Adhesives

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Introduction
Restorative Procedure
INDEX
Restorative procedure steps and products overview
3-6
Bonding:
Bonding & Adhesion, Prof. David Watts, Dr. Nick Silikas
7-8
OptiBond Family
1
9-10
OptiBond FL
11-12
OptiBond Solo Plus
13-14
OptiBond All-In-One
15-16
Composites:
Aesthetics and composite, Prof. Angelo Putignano
17-20
Herculite XRV Ultra
21-22
Clinical case: Class IV
23-24
Clinical case: Class V
25-26
Clinical case: Class II
27-28
Clinical case: Class I
29
Finishing and Polishing:
Finishing and polishing of composite restorations, Prof. Martin Jung
31-33
Surface treatment of composite filling overview
34-36
OptiDisc
37-38
HiLusterPlus Polishing System
39-40
OptiShine
41
Herculite XRV, OptiBond FL References
42
Authors Biographies
43
Achieving good aesthetic results simply,
reliably and quickly is an everyday challenge
in restorative dentistry. Kerr’s competence
in composites and adhesive systems
accompanied with smart Hawe restorative
tools offer predictable and faster results in
any clinical situation.
This restorative dentistry guide summarizes the
use of different materials, tools and techniques
essential for creating high quality restorations
with long term clinical success.
2
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Introduction
Restorative Procedure
STEP
PRODUCT
Caries
diagnostic
X-rays
KERR PRODUCTS
Film and Sensor Holder Line
Kwik-Bite
Cavity
preparation
Burs
SuperBite Posterior
Beavers Carbide Jet Burs
BlueWhite Diamond Burs
Accessories
SuperBite Anterior
Beavers Carbide Jet Bur
BlueWhite Diamond Bur
OptiDam™
SoftClamp™
Fixafloss™
OptiDam
OptiView™
SoftClamp
OptiView
Fixafloss
3
STEP
PRODUCT
KERR PRODUCTS
Adhesion
Total-Etch
OptiBond™ FL
OptiBond™ Solo Plus™
Self-Etch
Composite
Filling
Nanohybrid
OptiBond™ All-In-One
Premise™
Premise™ Packable
Herculite® XRV Ultra™
Microhybrid
Herculite® XRV™
Point 4™
Flowable
Premise™ Flowable
Premise
Premise Packable
Revolution™ Formula 2
Premise Flowable
4
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Herculite XRV Ultra
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Introduction
Restorative Procedure
STEP
PRODUCT
Application
methods
Matrices
KERRHAWE PRODUCTS
SuperMat® System
Hawe Adapt® Matrices
Lucifix® Matrices
Adapt SuperCap
Steel and Transparent Matrices
Lucifix Matrice
SuperMat System
Hawe Adapt® Sectional Matrices
Hawe Transparent Cervical Matrices
Wedges
Hawe Sycamore Wedges
Sectional Matrice
Cervical Matrices
Wedge Dispenser
Hand shaping
instruments
Polymerization
Halogen curing lights
LED lamps
CompoRoller™
CompoRoller
OptiLux 501, Demetron LC
Demetron A1 and A2
DEMI
Demetron A1 and A2
5
Demi
Finishing and
polishing
Flexible disc
Abrasive strips
OptiDisc®
OptiStrip™
OptiDisc
Abrasive brushes
Polishers
Professional cleaning
OptiStrip
Occlubrush®
OptiShine™
Occlubrush
OptiShine
GlossPlus Polishers
HiLusterPlus Polishers
HiLuster Polishing System
Cleanic®
CleanPolish and SuperPolish
Pro-Cup®
Brushes
Pro-Cup
Cleanic Mint, Apple and Bubble Gum
6
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Adhesives
Restorative Procedure
Adhesives
The mechanism of enamel bonding is based on a
micro-mechanical bond between the resin and the
phosphoric acid conditioned rough surface of the
enamel. Enamel conditioning remains the most
commonly used method to bond resin-composites
to enamel surface. It provides strong bonds.
Enamel conditioning may be regained by re-etching
the surface and applying the resin, thus recovering
the required shear bond strength at the enamel-resin
interface, and allowing the resin to mechanically
bond onto its surface.
Dentine however has a much more complex
structure than enamel. Prior to dentine-bonding,
the removal or modification of the smear layer is
indicated to clear the openings of the dentine
tubules by conditioning the surface of the dentine.
Bonding & Adhesion
Prof. David Watts, Dr. Nick Silikas, University of Manchester, UK
A fluid adhesive is then applied over the dentine
and cured, ensuring that optimum wetting of the
surface and absorption into the dentinal tubules
is achieved; thus creating an inter-penetrating
network with the demineralised collagen in the
dentinal tubules, hence forming the hybrid layer.
Preservation of the hybrid layer prior to the
application of the hydrophobic resin restoration
is imperative for an efficient bond to form between
the resin and dentine. Therefore, any contamination of any region of the adhesive system would
evidently jeopardise the integrity of the bond.
The mechanism proposed for this material was
to bond to the organic component of the dentine,
namely the collagen. The first work to investigate
the mechanism of bonding to the dentine was by
Nakabayashi (1). He first identified a layer between
the resin and dentine substrate referred to as
“hybrid” dentine, in that it was the organic components of the dentine that had been permeated by
resin.
The term “hybrid layer” has now become synonymous with bonding of resins to etched dentine.
There has been a tremendous amount of research
done on the hybrid layer, its structure, formation
and how it can be improved. This layer has also
been referred to as the “resin-dentine interdiffusion
zone” (2).
Classification
Numerous dentine bonding agents have been
commercially introduced. These changes have
been referred by some people as “generations”,
implying that there was a chronological development. This can be very confusing. A more consistent and logical approach is to classify bonding
agents by the number of steps needed to complete the bonding process.
“Three-step” or “Conventional” systems
This group typically consists of three separate
application steps: etching, priming and adhesive
resin. They are also known as “etch-and-rinse”
7
systems. Although they were the first ones
introduced, they are still widely used and have
been shown to provide reliable bonding. Their
main drawback seems to be technique sensitivity,
since any deviation from the recommended
procedure will result in inferior bonding.
“Two-step” systems
This group can be subdivided into two subgroups:
i) They have a separate etch and have combined
the priming and bonding steps. These systems
are often referred to as “Single-bottle” systems.
Similar problems found with the “Three-step”
system can also be seen here.
ii) Etching and priming steps are combined together and bonding is separate. This is referred to as
“Self-etching primers”. An acidic resin etches and
infiltrates the dentine simultaneously. The tooth
does not need to be rinsed which decreases
the clinical application time and also reduces
technique sensitivity by eliminating the need to
maintain the dentine in a moist state.
“One-bottle” or “All-in-one” systems
This is when all steps are combined into one
process. Their mode of action is similar to that of
the “self-etching primers”, but the bonding resin is
also incorporated. It is considered that these do
not etch as effectively as the previous ones. They
are the most recently introduced so limited clinical
data is available.
