
A Finishing Technique for the Composite Resin Restoration

 

Over the last several decades, significant advances have been made in dental composite resin technology. Among these developments are the introduction of various filler materials, filler size, loading and aggregation, resin monomers, and methods of adhering filler particles to the resin matrix. In addition to increasing the physical properties, color stability, and degree of conversion of the composite formulation, contemporary composite materials conduct, reflect, and refract visible light similar to natural tooth structure and are capable of generating seamless, highly aesthetic dental restorations. Regardless of these improvements, however, the practitioner must utilize appropriate finishing and polishing techniques after resin placement to yield restorations with the desirable surface luster. Undesired surface irregularities resulting from poor finishing and polishing may lead to the accumulation of plaque, recurrent decay, chronic gingival inflammation, and staining by foods and beverages—all of which shorten the efficacy and durability of even a meticulously placed composite restoration.

Lutz et al1 described essential post-placement steps as: 1) gross finishing, 2) contouring, 3) fine finishing, and 4) polishing. Before a clinician can properly utilize any material or technique, it is imperative to understand that each of these individual steps must be properly executed to completion prior to moving on to the next. In general, the progression is from coarse, medium, fine, to super-fine, and to omit one or more of these steps typically brings about inferior results.

Gross finishing is defined as the expeditious removal of gross excess, superfluous composite material that typically results from overfilling the cavity form or aesthetic restoration. This step is typically accomplished with coarse or medium grit diamond burs or 8- to 12-fluted carbide finishing burs in a high-speed handpiece. Coated Mylar abrasive systems in the form of discs or strips coarse and medium grits (100 µm or greater) that can also be effective for gross finishing, particularly in large planar surfaces and tight interproximal areas. Some clinicians may utilize bonded abrasive systems that are typically elastomeric materials in which the abrasive particles are evenly distributed, and which come in the form of points, cups, or discs.

Contouring is defined as the creation of the final aesthetic and functional form of the restoration and readying the surface for fine finishing and polishing. In anterior and posterior direct composite restorations, the contouring step involves the establishment of outline form, surface morphology, marginal adaptation, and proper occlusion. Contouring should not alter the cavosurface margin or surrounding healthy tooth structure. Therefore, medium to fine rotary diamonds and/or 12- to 16-fluted carbide burs used at lower speeds (30,000 to 40,000 rpm), as well as medium grit coated and/or bonded abrasive systems (40 to 60 µm) are highly useful. While numerous one- or two-step polishing systems are available and often effective, their efficacy is predicated on adequate gross finishing and contouring prior to utilization.

Fine finishing can best be described as the first step in creating luster and involves the removal of scratches and defects left by gross finishing and contouring. While gross finishing and contouring by definition alter the shape and form of the restoration, fine finishing does not. The key objective of fine finishing is to improve surface smoothness sufficiently enough to ready the composite surface for the creation of a high luster. Typical instruments employed in fine finishing include fine and super-fine diamond finishing burs (25 to 15 µm diamond particles), 16- to 24-fluted carbide finishing burs, and medium-fine sandpaper abrasives and silicone-based materials with grit sizes ranging from 600 to 1,200 µm.

Polishing is the final step(s) in creating a high luster or shine. Once fine finishing is accomplished, all that remains is to buff the composite surface to free it from microscopic irregularities and voids. Typically, ultrafine abrasive systems with particle sizes of 8 µm or less are utilized, and the motion and pressure of the stroke are as important as the material used. While super-fine diamond (less than 15 µm) and 24-fluted carbide burs can be effective, the majority of dentists utilize sandpaper discs and silicone-based materials (grit sizes greater than 1,200 µm) to polish restorations, based on access and convenience. When clinicians desire an extremely glossy surface, numerous loose-particle systems or polishing pastes are available in conjunction with felt buffs, goat hair wheels, or synthetic fiber brushes, wheels, and points. 

References

1. Lutz F, Setcos J, Phillips R. New finishing instruments for composite resins. J Am Dent Assoc. 1983;107:575-580.

2. Fruits T, Miranda F, Coury T. Effect of equivalent abrasive grit sizes utilizing differing polishing motion on selected restorative materials. Quintessence Int. 1996;27:279-285.

 

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