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Abrasives and Temporary Crowns Material (2) Dental Material II

Slide # 31
In todays lecture we will be talking about auxiliary dental materials. What materials to be used in finishing and polishing restorations regarding what structures they are.

Lecture # 19

In general terms, the procedure we do in finishing and polishing restorations we need to consider a few things:

- The type of abrasive you want to use

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The size of the particle whether you want to use the rough, the medium or the fine one The order in which you use these abrasives: you should always start from rough and proceed to fine. Dont shift a step unless you just want to remove for example surface stains or do the minimal finishing. At that time may be you can start from medium and go to fine and you dont need to start from rough. So, it depends on the case.

- You need to consider what anatomical features or morphology you want to achieve.
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You need to consider the adjacent tooth structure in order not to damage them. You want to avoid damage to adjacent enamel or adjacent teeth or tooth structure.

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You want to restore original features and you dont want to miss to the contact area.

When you are doing composite restoration, some of you use the abrasive strip in the contact area to smoothen the composite which causes the contact to become open. There was no contact to clean in the adjacent teeth. This is wrong. Normally teeth should contact unless the patient has generalized spacing between teeth or originally has a space between the teeth. But naturally there should be contact between teeth. So, when you do a class 2 or class 3 restoration, you dont touch the contact area at all. You can smoothen the filling underneath or above the contact point or area.

So you dont finish and polish the contact area it should be readily smooth and well contoured. When you use the matrix band or the cellulose strip, they will cause your contact area to be smooth without doing anything. So you condense your filling well and you fill the tooth completely and youll have a good contact there. So, you dont have to finish and polish it. Sometimes when you do a restoration, a bit of excess may overhang or overlap on the tooth surface like for example in this case. When you do a restoration, this sort of excess is minimal so they call it a flash, so part of your amalgam or composite filling is over the natural tooth surface and not within the cavity.

In another case, your restoration is overhanging in the inter proximal area. In this case if this excess remains under occlusion load, it will break off easily because it is weak. If it breaks off, part of your filling within your cavity might break off with it, which causes deficiency, micro-leakage etc. So it should be removed. Your filling should be in the confined of your cavity. In this case, if overhanging amalgam or overhanging metal from a crown
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remains, food can easily accumulate underneath it and plaque and it will cause gingival inflammation and the problems that come with. So, this too should be avoided to start with and if they already exist, they need to be removed. Sometimes, we cannot get access to the overhanging area in the intra proximal region you might end up repeating the whole thing. In class 2 amalgam cavities, if an overhang would happen if you dont for example fit your matrix down properly and you dont use the wedge. So, you always need to use the wedge between teeth. This would eliminate this problem (preventive) and you will have a filling that is continuous with tooth structure.

If you dont use the matrix down correctly, if you dont use the wedge, then youll have this problem: instead of finishing the filling in 10mn you will need 20mn to remove the overhang because it is difficult to reach it. Unfortunately, in this case the filling is deficient. So, if it is a composite filling or GIC filling you can add. But if it is an amalgam filling or ready set you cannot add because amalgam pieces do not adhere to each other, so you need to repeat your filling again. Now, if the overhang is not too much, it is not too extensive, if it is accessible and if you already have good contact, good restoration, if there is no danger of damaging the patient teeth, go ahead and try to remove it. If the overhang is too excessive, if you dont have access to it to remove it, if there is distance in your filling in other places or if there is no contact .

In some fillings like amalgam, you need to finish and polish after 24 hours. In other cases like composite or resin modified GIC you can go ahead and do finishing and polishing immediately. In cases of amalgam, you can remove excess when you do carving and varnishing and then if you want to finish and polish you can use different abrasives that are available. With the first that can

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be used weve got to paste like the prophy paste that is mixed with water and then with the rubber cup or brush. It can be used to polish the surface of amalgam to smoothen it and to minimize corrosion and tarnish. These are the benefits of finishing and polishing amalgam but never do this before 24 hours because amalgam is still weak, it is not set yet and if you do finishing and polishing before 24 hours certain pieces of the amalgam will go away, will be scraped off which might create deficiency in your filling. So with this variety of burs that can be used weve got a paste that is placed in the dappen dish and weve got the rubber cup and brush. So polishing can be done with bonded or coated abrasives. Weve got a variety of burs and the pumice or the paste that contain abrasives. And then you can use them to polish the amalgam.