Bonding mechanism
This micromechanical coupling of restorative
materials to dentine, via an intermediate adhesive
layer, is referred to as dentine bonding (3). The
8
resin in the primer and bonding step penetrates
the collapsed collagen fibrils (after demineralisation), and forms an interpenetrating network. This
layer had been described extensively and in great
detail (4, 5). The thickness of the hybrid layer
ranges from less than 1 µm for the all-in-one
systems to up to 5 µm for the conventional systems.
The bond strength is not dependent on the
thickness of the hybrid layer, as the self-etching
priming materials have shown bond strengths
greater than many other systems but exhibit a
thin hybrid layer. The etching, rinsing and drying
process cause the dentine to collapse due to the
loss of the supporting hydroxyapatite structure.
The collapsed state of collagen fibrils was hindering
the successful diffusion of the resin monomers.
To overcome this problem, two approaches were
introduced. The first one is called “dry-bonding
technique” and involves air-drying of dentine after
etching and subsequent application of a waterbased primer that can re-expand the collapsed
collagen (6, 7). The second one is the “wet bonding
technique” in which the demineralized collagen is
supported by residual water after washing (8). This
allows the priming solution to diffuse throughout
the collagen fibre network more successfully.
However, when it comes to clinical practice, it is
very difficult to find the correct balance of residual
moisture. Excess water can be detrimental to
bonding and these problems have been described
as “overwetting phenomena” (9). Since the
“dry-bonding technique” is considered to be
significantly less technique sensitive, it should
be preferred over the most difficult to standardize
“wet bonding technique” (2).
Relevant in-vitro bond strength studies can provide a useful indication of the prospective clinical
success of a system. However, the highest level of
evidence for comparing the efficiency of a bonding
system is obtained from randomised clinical trials.
Randomised clinical trials with elongated the
treatment periods will be very useful in assessing
both the effectiveness of a particular group and
a particular method of application.
References
1. Nakabayashi N, Kojima K, Masuhara E. The promotion of adhesion by
the infiltration of monomers into tooth substrates. J Biomed Mater Res
1982;16:265-273.
2. Van Landuyt K, De Munck J, Coutinho E, Peumans M, Lambrechts P,
Van Meerbeek B. Bonding to Dentin: Smear Layer and the Process of
Hybridization. In: Eliades G, Watts DC, Eliades T, editors. Dental Hard
Tissues and Bonding Interfacial Phenomena and Related Properties Berlin:
Springer; 2005. p. 89-122.
3. Eick JD, Gwinnett AJ, Pashley DH, Robinson SJ. Current concepts on
adhesion to dentin. Crit Rev Oral Biol Med 1997;8:306-335.
4. Van Meerbeek B, Braem M, Lambrechts P, Vanherle G. Morphological
characterization of the interface between resin and sclerotic dentine.
J Dent Res 1994;22:141-146.
5. Van Meerbeek B, Inokoshi S, Braem M, Lambrechts P, Vanherle G.
Morphological aspects of the resin-dentin interdiffusion zone with
different dentin adhesive systems. J Dent Res 1992;71:1530-1540.
6. Finger WJ, Balkenhol M. Rewetting strategies for bonding to dry dentin
with an acetone-based adhesive. J Adhes Dent 2000;2:51-56.
7. Frankenberger R, Krämer N, Petschelt A. Technique sensitivity of dentin
bonding: effect of application mistakes on bond strength and marginal
adaptation. Oper Dent 2000;25:324-330.
8. Kanca JI. Effect of resin primer solvents and surface wetness on resin
composite bond strength to dentin. Am J Dent 1992;5:213-215.
9. Tay FR, Gwinnett JA, Wei SH. Micromorphological spectrum from
overdrying to overwetting acid-conditioned dentin in water-free acetonebased, single-bottle primer/adhesives. Dent Mater 1996;12:236-244.
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Adhesives
Restorative Procedure
OptiBond™
Respected by leading opinion leaders, perceived as the gold
standard of the adhesive technology OptiBond family provides
performance, versatility and predictable results.
... the name that stands
for adhesive brilliance...
Chemistry Behind
OptiBond™ Family
Total-etch
No. of steps
Self-etch
GPDM Adhesive Monomer
3
2
1
All OptiBond adhesives comprise the unique
proprietary chemistry which made OptiBondTM
FL the gold standard among bonding agents.
Proven GPDM adhesive monomers are effective
in creating a superb bond with minimized risk of
microleakage and post-operative sensitivity.
4th generation
5th generation
7th generation
GPDM = Glycero-Phosphate-1.3 Dimethacrylate
Gel Etchant
Primer
Adhesive
9
Years in market
Application
Direct procedure
Indirect procedure
Etching
Application time
Bond strength Mpa
To dentine
To enamel
Properties
Filler load
Works on wet or dry dentine
Film thickness
Radiopacity
Solvent
Packaging
Storage conditions
Bottle content
Unidose™ content
10
OptiBond™
FL
OptiBond™
Solo Plus
OptiBond™
All-In-One
15 years
10 years
3 years
•
Yes
1:30 min.
•
•
Yes
1:10 min.
•
•
No
0:55 min.
Filled adhesive technology
The technology of filled adhesives was first
time ever introduced by Kerr in its OptiBond FL
adhesive.
Glass Filler in OptiBond Adhesive:
• Reinforces the dentin tubules for high bond
strengths and protection against microleakage
• Releases fluoride over the long-term
32 MPa
33 MPa
31 MPa
34 MPa
36 MPa
26 MPa
48%
•
~60 µ
267% Al
Water
Ethanol
15%
•
~10 µ
Ethanol
7%
•
~5 µ
Water, Ethanol,
Acetone
Ambient
temperature
Primer Bottle 8 ml
Adhesive Bottle 8 ml
0.1 ml
Ambient
temperature
Refrigeration
2 °C to 8 °C
5 ml
5 ml
0.1 ml
0.18 ml
• Decreases polymerization shrinkage
• Works as a shock absorber and thermal barrier
between the restorative material and the tooth
• Virtually eliminates post-operative sensitivity
• Works well in dry, moist or wet environment
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Adhesives
Restorative Procedure
OptiBond™ FL
Two-bottle total-etch adhesive system
OptiBond FL, from its launch in 1995 established
the standard in adhesive technology. Over 15
years it has been successful worldwide, proven
in long-term clinical studies and recommended
as the gold standard by leading dental
universities worldwide.
Features
After applying OptiBond FL I can achieve a
reliable bonding without any post-operative
sensitivity. Also I can use successfuly
OptiBond FL in any bonding procedure.
Prof. Marco Ferrari
• Unique structural bond. 48% filler load
delivers superior bond strength.
• Efficient application flow. One coat primer.
One coat adhesive. Wet or dry prep.
• Highly radiopaque. 267% radiopacity makes
X-ray detection easy.
