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Problem Solving Questions

Questions And Answers

Need help picking the right composite shade?

Here are some helpful hints on shade matching:

  1. Make sure the composite materials you are using exhibit long term color stability.
  2. Use a VITA Shade Guide.
  3. Educate your patient about the difficulties of shade matching.
  4. Clean teeth to be matched.
  5. Make sure that shade is taken against a clean, moist tooth.
  6. Take shade against opposing dentition; during the procedure the teeth will lighten.
  7. Don’t stare; take short looks.
  8. Use assistant’s opinion. The patient should not be involved at this point.
  9. Look at the total first, later the areas.
  10. Use room light as well as natural light.

Remember that resin shades are influenced by several variables:

  • The under color of the tooth being restored.
  • The thickness of the resin.
  • The polymerization process, color change upon polymerization. Renamel Microfill lightens slightly to the proper color; Renamel Microhybrid darkens slightly to the proper color.
  • The polishing procedure is necessary to produce the final color.
  • The use of opaquing and tinting.

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Having difficulty getting a polish on your microhybrid or nanofill composites?

Begin by using various finishing burs of your choice. The different shapes and sizes of burs will enable you to contour the bulk of your restoration. Next you should follow a 4 grit disc sequence (FlexiDisc Cosmedent): coarse, medium, fine, superfine. To achieve a good polish on your composite restoration it is important to follow the entire grit sequence through to completion. Each grit type plays an important role in the finishing and polishing process:

  • Coarse Disc - contours surfaces, removes imperfections and defines margins
  • Medium Disc - Completes the finish and removes small scratches
  • Fine Disc - Starts to create a nice polish
  • Superfine - Enhances your polish to an enamel-like luster

Start with the coarse disc (FlexiDisc Grey). This disc is the most abrasive of the four grits so use gently if you do not want to remove too much of your contours. Next, use the medium grit (FlexiDisc Blue), followed by fine (FlexiDisc Yellow) and lastly superfine (FlexiDisc Pink). Your final step should be to use a felt buff with your polishing paste (Enamelize by Cosmedent) and you will be left with an absolutely beautiful final polish every time.

If you prefer to use diamond polishers you should try Cosmedent’s new Nano/Microhybrid diamond polishing kit, which includes 9 reusable diamond polishers, one point, cup, and wheel of each grit; coarse for initial contouring; medium for finishing, and superfine to bring out the polish. Make sure to finish with a Felt Flexibuff and Enamelize polishing paste to achieve a beautiful final luster.

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Is your microfill restoration not polishing to a high shine?

It is very important to only use aluminum oxide discs, cups and points, strips and polishing paste when polishing a microfill composite because diamond polishers are too abrasive. Follow the below steps to achieve a higher shine on your microfill composites.

1. Contour your restoration (typically accomplished with a carbide bur)

2. Refine contour with a Coarse Disc (FlexiDisc Grey)

3. Remove small scratches and start polishing with a medium grit (FlexiDisc Blue)

4. Polish to a shine with fine disc (FlexiDisc Yellow)

5. Add surface characterization with Medium (Blue) followed by SuperFine (Pink) cups and Points. Make sure to use aluminum oxide cups and points on microfill composites because diamond impregnated polishers are too abrasive for microfill composites.

6. Polish to a high shine with SuperFine (FlexiDisc Pink)

7. Polish to the highest luster attainable using your aluminum oxide polishing paste with a felt buff (Enamelize and FlexiBuffs).

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Do you have difficulty determining when to use your flowable composites?

Use flowable composites such as Renamel Flowable Microfill and Renamel Flowable Microhybrid for fast and simple composite repairs. Situations that lend well to flowable composites include sealing margins, repairing pits and defects, small occlusal repairs, sealing gingival margins in Class II and Class III restorations, and in deep Class V restorations prior to overlay of a body microfill. Flowables are also used as a liner for posterior composite restorations. Cosmedent makes a flowable radiopaque cavity liner De-Mark specifically for this purpose.

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Do you ever misdiagnose composite as decay?

Use a radiopaque flowable composite liner under your body material, such as Renamel De-Mark by Cosmedent. Using a radiopaque cavity liner under your composite will help you easily distinguish between composite and tooth structure on an X-Ray, eliminating the problem of misdiagnosing decay. Some flowable composites are not actually radiopaque so make sure you choose a cavity liner that will show up clearly on an X-Ray.

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How long do I cure my composite?

Each incremental layer should be cured for 20 seconds. The final polymerization should be for 60 seconds. Remember, it is always better to over-cure your composite than to under-cure, so do not skimp on this step.