So, this is a bonded abrasive bur that is used to polish the surface of amalgams. They come in different shapes or forms. Some of them are cone shaped, some are shaped like wheels and then at the end the paste is used with a cup or brush to give us this shiny and smooth surface and always when we do a class 2 amalgam, it is a good idea to use a dental floss so that if there is any excess interdentally while the material is not yet fully set. You can pass it in between teeth to remove excess. So, usually we use a finishing bur and then the abrasive paste. You already have done finishing and polishing composite so you are familiar with it. The easiest way is to use disks, we call them Toffler disks (its is a trade name). We to start with the coarse to the medium, fine and superfine as well.

Abrasive grades are available from rough to smooth and as said dont use them in the contact area, only underneath it or on top or above it. So, initial finishing removing gross or major excess and then going on to medium or fine to achieve a smooth, well contoured surface on the filling material. Sometimes, we also can use diamond burs, finishing burs that have a smooth
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surface not finishing diamond burs that are color coded having a yellow band around them. These are smooth enough to be used on the surface of composite. We should be careful not to use them on the tooth surface because Toffler disks, (cant hear it) and diamond can remove enamel. So, you need to be careful when using them and you dont need to apply pressure and always remember to use water to prevent excess heat that may hurt the tooth nerve (so always cool it with water). Now, nobody uses gold restoration or gold crowns anymore. But usually they are finished using the rotating wheel /clock wheel. This wheel is coated with iron oxide material. Again it is a type of abrasive and as said no one uses it so never mind it. Porcelain can be finished with diamond paste. Diamond is the hardest material and porcelain is a very hard material too.

So, diamond paste can be used to achieve a smooth finish surface,. Burs are also available. If you remember when we talked about doing scaling and polishing for patients. Scaling is done to remove plaque and calculus and after we do this treatment, we usually use prophylaxis paste to smoothen the surface to remove certain stains from the enamel. Now, it is Ok to use this paste if you have got an amalgam restoration on teeth but in case of composite your paste should not be too rough. Otherwise it will remove part of the composite and it can cause staining of the composite material. So if you want to polish composite with a paste, usually aluminum oxide paste is used.

So, in case of composite you should use the fine paste in order to avoid damage or causing deficiency in the restoration. If it is not effective enough to remove staining, because all composites stain with tar, you can go to rough paste. So start with fine in order not to damage composite and if it is not working you can go to a coarser abrasive. Of course always use light pressure with water for less than 30sec.
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When you are polishing crowns, whether made of gold or porcelain, you should always be careful not to damage the area where the crown sits on the tooth where you have placed your cementing agent because you dont want to remove the cement or losing agent and cause deficiency. But again the polishing technique is the same. The polishing paste used is made out of diamond for porcelain and aluminum oxide for gold. Another technique of doing polishing is using air abrasion polishing which means you are forcing material under pressure against the restoration. In case of crowns for example, we said that we can do sandblasting or abrasion on the inner surface of the crown to make it rough to improve their retention (micromechanical retention). Same thing in air polishing, water or air or sodium bicarbonate are forced under pressure against the restoration to remove debris or stains. So this is one other technique instead of using hand pieces. So the place the restoration like inlay or onlay that was fabricated in the lab.

They place it in a chamber and under pressure they force air or sodium bicarbonate so that the surface will be smoothed. In case of air abrasion, you will be doing something more aggressive to create a rough surface for retention. This is different. So in case of polishing air, water, sodium bicarbonate if micromechanical retention is needed, then air abrasion can be used and it is filled with aluminum oxide particles or sometimes silica particles that are forced against the restoration surface to make it rough like crowns or if you want to repair the crowns, if the crown was taken off and you want to place it again, part of the porcelain was broken, you want to repair a composite, you need to create a rough surface for bonding, you can do this or air abrasion can be done.

So this is an air abrasion tip, there polishing unit so the restoration can be fixed in place and then air polishing or air abrasion may be done.
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Whenever we do finishing and polishing we need to protect ourselves from the debris that come out or splatter from water that is mixed with the paste. So you need to protect your eyes, your mouth and nose with a mask and always use gloves because for example if a patient has an infectious disease and you are using this paste with water, anything can fly all around and may cause you to become infected. So wearing gloves, masks or glasses is necessary. Sometimes to minimize bacteria inside the oral cavity before finishing and polishing, we ask the patient to use an antibacterial mouthwash. This will minimize the bacteria inside the oral cavity and minimize the risk of contamination.

But still wearing gloves, masks or glasses and sterilizing all the instruments that are used is necessary to prevent group infection between patients. Later on after we finish all this, you need to instruct your patient to maintain good oral hygiene. So composites are very nice, have a good shade, they look like natural and they remain so for a long period of time provided that the patient performs good oral hygiene. We can tell the patients if they want to maintain the filling looking like this for a long time they need to brush their teeth effectively. They dont need to use mouthwash, good brushing should be enough. They can avoid drinking too much tea or coffee and whatever causes stains, but maintaining good oral hygiene is a must.