• Delivery options. The only two-bottle
adhesive available in bottle and Unidose delivery.
• Proven long-term performance.
The legend among
the adhesives
11
OptiBond™ FL
Application Guide
Clinical Success
OptiBond FL wins
REALITY’S 20th
Anniversary Legacy
Award, emblematic of
extraordinary long-term
clinical performance.
Technique13-year Clinical Study
Technique
Technique
Technique
Clinical Evaluation of a Dentin Adhesive
Technique
Technique
Technique
Technique
13 Year Results, A. A. Boghosian
Summary
Summary
Summary System:
Summary
and J.L. Drummond and E. P. Lautenschlager,
Summary
Summary
Summary
Summary Northwestern University Feinberg School of
Medicine.
1. Etch enamel with Kerr
Gel Etchant
(35% phosphoric acid)
for 15 seconds.
5. Air dry for 5 seconds.
2. Rinse thoroughly for
15 seconds.
6. Using second applicator,
apply Adhesive (black
rocket for Unidose
delivery) with light
brushing motion for
15 seconds.
3. Air dry for 3 seconds.
Do not dessicate.
7. Air thin for 3 seconds.
4. Apply Primer (yellow
rocket for Unidose delivery)
with light brushing motion
for 15 seconds.
8. Light cure for
20 seconds*. Surface
is ready for composite
placement.
Conclusion: At thirteen years, the OptiBond
adhesive system has demonstrated outstanding
performance in both retention and sealing of
the tooth. OptiBond has further demonstrated
effectiveness, in conjunction with composite,
eliminating sensitivity resulting from abfraction
lesions.
Over 10 years
posttreament with
OptiBond FL.
Over 13 years
posttreatment with
OptiBond FL
Cases courtesy of Dr. Alan Boghosian
* Recommended Cure Times: Demi 5 sec., L.E.Demetron II 5 sec., L.E.Demetron I, 10 sec. or Optilux 501 in Boost mode 10 sec.
12
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Adhesives
Restorative Procedure
OptiBond™ Solo Plus
Single component total-etch adhesive
OptiBond Solo Plus is a single component
adhesive that combines primer and adhesive
in one step. Combining primer and adhesive
in one bottle answered the need for a simplerto-use bonding agent that maintained total-etch
strength and durability.
Features
Case courtesy of Prof. Angelo Putignano
13
• Strong bond. Proven performance achieved
with simplified application procedure.
The durable chemical and micro-mechanical
bonds protect against microleakage to ensure
superior marginal integrity.
• Filled technology. OptiBond Solo Plus is
15%-filled with the same 0.4 micron filler
found in Kerr's industry-recognized composites.
• Ethanol based. The adhesion promoters are
carried in an ethanol solvent, diminishing both
the tedious need for multiple coats and constant
reapplication commonly found with acetone
adhesives.
• Versatile. Effective in use for all direct
and indirect indications. Use in moist or
dry environment.
• Unidose™ delivery. Available in bottle and
Unidose delivery.
High performance easy-touse total-etch adhesive
Clinical Research
OptiBond™ Solo Plus
Application Guide
Dentin Shear Bond Strength (MPa)
of 5th-Generation Adhesives
35
30
31
25
20
20
21
22
23
23
15
10
5
Table missing
0
Excite®
Adper™
Prime® & One Step® OptiBond®
Single Bond Bond NT™
Plus
Solo Plus™
Published by H. Lu*, H. Bui, X. Qian, D. Tobia, Kerr Corporation,
IADR 2008, #401
1. Etch enamel and
dentine for 15
seconds.
5. Twist open the
unidose.
2. Rinse thoroughly
for 15 seconds.
6. Dip brush. Apply
OptiBond Solo Plus
for 15 seconds using
light brushing motion.
3. Air dry for 3 seconds.
Do not dessicate.
XP Bond™
4. Shake unidose before
dispensing.
7. Air thin for 3 seconds. 8. Light cure for 20
seconds*. Surface is
ready for composite
placement.
STRONG DURABLE BOND. SEM Image
shows excellent penetration of OptiBond
Solo Plus into demineralized dentin,
forming long resin tags and a well-defined
hybrid layer, which results in superior bond
strength.
* Recommended Cure Times: Demi 5 sec., L.E.Demetron II 5 sec., L.E.Demetron I, 10 sec. or Optilux 501 in Boost mode 10 sec.
14
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Adhesives
Restorative Procedure
OptiBond™ All-In-One
Single step, self-etch adhesive
OptiBond All·In·One Self-Etch Adhesive delivers excellent penetration
of dentin tubules, providing exceptional bond strength and protection
against microleakage and post-op sensitivity. Its unique nano-etching
capability enables the most effective enamel etching of any existing
single-component adhesive, creating a deeper etched surface for higher
mechanical retention and chemical bonding. In addition its low film
thickness creates an effective, single-phase adhesive interface for easier
seating and better fit of your final restoration.
Effective enamel nano-etching
SEM image shows clearly
exposed nanoscale enamel
hydroxyapatite crystals,
which present greater
rough surface area
for micromechanical
retention and chemical
bonding.
15
Well defined adhesive layer
Dentin Interface and
Superb Sealing Ability
Provides a Well Defined
Adhesive.
SEM shows the composite,
OptiBond All-In-One
adhesive layer and dentin
bonding interface.
Effective bonding
in a simple way
Clinical Research
OptiBond™ All-In-One
Application Guide
Shear Bond Strength of Single-Component
Self-Etch Adhesive Systems to Human Dentine
(24 hr)*
35
20 seconds
Shear Bond Strength (MPa)
35,0
30
25
20
20,2
15
10
10,3
5
0
Clearfil®
S3 Bond
2. Twist open.
3. Dip brush.
4. Apply first application
with scrubbing motion.
20 seconds
4. Apply second
application with
scrubbing motion.
7. Gently air dry, then
use medium force
to air dry for at least
5 seconds.
8. Light cure for
10 seconds*.
iBond™
Xeno® IV
28,2
25
20
21,7
23,0
21,6
15
10
11,3
5
0
GBond™
iBond™
Xeno® IV
OptiBond®
All•In•One
* Study conducted by Dr. James Dunn of Loma Linda University.
Trademarks are property of their respective owners.
* Recommended Cure Times: Demi 5 sec., L.E.Demetron II 5 sec., L.E.Demetron I, 10 sec. or Optilux 501 in Boost mode 10 sec.
16
OptiBond®
All•In•One
30
Clearfil®
S3 Bond
5. Dip brush.
GBond™
Shear Bond Strength of Single-Component
Self-Etch Adhesive Systems to Bovine
Enamel (24 hr)*
Shear Bond Strength (MPa)
1. Shake.
32,2
30,4
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Composites
Restorative Procedure
COMPOSITES
Since the ancient times great philosophers, such
as Plato, Baumgarten, Kant, Hegel, Vico and Croce,
have sought to place the concept of aesthetics and
beauty on a rational and “scientific” basis.The triad
of beauty, goodness and truth represents the ideal
to which individuals should aspire in the attainment
of what is called “perfection”, which perhaps does
not exist. Most widely shared concepts on
perceived beauty arise from interaction between
“sensibility” emotional and instinctive influence,
and “intellect” or rational factors. Hutchinson and
Shaftesbury defined felicitously aesthetics as the
aptitude for perceiving harmony (Inquiry into the
origin of our ideas of beauty 1725).
