PAULO MONTEIRO

DIRECT ANTERIORS - CASES - TIPS AND TRICKS

THE STEP BY STEP IN FINISHING AND
POLISHING: PART I

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We often talk about the problems and challenges of restoring a tooth and selecting the color for a direct
composite resin restoration. However, the shape and texture that we can give to our restoration plays an
important role just as the shade selection.

In the direct restorative process we must follow several steps to achieve aesthetic, natural and predictable
results. These steps are: planning, dental preparation, adhesion, layering and finishing and polishing.

The natural tooth is rich in small details that make all the difference in integrating the restoration when
they are replicated. These details can be: length, width, proportion, length / width, contour, flat area, lobes,
crests, vertical grooves, texture, wear facets, incisal edge thickness, fracture lines, periquimatias, point and
contact surface, embrasures, palatine concavity and cingulum.

The details of shape and texture thus become essential to the integration of the restoration with the
remaining natural teeth and smile of the patient.

First, it is mandatory identify the surface type of the patient's natural teeth, see if there is a surface texture
or just a smooth surface, without much detail. The act of observing the natural tooth becomes fundamental
for us to understand what we must reproduce in our restoration. Observing the patient's anterior teeth
from various angles can give us a lot of rich information about the details of shape and texture.

When direct observation is not enough or becomes complicated, we can use some auxiliary methods of
texture identification, such as silver powder or articulating paper, passing over the vestibular surface of the
natural tooth. In this sense we will be able to observe the differences between zones of high reflection of
light and zones of shadows, more prominent zones and grooves more or less detailed.

In case the surface of the natural teeth to be copied is smooth, the clinical process of reproduction can
become simpler as we will have to go through fewer steps: details of shape, polish and hight shine surface.

When we want to have a polishing and textured tooth we can divide this procedure into four shapes: shape
details, macro texture details, micro texture details and brightness.

The first step of finishing and polishing involves checking and/or correcting the shape of the tooth. The
shape is responsible for the symmetrical proportion and integration of the restoration with the various
teeth. To check the shape we have to observe the angle lines, which divide the plane area of ??a large
reflection light (between the angle lines) and the shadow area, which lies outside the angle lines and is
rounded.

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By working in the distance between the angle lines we can create optical illusions between wider or
narrower, longer or shorter teeth, maintaining the actual proportion of the tooth. So if we want to give the
illusion that the tooth is narrower, we should approach the angle lines, decreasing the flat area. On the
other hand if we want to create the illusion that the tooth is wider, we should move away from the angle
lines by increasing the flat area.

Typically, this correction of angle lines and flat area is made with medium grain discs or with fine-grained
diamond drills.

Then the contour of the incisal embrasures must be done. This contour may range from straight or curved.
Usually the distal angle is more rounded than the mesial angle. In a feminine smile, the incisal embrasures
are usually rounder too.

The outline of the embrasures is usually made with abrasive discs. Almost all brands that have abrasive
discs provide four particle sizes identified by color. In the finishing process we usually use only the two
intermediate grains (for example Sof-Lex (3M) dark orange and light orange). This is because if we use the
more abrasive we can remove too much composite resin and if we use the less abrasive we only add
brightness to the resin.

To finalize the details of shape, it is necessary to verify and/or rectify the vestibular contour of the
restoration, respecting the transitions and inclinations between the cervical third, middle third and incisal
third. This procedure is usually done with medium or fine grain diamond drills (depending on the amount of
composite resin to be corrected).

Before proceeding to the details of macro and/or micro texture, inter-proximal polishing and removal of
cervical excess should be done.

Interproximal polishing should be done with strips of sandpaper. These may be more or less abrasive (for
example Epitex, GC) depending on the amount of interproximal material to be removed and polished.

If there is too much excess in the cervical crenellations or the need to rework these crenellations, metal
polishing strips should be used. These sandpapers are also available in different abrasives (eg from GC,
Edenta, Intensive, Coltène, etc.).

Cervical excesses can be removed with a #12 surgical blade (by shaving the center of the tooth out) or by
an instrument itself called Excesso (LM Art Excess).

After the details of shape and contour, it is advised to pass a rubber or a rubber disk on the composite
resin to smooth the entire surface.

After correcting the shape, contour and volume of the restoration, if we want to recreate a textured tooth,
we should go to the macro texture details.

The macro texture can be divided into two groups: vertical macro texture and horizontal macro texture.

The vertical macro texture existent especially in the upper incisors can be called vertical grooves or "V-
shape grooves". This macro texture shows the relief made by the three developmental lobes (mesial,
central and distal) and by the depressions between them (commonly called groove). These vertical
grooves are usually more open in incisal and will narrow each time we walk to the cervical of the tooth,
giving the "V" shape to this depression. There are usually two vertical grooves, of which the distal is usually
longer than the mesial. This procedure is usually done with low-rotation fine-grained diamond drill.

The horizontal macro texture is more evident in the cervical third and in the transition with the middle
third of the tooth. It consists of 2 to 3 small, very smooth horizontal grooves that lie between the angle
lines. This procedure is usually done with fine grain spherical diamond drills in low rotation.