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How thick of an increment can I cure my composite?

Regardless of whether you are using a nanofill, hybrid or microfill composite, each composite increment should be placed no more than 2 to 2 ½ millimeter increments at a time and then polymerized.

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I have problems with my composite sticking to my instruments. What should I do?

Cosmedent’s new Brush & Sculpt eliminates this very problem.  Brush & Sculpt is a virtually clear liquid resin that is designed to help you apply, smooth and manipulate your composite without it sticking to your brush or instrument.

Another way to eliminate composite sticking to your instrument is to make sure your instruments are titanium coated. Do not ultrasonic these instruments as they can create microscopic scratches and ultimately remove trace amounts of titanium from the instruments causing more sticking problems in the future.  If you still find your composites sticking to your titanium instruments, and you are not interested in using a composite wetting agent such as Brush & Sculpt, you may use damp alcohol gauze intermittingly swiping between adding to your composite restoration.

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How do I etch composite?

There are two methods to prepare the surface of hybrid and nanofill composites for repairs. The first is to use a clear composite etch (9.5% hydrofluoric acid). It is important to use clear etchant because tinted solutions will stain composite. Adjacent teeth and soft tissue need to be protected before starting. We recommend using a light-cure resin dam material, such as GINGA-Guard from Cosmedent. Your composite etchant should be applied and allowed to work for five minutes, then rinsed off with copious amounts of water.

The second method is to prepare the surface is using a microetcher. As with the first method, protecting the adjacent teeth and soft tissue is important. Follow the instructions from the manufacturer to prepare the surface. 

*Remember never use a hydrofluoric acid on a microfill. You may use 10, 32, 37 percent phosphoric acid to “clean” a microfill, but in truth, phosphoric acid is primarily used to etch dentin and/or enamel to remove the smear layer and prepare the tooth structure for a bonded procedure.

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Need help bonding to metal?

Bonding to metal should be an easy procedure if you follow several very important rules. First, you must isolate the area to be bonded. Use of cotton rolls, retraction with a mouth mirror, a bite block, a rubber dam material to protect the gingival tissue, and the use of a saliva ejector or oral evacuator is important. (Not all of these items may be necessary, but the point is, you must find an accurate means of isolating the repair area if you want the procedure to be successful.)

All metal, whether precious, semi-precious or non-precious should be adequately isolated from water or any oral fluids such as blood or saliva. Microetch the metal using a sandblaster with aluminum oxide particles or you can use a course or medium diamond bur to roughen or prepare the metal. Do not use both methods as it would be redundant.

Next, apply bonding resin and light cure. It is important to follow the manufacturer’s instructions to whatever bonding adhesive system you are using and make absolute certain that it is applicable for such procedure. Next, in order to block out metal shine through you should apply a layer of Cosmedent’s Pink Opaque and light cure. It is better to place one or two thin coats, light curing between each coat, than to place one thick coat. Pink Opaque is really the only material that will naturally block out metal from shining through to your final restoration.

Next, place a thin layer of your composite (Renamel NANO or Renamel Microhybrid) on top of the Pink Opaque layer and shape it accordingly. Then apply a microfill if so desired. Otherwise, after the nano or hybrid has been placed, light cure, finish and polish.

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Do you know how to remove the oxygen inhibited layer?

The air inhibited layer, often referred to as the “sticky layer”, is the phenomenon that occurs on each cured/polymerized layer of composite. It is in fact, the very reason that each additional layer of composite can continue to be added to a restoration. Removing the oxygen air inhibited layer is simple and occurs in the initial phases of finishing and polishing. The oxygen inhibition layer can also be eliminated prior to the final cure by placing a coat of a clear glycerin gel (Oxygone) on the surface. Since the composite is no longer exposed to oxygen, the sticky layer is removed. Remember that if you wish to apply more composite to the restoration after you remove this air inhibited layer, you must add unfilled resin to the composite surface and polymerize it once again.

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Need to match existing teeth that have hypo/hypercalcification?

Take the blunt edge of a brush (Cosmedent’s Brush #3 is very good for this purpose) and dip the very end of the bristles into a White Opaquer (Creative Color White Opaque) and dab/apply the material either on top of a polymerized nanofill or hybrid layer. After the white opaque has been strategically placed and light cured, you may then overlay with microfill. Once the microfill is cured you should start to see your characterization effects shining through the microfill layer. You may also entrap the white opaque within the body or matrix of the microfill material by troughing out a desired area, placing the Creative Color White Opaque and then squeezing the troughed out area together and then light cure.