Cosmetics is usually regarded as the quest for a
stereotype of beauty regardless of the context of
the subject. Whereas, aesthetics is an expression
of a natural archetype in accordance with
mathematical proportions with distinct and
measurable ideals of beauty. In this respect, an
inate sense of aesthetics has been theorized,
defined as the passive ability to receive ideas of
beauty from all objects in which there is uniformity
in variety (“harmony”) (1). These objective factors,
which accept an interaction between the object and
the “mental categories” of the observer, provide the
rational basis of beauty. Numerous rules of beauty
17
Aesthetics and composite
Prof. Angelo Putignano, University of Marche, Ancona, Italy
have been applied to anatomy in formulating
dentofacial proportions coherent with the “golden
section” (Leonardo), or in accordance with
anthropometric (cephalometric) parameters
adopted from epidemiological studies. However,
there are a series of subjective factors peculiar
to instinctive emotional and psychological context
of the observer, which can significantly condition
the sensitivity to beauty. Taste and perception of
beauty are correlated with the era and specific
historical, cultural and social context which the
observer inhabits. Pilkington defined dental
aesthetics in 1936 as “the science of copying,
harmonising our work with that of nature, seeking
to minimise it as much as possible”.
A few decades ago, the majority of dentists working
in the field of restorative dentistry concentrated on
long-term solutions and the appearance of the
restorations was of secondary importance (2).
In practice, amalgam restorations and gold alloy
crowns were utilised as the main and most lasting
solutions and patients accepted these dental
restorations despite their poor appearance. The
evolution of preventive and conservative dentistry
has had a great impact on the development of
restorative aesthetic dentistry. The success of
preventive dentistry has resulted in teeth without
caries and therefore white and not restored, with
a resulting increase in the demand for aesthetic
restorations.
Good appearance, together with good overall health,
with adequate restoration of function, and an
attractive smile play an important role in modern
society. In general, a smile is beautiful when the
teeth are well characterised in respect to their
shape, contour, colour, surface texture and detail,
emergence profile, angle and position, and incisal
occlusion. A successful aesthetic restoration will
appear to be completely natural, provide function,
preserve as much healthy tooth structure as
possible and support a healthy periodontium.
To achieve this objective the clinician must select
the most suitable materials for resistance,
biocompatibility, and of course aesthetic
appearance. Composite resins have been in
use for over three decades and nowadays
adopted more and more often because of
their excellent aesthetics and their improved
mechanical properties (3).
The term composite refers to a combination of at
least two chemically diverse materials, with a distinct
interface to separate the two components. Superior
properties are exhibited when in combination, as
compared to when used separately.
When formulating a composite resin, we identify
three different components:
• Organic matrix;
• Inorganic filler;
• Binding agent.
18
The organic matrix of the most modern composite
resins consists mainly of the monomer developed
by Bowen in 1957, through a reaction between
one molecule of bisphenol A and two molecules of
glycidyl methacrylate (GMA). This yields a viscous
monomer of high molecular weight which is called
BISGMA. In the composite resin matrix there are
other monomers of lower molecular weight in
lower percentages such as TEDGMA (triethylene
glycol dimethacrylate, the most used), UEDMA
(diurethane dimethacrylate, sometimes used as
the sole component of the matrix), MMA (methyl
methacrylate) and others of less importance.
The second component of a composite resin
is the inorganic filler, which is added to the
matrix to improve its physical properties which
are otherwise insufficient, such as hardness,
resistance to compression, resistance to wear
and impermeability.
The fillers can be classified on the basis of their
chemical nature into fillers based on silicon dioxide
or colloidal silica, quartz, vitreous materials, other
metals or zirconium.
On the other hand, Bayne in 1994 suggested the
following subdivision based on the diameter of
the particles:
• mega fillers (from 2 to 0.5 mm)
• macro fillers (from 100 to 10 µm)
• medium fillers (from 10 to 1 µm)
• mini fillers (from 1 to 0.1 µm)
• micro fillers (from 0.1 to 0.01 µm)
• nano fillers (from 0.01 to 0.005 µm)
Based on production techniques, conventional or
traditional fillers are produced by trituration of the
inorganic substances listed above, obtaining a
macro filler with particles of irregular shape and
size, which require little monomer to become wet,
therefore conferring less viscosity, but they make
the restoration difficult to finish and polish and
also favour the formation of micro fractures.
Fillers obtained by precipitation of pyrogenic silica
at high temperatures, introduced successively,
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Composites
Restorative Procedure
consist of spherical particles of microfiller
(between 0.04 and 0.06 µm). One of the most
innovative products in this family of materials is
the micro filler composite with prepolymerized
spherical particles. The micro fillers in general are
able to provide a significant advance in the qualities
of the composite; in addition, this particular type
of micro filler confers further advantages due to
the spherical shape of the filler:
• Better matrix-filler bond;
• Less internal matrix-filler tension as there are
prepolymerized spheres loaded with evenly
distributed SiO2;
• Consequent improvement in wear and fatigue
characteristics.
However, this class of materials does not represent
the solution to all the requirements of a dental
restoration, as even they are affected by technical
gaps: the micro fillers are not capable of supporting
high occlusal loads, especially because of the
lower resistance of the pyrogenic silica when
compared with fillers based on glass and above all
quartz. Moreover, contraction due to polymerization
represents one of the major weak points of the
micro fillers; this can compromise the toothrestoration interface, the most critical zone of
a restorative treatment (4,5).
The experience obtained with traditional macro
composites (TC) and micro fillers, both homogeneous and non-homogeneous (HMC and IMC),
has provided the manufacturers with the
knowledge base needed for achieving a
material that can now be used in all classes
of dental cavities, as it has both the physical
19
characteristics of the former and the aesthetic
characteristics of the latter: the hybrid composites.
Hybrid composites are highly loaded materials
(over 70% in volume).
The technology of the hybrids is based on the
presence of a double dispersed phase, consisting
of ceramic-vitreous macro particles similar to the
macro fillers, though of more limited dimensions
(for the most part between 10 and 50 µm), as well
as micro particles consisting of pyrogenic silica,
which are typical of the micro fillers (approximate
dimensions 0.04-0.06 µm) (6). The mixed filler
provides a clear improvement in the material in both
the physical characteristics and the aesthetic
benefit. The macro particles are responsible for
the increased mechanical resistance of the material
because they have a higher elasticity modulus
compared to that of the matrix with which they form
a single body. In this way, an applied force should
induce flexion of the particles before it can act on
the resin, which is the real weak point during the
application of loads. Furthermore, the high filling
value reduces the percentage of resin employed,
consequently reducing the contraction on
polymerization. The improved aesthetic benefit
is a function of the presence of the micro filler,
which guarantees better polishing and an
extremely wide range of shades (7, 8).