After the preparation of the vertical and horizontal macro texture, it is necessary to soften the depressions
caused by the drills on the surface of the composite resin. This softening of the surface of the composite
resin should be done with rubbers.

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There are different types of rubbers for smoothing the macro texture, depending on the amount of
smoothing and degree of polishing desired.

Several manufacturers offer rubber systems with different granulations (ex Astropol, Ivoclar). When these
different granulations exist it is necessary to go through the entire polishing system, starting at the most
abrasive rubber and finishing at the less abrasive rubber.

The rubbers should run through the vertical or horizontal lines marked by the drills previously, leaving the
surface of the resin with a smooth appearance and with tenuous transitions between depression areas and
prominent areas (lobes).

After smoothening the macro texture, the vertical and horizontal micro texture must be done (if present in
adjacent natural teeth).

The vertical micro texture usually consists of small vertical grooves that normally exist in the middle of the
vertical macro texture grooves.

The horizontal micro texture consists of thin horizontal lines that extend from the cervical to the incisal of
the vestibular surface. These lines, usually called periquimatias, are extremely thin and are very close to
each other.

A very thin diamond drill should be used in this step. The position of the drill relative to the vestibular
surface of the restoration should be about 45 degrees, using a very gentle pressure and always in the same
direction (mesial to distal or distal to mesial).

After re-creating the micro-texture, the surface of the composite resin should be slightly smoothed. This
softening can be done with low abrasive rubbers or with new spiral materials such as Sof-Lex Spiral (3M
ESPE) or ShapeGuard (Coltène). In addition of softening the composite resin and giving it a natural look,
they also add some shine to the restoration. If a natural tooth are not too shiny on the surface, or that have
low gloss, this may be the last step in the finishing and polishing process.

To finish the finishing and polishing process and give to the composite resin a natural appearance of
enamel gloss, it is recommended to use a low-grade (less than 0.5 micron) diamond pastes or aluminum
oxide pastes. These pastes should be applied with a felt disc or a soft-brushed brush, to not scratch the
surface of the composite resin. Circular movements should be made with low pressure and use low rotation
(maximum of 5000 rpm).

These steps described above can be performed with water or without water. The advantage of not using
water is to have a better visibility of the details. In this case, plenty of water should be used between each
step to cool the tooth and clean all debris created by the instruments.

It is also recommended the use of a low speed rotating hand peace (multiplier contra-angle) for the
accuracy of the details.

In this first article dedicated to the finishing and polishing of composite resin restorations we will address
the "direct restorations in anterior teeth” and we intend to demonstrate the most important details in the
identification of the texture and shape of the natural tooth, the step by step in the making of a natural and
suitable texture and the materials necessary for its execution.

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Img. 1 - Anterior view of the natural tooth. The act of observing the natural tooth becomes fundamental for
us to understand what we must reproduce in our restoration

Img. 2 - In a direct composite restoration, the shape is much more important than the shade. If we change
the shape, we can totally change the integration of the restoration.

Img. 3 - The angle lines give us the shape of the tooth.

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Img. 4 - Tooth with a poor texture and smooth surface. Observing the patient's anterior teeth from various
angles can give us a lot of rich information about the details of shape and texture.

Img. 5 - Tooth with a rich texture surface.

Img. 6 - Horizontal macro texture existent in the central incisors.

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Img. 7 - Horizontal micro texture (Periquimatias) existent in the anterior tooth.

Img. 8 - One of the materials for texture identification is the silver powder.

Img. 9 - Two methods for the texture identification are the silver powder or articulating paper.

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Img. 10 - Sof-Lex (3M) polishing grain disc system.

Img. 11 - Diatech SwissFlex grain (Coltène) polishing disc system.

Img. 12 - OptiDisc (Kerr) polishing grain disc system.

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Img. 13 - Excesso (LM Arte by Style Italiano) can be used to remove the cervical composite resin excess.

IImg. 14 - nterproximal polishing should be done with strips. These may be more or less abrasive (Epitex,
GC).

Img. 15 - If there is too much excess in the cervical embrasures low grain metal polishing strips should be
used (GC).

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Img. 16 - There are several finishing drilld kits which allow the creation of a suitable texture (ex. Finishing
Style by Style Italiano or Brilliant Dentistry by Diatech)

Img. 17 - Some drills that we can use to make macro and micro texture details (Brilliant Dentistry by
Diatech).

Img. 18 - With the fine grain drill 864 014 12F we can correct the angle lines, correct the buccal surface
profile and create the macro texture details.

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Img. 19 - With the diamond grain drill 898 016 11ML we can correct the the buccal surface profile remove
more excess of composite resin.

Img. 20 - With the fine grain drill 801 023 F we can create the horizontal macro texture on the cervical
third of the tooth.

Img. 21 - With the fine grain drill 853 008 3.5XF we can create the horizontal micro texture (periquimatias)
and the vertical micro texture.

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Img. 22 - The softening of the surface of the composite resin should be done with rubbers.