If the patient for example has a complete denture or partial denture, we always tell him to use a braces to maintain the quality of the surface of the restoration. So we need to give the patient these instructions and to tell them to come regularly every 4 or 5 or 6 months just to monitor and review (regular visits help to monitor everything). When we talk about crowns and bridges we say that teeth are prepared, impressions are taken and sent to the lab and the lab constructor reaches for
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you. In between visits what will we do? Can we send the patient with a prepared tooth just like that? Of course we cant. Because when we prepare teeth we remove part of the enamel and dentin. It is exposed and it can cause sensitivity, gingival overgrowth or tilting of teeth because of the space. So we need to provide temporary covering (light temporary restoration). This temporary covering will protect the vitality of teeth; prevent sensitivity, gingival overgrowth or movement of adjacent or opposing teeth.

So when we prepare a tooth we are reducing the size of the tooth by removing enamel and dentine. So there is no more contact between this prepared tooth and adjacent and opposing teeth. This space if it is left for a long period of time adjacent teeth and opposing teeth can move and this is natural. If there is no contact between teeth, teeth will tend to tilt or move and this is physiological. We want to prevent that because if adjacent teeth move and close up the space we cannot fix the crown after we make it. So temporary covering is necessary. So before doing preparation of the teeth, we usually take a primary impression of the teeth that we want to prepare with rubber material. Then we use this impression to make the temporary crown. The rest of the procedure you will learn about it when you will do crowns and bridges later on.

The important thing here is to learn about the material we will use so you can use it correctly. Commonly we use acrylic based material. Another type of material that can be used for temporary crowns and bridges is composite paste. It is a better material but is more expensive. The shade of the composite is better, shrinkage is less, less seat when setting, less exothermic reaction or less heat from the exothermic reaction so better properties.

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But acrylic material is cheaper so people tend to use acrylic material. Once the temporary crown is made, it will initially seat in the patient mouth until you fill its covering. Then you take it out and allow it to complete setting outside to prevent the heat that results from the reaction from damaging the tooth or causing sensitivity. So this material ideally should not be irritant or toxic and should have a sufficient working time, sufficient strength. So that it can remain in the patient mouth without being structured on the occlusion load. It should harden quickly in the patient mouth, should not produce excess heat when it is set in. These are the requirements.

Acrylic material and composite material are either chemical cured. Some of them are also light cured. The chemical cured material similar to acrylic resin, polymetal methacrylate powder, metal methacrylate liquid. Some of them have a different monomer, instead of metal methacrylate it contains isobutylmethacrylate just to make it less irritant because we know metal methacrylate monomer causes irritation.

Referring to the composite material, it is either 2 paste system or 1 paste if it is light cured. So either powder and liquid for the acrylic material are mixed and placed in the impression that you took and then placed on top of the patient teeth or it can be single paste light cure. So you can tell when the composite material becomes rubbery. This thin rubbery stage is very clear and you can better recognize it when compared to acrylic material. Shrinkage is less, less seat when it is set. But in general both materials have exothermic setting reactions and undergo shrinkage. Composite shrinks less and the shades are better especially when you are working in the interior part of the mouth. It is a good idea may be to use composite temporary crowns because they provide better shade (for esthetic purposes).

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When you make these crowns you need to be careful. If part of the crown is thin it can break off easily because they are meant to be very strong since they are temporary. So thin areas mean that your preparation was not enough because you did not take enamel and dentine as much as you should. This will produce a thin area in the temporary crown.

Again you will understand this better once you train how to do crowns and bridges. So monomer can cause irritation but other types of distal monomers are available. This material is not very strong but it can be used temporarily until the porcelain crown is used. -----------------------------------------------------------------------------7mdellla done DONE by MAM <3 <3 <3 alla y7fa'9ek o y5aleki lya Je t'aime beaucoup :* Luv u papito o srrry cz a5adt mnn w2t mam :P Miss u ma twinz (omayma &soumaya) I wanna say hi 2 Ma big sis DR.rai7ana Study well ya 6ollab n gd luck o srry cz m late ur lit sis ((kawthar mohammed saleh aouididi)) Luff u ma frnd katia (soosi el.asfar e.9'3eeer) o thnx 3 dwali :P O e.shokr 6ab3an la snaa2 8asim elle t3bit m3i

"God , protect my country Tunisia "

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