The third component of composite is a silane
coupling agent, a bifunctional molecule capable of
binding two different materials. Silane is an organic
silicon glue which has two functional groups, one
of which binds to the methacrylate groups of the
resin, the other to the silicon dioxide of the filler.
Composite resins harden when the monomers form
long chain polymers. This is called polymerization.
In addition, there is an initiator in the resin, a
molecule that, when activated, provides the free
radicals necessary for polymerization to progress.
The most commonly used initiator employs visible
light or UV rays to become activated (9). Those
belonging to the second group, now fallen into
disuse, are basically represented by benzoinodimethyl ether, whereas a diketone is the most
widely used molecule in the most common and
recent composites: camphoroquinone together
with NN-dimethylaminoethylmethacrylate.
Activation of the diketone initiator is by a lamp
using visible light with a wavelength between
430 and 480 nm. These molecules initiate
polymerization by forming a three-dimensional
network with many cross-links; while the
reticulation process is proceeding, the levels
of free radicals and the dimethacrylate molecules
not involved in the process tend to drop
drastically, preventing complete conversion
of the double bonds of the dimethacrylate.
When the composite hardens, the degree of
conversion (DC), which is the percentage of
monomers that undergo polymerization, hardly
exceeds 75% under standard conditions. The
degree of conversion is a determinant for a
series of physical properties of the composite,
such as hardness and resistance to wear.
When two monomers combine the molecular
structure is shortened. Therefore the greater
degree of conversion will increase the percentage
of contraction, because the overall length of a
polymer is less than that of the individual
monomers. In fact, the monomers combine with
covalent bonds, assuming a distance between one
another that is three times lower than that of the
Van der Waals bonds that exist between one
monomer and another. A composite will contract
more when used in a single mass (bulk fill) than with
minimal successive increments (incremental fill).
The direction of contraction depends on the shape
of the cavity and the strength of adhesion. In fact,
adhesive placed on the walls of the cavity opposes
the contraction of the composite, so that the
surface of the material that is in contact with a
wall of the cavity cannot contract because of the
prevailing effect of the adhesive. Therefore, if the
composite is in contact with one wall only, the
contraction takes place towards it and involves all
the other free surfaces. If there are two walls, the
remaining unsupported surface will be left free to
contract; if all the walls of a cavity are present, the
composite adheres to them and the only wall free
to contract is the occlusal one. Therefore, the
greater the number of walls to which the composite
adheres, the greater is the C-factor, that is, the
relationship between the adhesive surface and
the free surface and thus the greater is the stress
to which the material will be subjected when
contracting, as Feilzer stated in 1987. The stress
within the tooth-composite interface has been
measured at about 4 MPa for each surface.
20
During polymerization, there are two phases, one
called the pre-gel phase in which contraction of
the composite is compensated by the intrinsic
flowing of the material, so as to diminish the
contraction and reduce stress; the second is called
the post-gel phase, separated from the former by a
gel point, in which the material is no longer able to
run to compensate the contraction so that stress
is produced. A rigid composite will have a higher
modulus of elasticity or Young’s modulus, and
will develop more stress during polymerization,
having a shorter pre-gel phase; conversely, a
fluid composite will have a lower modulus of
elasticity with a longer pre-gel phase.
Although the composites are regarded as optimal
materials, they certainly have certain limits that
may potentially frustrate the aims of a restoration.
The main deficiency, and this applies for all classes
of composite including the hybrids, is contraction
on polymerization, that is, the reduction in volume
that the resin undergoes during the polyaddition
phase. As a result there is potential that a
marginal defect will form between the tooth and
the filling caused by the contraction. On the other
hand, the absence of the formation of a fissure
introduces tensile forces into the restoration
that will strain the tooth walls, with the risk of
fracturing them, or strain the restoration itself
with subsequent failure of the restoration. In order
to avoid this, clinical cases considered for direct
restorative treatment with composite resins should
be assessed carefully. Appropriate techniques
must be used to compensate for the limitations,
albeit reduced in the case of hybrids resin systems.
Even if the evolution of the composites is
approaching its technological limit, there is
certainly scope for improvement and it is possible
that in the near future there may be a self-adhesive
composite resin, that will be the material of choice
in aesthetic reconstructions. The hybrids come
closest to the ideal material from the aesthetic
point of view although, like all composites, they
have some undesirable physical properties which
have not yet been fully resolved.
References
1. Ceruti A, Mangani F, Putignano A. Odontoiatria estetica adesiva – Didattica
Multimediale. Ed. Quintessence. 2008 Cap.1; p:18-20.
2. Christensen GJ. Longevity versus Esthetics. The Great Restorative Debate.
JADA 2007, 138, 1013-1015.
3. Raj V, Macedo GV, Ritter AV. Longevity of Posterior Composite Restorations.
Journal Compilation 2007, 19(1), 3-5.
4. Abe Y, Lambrechts P, Inoue S, et al. Dynamic elastic modulus of “packable”
composites. Dent Mater 2001;17:520-5.
5. Burgess JO, Walker R, Davidson JM. Posterior resin-based composite:
review of the literature. Pediatr Dent 2002;24:465-79. Review.
6. Dino R, Cerutti A, Mangani F, Putignano A. Restauri estetico-adesivi indiretti
parziali nei settori posteriori. Ed.U.T.E.T. 2007 Cap. 2; p: 18-22.
7. Christensen GJ. Preventing postoperative tooth sensitivity in class I, II and
V restorations. J Am Dent Assoc 2002;133:229-31.
8. Fabianelli A, Goracci C, Ferrari M. Sealing ability of packable resin
composites in class II restorations. J Adhes Dent 2003 Fall; 5:217-23
9. Lee IB, Son HH, Um CM. Rheologic properties of flowable, conventional
hybrid, and condensable composite resins. Dent Mater 2003;19:298-307.
Your practice is our inspiration.™
All you need is Kerr
Composites
Restorative Procedure
Herculite® XRV Ultra™
The legacy of Herculite
For 25 years Herculite XRV has been the
industry standard for composite restoratives.
Herculite XRV Ultra is a nanohybrid version of
Herculite XRV (microhybrid), that incorporates
more biomimetic, “tooth-like” features into a
restoration. Based on the latest nanofiller
technology, in addition to offering improved
handling, polishability and wear resistance,
Herculite XRV Ultra delivers an improved lifelike
appearance to final restorations by replicating
the opalescence and fluorescence of the natural
tooth.
Herculite restoration after 13 years
Case courtesy of A. A. Boghosian, J. L. Drummond and
E.P. Lautenschlager – Study conducted by Northwestern University
The Advantages of Nanotechnology
Herculite Ultra’s advanced nanotechnology
delivers additional benefits that can’t be
found in traditional microhybrid composites.