Img. 23 - When different granulations exist it is necessary to go through the entire polishing system,
starting at the most abrasive rubber and finishing at the less abrasive rubber.

Img. 24 - Enhance polishing rubbers (Denstply).

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Img. 25 - Silicone carbide brushes. These brushes can be used to brighten the composite resin, but when
used with pressure they can scratch the surface of the resin.

Img. 26 - The softening and brightness can be done with low abrasive rubbers or with new spiral materials
such as Sof-Lex Diamond Spiral (3M) or ShapeGuard (Coltène).

Img. 27 - The polishing pastes should be applied with a felt disc or a soft-brushed brush, to not scratch the
surface of the composite resin (ex. Flexibuff, Cosmedent).

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Img. 28 - To give to the composite resin a natural appearance of enamel gloss, it is recommended to use a
low-grade diamond pastes or aluminum oxide pastes (ex. Diashine Intra Oral polishing paste).

Img. 29 - To work on the natural shape of the tooth we should verify the: angle lines, incisal embrasures
contour and buccal contour.

Img. 30 - To create the macro texture of the tooth we should reply the: vertical macro texture (V shape
grooves) and horizontal macro texture.

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Img. 31 - To create the micro texture of the tooth we should reply the: vertical micro texture and horizontal
micro texture (periquimatias).

Img. 32 - To correct the angle lines and after drow it with a pencil, we can use the fine grain drill 864 014
12F in a 45 degrees to the tooth surface.

Img. 33 - Correction of the angle lines.

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Img. 34 - Correction of the boccal contour.

Img. 35 - The buccal contour can be made with a diamond grain drill 898 016 11ML, following the three
thirds of the buccalr surface.

Img. 36 - The outline of the embrasures is usually made with polishing discs (Sof-Lex disc, 3M, dark orange
and ligjt orange).

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Img. 37 - To create the vertical macro texture (V-shape grooves) we can use the fine grain drill 864 014
12F, following the pencil drowing.

Img. 38 - To create the horizontal macro texture we can use the fine grain drill 801 023 F.

Img. 39 - After create the macro texture details we should softening the surface of the composite resin with
rubbers, in a very smooth way.

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Img. 40 - To create the horizontal micro texture (periquimatias) we can use the fine grain drill 853 008
3.5XF.

Img. 41 - After create the micro texture details we should softening the surface of the composite resin with
a very gentle rubber, like the Sof-Lex Diamond Spirals (3M).

Img. 42 - To give to the composite resin a natural appearance of enamel gloss, it is recommended to use a
low-grade diamond pastes or aluminum oxide pastes. These pastes should be applied with a felt disc or a
soft-brushed brush, to not scratch the surface of the composite resin.

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Img. 43 - Final outcome of a direct composite veneer restoration (Filtek Supreme XTE, 3M) after the step
by step finishing and polishing procedures. It is very visible the high polish and shining of the surface of the
composite resin, similar to what exists in the natural tooth.

Img. 44 - Final texture details.

Img. 45 - Clinical example of a simplified and predictable finishing and polishing sequence (case 1).

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Img. 46 - Clinical example of a simplified and predictable finishing and polishing sequence (case 2).

Img. 47 - Surface details of a direct composite resin veneer restoration after finishing and polishing.

Img. 48 - Surface details of a direct composite resin veneer restoration after finishing and polishing.

Finishing and polishing can be considered the last step in the direct restorative process. However it should
be regarded as one of the most important allowing the actual natural integration with the adjacent teeth.
It is essential to obtain a smooth and polished surface of the restoration so that its chromatic stability, and
surface state is as durable as possible over time.
However, for the details of shape, texture and brightness to last longer, a periodic maintenance of the
restoration is necessary, where the surface and gloss state must be evaluated. If necessary, the restoration

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should be re-polished. This procedure can often be done during the periodic oral hygiene consultations of
the patient.
Composite resins have some limitations of longevity, the use of a correct finishing and polishing technique
can increase a over life composite resin restoration and reproduce the natural surface of the natural tooth.

Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 10 Surface and polishing
Quintessence Books, 2012
Gönülol N1, Yilmaz F. The effects of finishing and polishing techniques on surface roughness and color
stability of nanocomposites. J Dent. 2012 Dec;40 Suppl 2:e64-70.
Fahl JR, N. (2011) Mastering Composite Artistry to Create Anterior Masterpieces - Part 2. Journal of
Cosmetic Dentistry: 42-55, Winter.
Schmitt VL, Puppin-Rontani RM, Naufel FS, Nahsan FPS, Coelho Sinhoreti MA and Baseggio W. Effect of the
Polishing Procedures on Color Stability and Surface Roughness of Composite Resins. ISRN Dent. 2011; 2011:
617672 published online 2011 Jul 11. doi: 10.5402/2011/617672
PMCID: PMC3169916.
Abzal MS, Rathakrishnan M, Prakash V, Vivekanandhan P, Subbiya A, Sukumaran VG Evaluation of surface
roughness of three different composite resins with three different polishing systems.J Conserv Dent. 2016
Mar-Apr;19(2):171-4. doi: 10.4103/0972-0707.178703.

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