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How do I add staining and crazing to my composite restoration?

Staining can be accomplished by adding a tint (Creative Color Tints by Cosmedent) to a polymerized hybrid or nanofill layer and then overlaying with a microfill composite (Renamel Microfill). Craze lines can be created using a technique called Trapping. The uncured facial layer of composite is sliced with a thin instrument such as an IPCT by Cosmedent. The tints should be added into the slices and then the microfill can be gently squeezed together, so that the tints are trapped or sandwiched within the matrix of the material. *Staining and crazing effects should never be on the outermost surface of the composite restoration.

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What creates the white line at a composite margin in Class I or II fillings?

Shrinkage of material away from the margin is usually the case for this white line appearing at the margin. The white line may also be indicative of microleakage as well.

This is why we recommend incrementally placing posterior composite restorations and light curing between every 2-2 ½ mm increment- as opposed to “The bulk fill” technique. Improper polishing may also be suspect to this revealing white line as well. 

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If the class II is deep on dentin, how do you best prevent micro leakage, and recurrent caries. Do you need to use a glass ionomer ? Also what is the best, longest lasting posterior composite and why. Will it last as long as amalgams?Thanks, Dr. O

Thank you for your recent question submitted on the dental composites website. The best way to prevent micro leakage and recurrent caries is to make sure that you are following the correct placement and polishing technique. If posterior composites are placed and finished properly, they typically hold up beautifully. We do not support bulkfill composites for posterior restorations. We find if you carefully place your composite in 2mm increments and make sure that your margins are completely sealed before you go through the finishing and polishing process you will be quite happy with your end result.

 

As far as a glass ionomer goes, the choice is up to you. Dr. Mopper does not use a glass ionomer. You can either total etch without the glass ionomer (as Dr. Mopper practices) or you can put in the glass ionomer first, the choice is yours.

 

It is hard to say what is the best and longest lasting posterior composite since nanofills are newer to the market than microhybrids. We have seen composite cases with microhybrid that have lasted for 30 years. Time will tell if nanohybrids and nanofill materials will produce the same results. This is also the case with amalgam. Almagam can hold up in the mouth for a very long time. However, composites have not been around as long so it is difficult to tell if posterior composite restorations will last the same length of time. As previously mentioned, we have seen composite cases that have lasted for 30 years and we are firm believers in the strength and longevity of composite materials if proper technique is followed.

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how renamel nano is used as a single layer for enamel and dentin build upp? how does it simulate enamel and dentin?

Renamel Nano was specifically made to be used as just that- an enamel/dentin “substitute.” The big key here is this: IF the tooth DOES NOT require a color change then use the nano. If on the other hand, you need to mask dark dentin, use the hybrid followed by opaquer etc. the nano was designed to have just the right amount of opacity and translucency to allow it to blend into tooth structure beautifully.

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I'm 4th year student, I want to know how can I make A beautiful composite restoration?Please explain the most important steps Simply and shortly..Thank You!

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I had seen post op X-ray of my new composite restoration having a void between flowable composite and bulk fill in class 2 proximal box!How do I avoid it?

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Hi,My understanding is that medium grit diamond instruments no longer require a blue band for identification.Please clarify and why.thank you.Regards,Sonja Goldman

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what is the best and easiest way to contour the occlusal surface in class 1 and 2 in composite .. instruments and such carving to me is hard to access ,, and what about coping layer from an acrylic model ?

Good morning Dr,

 

Thank your for your question.

Please visit our website at www.cosmedent.com at the top of the page you will see Resources-when you hover over that word, a box will appear-hover over Tip of the Month-

Another box will drop down-please click on tip of the month March 2014-this tip is on Class I composite restoration presented by Dr. Jason Smithson.

 

After you have completed watching this tip, scroll down to January 2012 for Class ll tip of the month presented by Dr. Dennis Hartlieb.

These two dentists both teach courses on anterior and posterior composite restorations. You will find our CEE-Center for Esthetic Excellence 2015 courses posted on our website as well.

 

I am sorry I do not understand your language regarding “what about coping layer from an acrylic model.

You may email me directly at Erika@cosmedent.com or you may call my direct line at 800-837-2321 if you would like to speak to me.

 

Most Sincerely,

Erika

 

 

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what can i do to prevent the formation of white line at restoration margin in class iii composite restoration , it is very frustrating problem to me .

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I etch, prime and bond. Add pink opaque and cure it with light. Then composite n cure. The composite will flake off with pressure. Consult please.

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how can I restore deep class 2 composite when its below the cementoenamel junction?

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