As a nanohybrid composite, Herculite XRV
Ultra combines conventional hybrid fillers with
smaller filler particles in size of about 50 nm.
These smaller particles enable Herculite XRV
Ultra to deliver improved polish and clinical
gloss, better aesthetics and superior
mechanical strength.
21
Compared to Other Composites
Plucking, or natural wear over time, tends to
occur faster in restorations with larger particles,
decreasing the overall life and esthetics of
the restoration. When polymerized, the large
prepolymerized particles virtually disappear
and the surface is easily polishable. The
polished surface consists only of nanohybrid
particles below the wavelength of visible light.
Nanohybrid composite
Improved Handling
Clinical Research
Gloss Retention
Handling Comparison Map
Over time, resin in a composite restoration wears off,
exposing glass fillers and creating a rough surface.
If the filler size is smaller than the average wavelength of light
(as in the case of Herculite Ultra, Premise™, and Point 4™),
light will be diffused uniformly and the surface will appear
glossy, resulting in superior gloss retention over time despite
resin wear.
Sticky
Z100™
TPH3
Esthet X
Venus
Point 4
Filtek Z250
Herculite XRV ™
Grandio
Creamy
Stiff
Premise ™
Gradia™ Direct
Toothbrush test, University of Leeds
Filtek™ Supreme Plus
90
Herculite XRV Ultra
73
80
70
69.1
65.2
62.3
51.1
60
50
Non-Sticky
Map was created with input from
various clinicians and Kerr R&D.
40
30
20
10
0
Here’s what clinicians are saying about
Herculite XRV Ultra
Herculite® Ultra
Kerr
Herculite
Ultra
5
4,85
4,54
Miris™
Coltene Whaledent
Venus
Before
“Adapts really well, not sticky at all, really sculptable”.
“Superb for a nanohybrid. Best composite ever”.
4
Tetric EvoCeram®
Ivoclar
4,69
4,77
4,77
4,69
Thickness
Adaptability
Compression
w/ Instrument
Adherence
to Instrument
4,92
3
After
2
1
Worst
0
Handling
Stickiness/
Tackiness
Resistance
to Slumping
Photographs courtesy of University of Leeds
22
Filtek™ Z250
3M
Gloss meter readings were taken using a gloss meter at 600 minutes
after the initial reading.
90% of focus group attendees said they would purchase Herculite
Ultra over their current composite.
Best
Venus®
Heraeus Kulzer
Your practice is our inspiration.™
Tetric
Evoceram
All you need is Kerr
Composites
Restorative Procedure
Herculite XRV Ultra in Clinical Cases
Class IV
Case courtesy of Prof. Angelo Putignano.
23
1) Initial case.
2) Teeth models taken for diagnostic wax-up.
3) Silicne key from diagnostic wax-up.
4) Silicone key located.
5) The case with applied OptiDam.
6) Silicone key with OptiDam.
24
7) Etching for 15 seconds with
Gel Etchant.
8) Palatinal wall A2 Enamel mass, small
amount of A3 dentin on the most
coronal part of the injury was placed.
9) A2 dentin mass was applied to cover
the former layer and sculpted with
grooves.
10) The incisal mass is used both around and
between the grooves to create a translucent
effect and to highlight the grooves.
11) The most coronal part is then slightly
pigmented with orange, while whitish
areas are designed with Kolor + Plus® White.
12) Labial A2 enamel mass applied in a
very fine layer.
13) The case after fininishing and
polishing.
14) The completed case after the
10-day follow-up.
Your practice is our inspiration.™
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Composites
Restorative Procedure
Class V
Case courtesy of Prof. Angelo Putignano.
The present case concerns a 30 year old patient with multiple erosions
from particular dietary habits and inadequate oral hygiene:
25
1) Initial situation, erosions on 1.1
and 2.1.
2) RubberDam isolation.
3) Gentle roughening of sclerotic dentin
with rounded carbide bur.
4) Finishing line with 20 micron
diamond bur.
5) Etching with 37% phosphoric acid.
6) OptiBond Solo Plus adhesive applied
with scrubbing motion for 15 seconds;
light cured for 10 seconds with Demi.
7) Application of a thin layer of Premise
Flow A3.5; light cure for 20 seconds
with Demi.
8) First layer of Herculite XRV Ultra,
A3 Enamel, on cervical part;
light cure for 20 seconds.
9) Second and last layer of
Herculite XRV Ultra, A3 Enamel;
light cure for 20 seconds.
10) Finishing with OptiDisc
Coarse/Medium, small size.
11) Polishing with GlossPlus Polisher
Minipoint.
12) High gloss polishing with HiLuster
Dia Polisher Minipoint.
13) Final case after RubberDam removal.
26
Your practice is our inspiration.™
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Composites
Restorative Procedure
Class II
Case courtesy of Prof. Angelo Putignano.
27
1) Initial case.
2) Preliminary preparation.
3) Cavity smoothing with Pasteless
prophy without fluoride.
4) Cavity preparation after caries removal
revealing sclerotic dentin.
5) Etching with Gel Etchant 15 seconds.
6) Bonding with OptiBond Solo Plus.
Apply for 15 seconds and light cure
for 10 seconds.
7) A thin layer of Premise Flow.
8) Build-up of interproximal wall.
28
9) First layer of Herculite XRV Ultra,
Dentin A3,5, light cured for 20
seconds.
10) Buccal dentin masses A3,
light cured for 10 seconds.
11) Lingual dentin masses A3,
light cured for 10 seconds.
12) A thin layer of Enamel A3 under
glycerin to avoid air inhibition.
13) Interproximal emergence profile
of restoration.
14) Finishing procedure with multi-blade
bur.
15) Occlusal check.
16) Polishing with OptiShine.
17) Final result.
Your practice is our inspiration.™
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Composites
Restorative Procedure
Class I
Case courtesy of Prof. Angelo Putignano.
29
1) Initial case.
2) Prepared cavity.
3) Etching with Gel Etchant
15 seconds.
4) Bonding with OptiBond Solo Plus,
apply for 15 seconds and light cure
for 10 seconds.
5) Dentin layer A3, light cured for
20 seconds.
6) Final result.
30
Your practice is our inspiration.™
All you need is Kerr
Finishing and Polishing
Restorative Procedure
Finishing and Polishing
Superior aesthetics is one of the key features of
dental composite restorations. Shading, optical
appearance and surface texture of a tooth
coloured restoration is crucial for patient’s
satisfaction and comfort [Jones et al., 2004].
The behaviour of composites in the biological
environment of the oral cavity are strongly
influenced by surface quality. Surface irregularities
enhance plaque accumulation [Ikeda et al., 2007],
which in turn can lead to secondary caries and
inflammation of the adjacent gingival tissues.
Especially in case of restorations that are exposed
to strong occlusal load and parafunctional activity,
surface roughness affects the wear resistance and
the abrasivity of dental composites [Willems et al.,
1991; Mandikos et al., 2001]. Rough composite
surfaces are liable to discoloration and staining
[Patel et al., 2004; Lu et al., 2005]. Moreover,
material properties such as mechanical and
flexural strength as well as microhardness of resin
based composites are improved by minimizing
surface roughness [Gordan et al., 2003; Venturini
et al., 2006; Lohbauer et al., 2008]. Thus
accomplishing a superior surface finish is a
31
Finishing and polishing of composite restorations
Prof. Martin Jung, Justus-Liebig-University, Giessen, Germany
prerequisite for patient’s satisfaction and for the
longevity of a composite restoration.
Composite surfaces, that are cured against a
mylar matrix, show minimum surface roughness
[Yap et al., 1997; Ergücü and Türkün, 2007; Üctasli
et al., 2007; Korkmaz et al., 2008] Clinically, most
composite restorations require further finishing and
polishing after placement. Finishing includes elimination of excessive material, adjustment of surface
morphology and removal of occlusal interferences.
This causes a roughening of surfaces, which must
be eliminated by subsequent polishing. Rotary
polishing instruments must be equally effective
when exposed to hard filler particles and soft resin
matrix, without damaging the composite surface.
Instruments for finishing require a degree of
cutting efficiency without leaving the surfaces
rough. Finally, rotary instruments for finishing and
polishing must work on different types of surface
morphology (flat, convex concave surfaces).
There are two types of burs recommended for
initial finishing of composite restorations; they
are diamond and tungsten carbide finishing burs.
Finishing diamonds are characterized by a
comparatively high cutting efficiency, depending
on the size of the abrasive diamond particles
[Jung, 1997]. Due to the aggressive effect of
the diamond particles, finishing diamonds leave
composite surfaces in a rough state [Jung et al.,
2007b].
Case courtesy of Prof. Angelo Putignano
Tungsten carbide finishing burs vary with respect
to the number and orientation of the cutting flutes.
These instruments are characterized by a limited
cutting efficiency and achieve a smooth composite
surface with only little remaining roughness [Jung,
1997; Barbosa et al., 2005; Turssi et al., 2005].
There is some controversy in the literature as to
whether there are significant differences between
different types of tungsten carbide finishing burs
with respect to the resultant surface quality [Jung,
1997; Radlanski and Best, 2007].
After initial finishing and contouring the composite
surfaces are in a variably rough state, depending
on the extent and amount of corrective work and
on the number and type of burs used. In order to
accomplish a superior aesthetic result, maximum
reduction of remaining roughness is necessary by
subsequent polishing.
surfaces [Tjan and Clayton, 1989; Wilson et al.,
1990; Hoelscher et al., 1998; Setcos et al., 1999;
Roeder et al., 2000; Üctasli et al., 2007]. Because
of their shape, flexible discs are efficient on flat or
convex surfaces; they are not recommended for
application on concave surfaces [Chen et al., 1988;
Tjan and Clayton, 1989]. Discs of different diameter
and thickness can be adapted to several clinical
situations. Most disc systems are available in three
or four working steps, permitting a high cutting
efficiency and effective roughness reduction.
For this reason, flexible discs represent the only
technique which can be used both for finishing
and polishing.
There are a great number of polishing techniques
available for composite restorations. Polishing
systems vary with respect to the shape and size
of the individual instruments, and the number of
working steps.
Flexible discs generally yield well smoothened
composite surfaces and permit an effective
reduction of remaining roughness. For this
reason, flexible discs were regarded as some
kind of clinical polishing standard for composite
32
Case courtesy of Dr. Joseph Sabbagh
Rubber polishers are supplied in various sizes
and shapes enabling the application of rubber
polishers to both convex and concave composite
restoration surfaces. Most of the products in this
group are made of rubber-like silicon matrix.
The abrasive particles which are integrated into
the matrix are usually made of silicon carbide or
dioxide, aluminium oxide or diamond particles in
different grain sizes. The way these rubber
polishers are used differs considerably. It varies
from a single-step application to two, three or
four working steps. The polishing efficiency is
dependent on the individual products used.
Many systems achieved a good composite surface
quality, comparable to or even better than flexible
discs [Jung et al., 2003; Jung et al., 2007a]. Other
products caused less favourable polishing results
[Ergücü and Türkün, 2007; Cenci et al., 2008].
The efficiency of one-step vs. multi-step systems
is discussed in the literature [Da Costa et al., 2007;
Jung et al., 2007a].
Polishing brushes represent a different approach
towards minimizing composite roughness. Silicon
carbide abrasive particles are integrated into the
matrix of special synthetic filaments. This enables
a universal application of polishing brushes on
different types of composite surface morphology.
Polishing brushes are one-step systems; their
polishing efficiency is favourable but depends
on the quality of initial finishing [Krejci et al., 1999;
Jung et al., 2007a].
Your practice is our inspiration.™
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Finishing and Polishing
Restorative Procedure
Felt wheels are another one-step polishing system,
with abrasive diamond particles attached to a felt
matrix with wax. Felt wheels can be used on
various types of composite surfaces because of
the soft matrix. Felt wheels must be discarded
after a single use for infection control. The
polishing results depend strongly on the kind of
initial finishing [Jung et al., 1997; Jung et al., 2003;
Scheibe et al., 2009].
Finally, gels are an alternative for polishing
composites. Their application in a single or
few steps is possible on all types of surfaces.
Polishing gels are used on discs, plastic tips or
brushes. A diamond based polishing paste
achieved favourable results on a hybrid composite
[Jung, 2002]. Polishing pastes based on diamond
particles achieved lower roughness compared
to aluminium-oxide gels [Kaplan et al., 1996].
The use of gels as a final polishing step is
recommended [Turssi et al., 2000; Radlanski
and Best, 2007].
33
For rotary instruments there is only limited access
to proximal surfaces. This special situation requires
the use of manual finishing and polishing strips,
although their polishing efficiency seems to be
limited [Whitehead et al., 1990]. Alternatively
diamond-coated oscillating finishing files may be
used in cases with greater amounts of excess
composite material in the proximal-cervical area
of composite restorations. Oscillating diamond
files caused rough areas after application to cervical
margins of composite-inlays. A subsequent use of
polishing paste on plastic files achieved a reduction
of remaining surface roughness [Small et al., 1992].
The choice of an appropriate system for finishing
and polishing of composite restorations depends
on a several factors; there is no universal system
for all clinical indications. The accessibility and
morphology (convex or concave) of surfaces and
the need and extent for initial finishing is of great
importance. Finally the choice of a particular
polishing system should be made based on the
texture and roughness of the surfaces after initial
finishing. The success of one-step polishing
systems is strongly dependent on the surface
roughness after initial finishing. Polishing
systems with two or more working steps are
less sensitive to the kind of initial finishing.
All references are available upon request.
Surface treatment of composite filling
Surface
Roughness
Occlusal / Concave Surfaces
CONTOURING
Adjust primary
geometric form.
Carbide Bur 12 Blades
Diamond 40 µm
Dia: sRa=1.25 µm
Carbide Bur 30 Blades
Diamond 20 µm
Dia: sRa=0.56 µm
FINISHING
Remove composite excesses.
Shape Occlusal anatomy,
lingual fissures,
secondary anatomy.
POLISHING
Eliminate surface scratches.
Reduce surface
roughness below
Ra = 0.35 µm.
Occlubrush and
OptiShine is
universal polishing
tool for all occlusal
and concave
posterior surfaces
Occlubrush
OptiShine
Gloss
GlossP: sRa=0.26 µm
HiLuster
HiLust: sRa=0.10 µm
HIGH GLOSS POLISHING
Reduce surface roughness to
high gloss below
Ra = 0.2 µm.
34
Your practice is our inspiration.™
All you need is Kerr
Finishing and Polishing
Restorative Procedure
Surface
Roughness
Convex / Flat Surfaces
CONTOURING
Adjust primary
geometric form.
Carbide Bur 12 Blades
Diamond 40 µm
OptiDisc Extra-Coarse
Disc: sRa=1.20 µm
Carbide Bur 30 Blades
Diamond 20 µm
OptiDisc Coarse-Medium
Disc: sRa=0.63 µm
FINISHING
Remove composite excess.
Shape Occlusal anatomy,
lingual fissures,
secondary anatomy.
POLISHING
Eliminate surface scratches.
Reduce surface
roughness below
Ra = 0.35 µm.
OptiDisc Fine
OptiShine
Gloss Polisher
Disc: sRa=0.33 µm
HiLuster Polisher
Disc: sRa=0.12 µm
HIGH GLOSS POLISHING
Reduce surface roughness to
high gloss below
Ra = 0.2 µm.
OptiDisc Extra-Fine
35
Surface
Roughness
Interproximal Surfaces
CONTOURING
Adjust primary
geometric form.
Diamond strip not
recommended for
anterior application
Diamond 40 µm
Diamond Strip
Strip: sRa=0.90 µm
Diamond 20 µm
Finishing OptiStrip
Strip: sRa=0.58 µm
FINISHING
Remove composite excesses.
Shape Occlusal anatomy,
lingual fissures,
secondary anatomy.
POLISHING
Eliminate surface scratches.
Reduce surface
roughness below
Ra = 0.35 µm.
OptiDisc can
also be used
interproximally
Polishing OptiStrip
OptiShine
OptiDisc
OShine: sRa=0.25 µm
HiLuster
HiLust: sRa=0.10 µm
HIGH GLOSS POLISHING
Reduce surface roughness to
high gloss below
Ra = 0.2 µm.
36
Your practice is our inspiration.™
All you need is Kerr
Finishing and Polishing
Restorative Procedure
OptiDisc®
The first translucent finishing and polishing disc that is both gentle and more efficient. The flexible discs
are used for finishing and polishing of composites, glass-ionomers, amalgams, semiprecious and precious
metals. The use of the complete system gives the restoration a final polish equal to the natural dentition.
OptiDisc
KERR
Sof-Lex XTTM
3M ESPE
Features
• Unique fixation between disc and mandrel. Optimal torque transmission to disc,
no sliding and no rpm sensitive.
• Optimized disc flexibility. For excellent adaptation to tooth anatomy.
• Translucent discs. Good view of the working area.
• Colour coded stages of abrasivity. Easy recognition of grit size.
• Ready to use abrasive layer. High efficiency. Uncoated cutting edges for high efficiency from the start.
Disc: sRa=1.20 µm
Disc: sRa=0.63 µm
Disc: sRa=0.33 µm
Ø
37
15.9mm
12.6mm
9.6mm
Disc: sRa=0.12 µm
The Mandrel
• Metal mandrel
• Patented mandrel design. Mandrel is placed
below the surface of the disc to avoid
contact with the tooth.
• Special coating of the mandrel. Protection
against metal marking of restoration.
Abrasive coating
OptiDisc Kerr
200 µm
<
>
Extra-Coarse
Coarse-Medium
Fine
OptiDisc can be turned
on the mandrel in order
to have an easy access
of active side on mesial
and distal surface of
the tooth.
Extra-Fine
200 µm
<
>
Coarse
Medium
Sof-Lex XTTM 3M ESPE
Super Fine
Fine
SEM pictures show comparison of abrasive
coating of 2 competitive materials.
Mass removal after each application
of 20 sec. on Point4
SEM pictures courtesy of Dr. Jean-Pierre Salomon, France
0.0160
0.0140
3M Soft-Lex
OptiDisc
Glue
Glue
Abrasive
Polyester
Foil
Mass removal (g)
0.0120
Abrasive
0.0100
0.0080
0.0060
0.0040
0.0020
OptiDisc
TM
Sof-Lex XT
3M ESPE
OptiDisc has a ready to use abrasive layer - uncoated cutting edges for
high efficiency from the start.
38
0.0000
3M Coarse
3M Medium
Hawe Extra coarse Hawe Medium/Coarse
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Fine
Super Fine
All you need is Kerr
Finishing and Polishing
Restorative Procedure
HiLusterPlus Polishing system
2-step polishing system for composites
Features
• High-gloss results in only 2 steps. Smooth surface and high gloss in two steps.
• Efficient. Pre- and gloss polishing in one single step by efficient GlossPLUS polishers,
final roughness after first step around sRa 0.25 µm.
• Diamond particles. Outstanding final result thanks to diamond particles integrated in the HiLusterPLUS
polisher, final roughness around sRa 0.10 µm is achieved after second step.
• Optimum flexibility. The flexibility of the polishers is optimized for excellent adaptation to the tooth
anatomy.
• Good adhesion between the mandrel and the polisher. Avoids detachment of abrasive parts.
• Hygienic. Can be autoclaved at 134 °C.
GlossPLUS Polishers
Flame
Part. No. 2651
Minipoint
Part. No. 2652
Cup
Part. No. 2653
Disc
Part. No. 2654
Material of Polisher:
GlossPlus Polisher:
HiLusterPlus Dia Polisher:
Material of Mandrel:
Aluminium oxide particles embedded into a silicone elastomer.
(mean particle size: 20 microns)
Silicone carbide and diamond particles (5 microns)
embedded into a silicon elastomer.
Golden coated mandrel
HiLusterPLUS Dia Polishers
Flame
Part. No. 2661
Minipoint
Part. No. 2662
Cup
Part. No. 2663
Disc
Part. No. 2664
39
GlossP: sRa=0.26 µm
HiLust: sRa=0.10 µm
Usage on different surfaces
Comparison HiLuster Polishing System and Enhance+PoGo
polishing system used on Herculite XRV Ultra
1: Reference surface
OptiDisc coarse/medium
GlossPlus Polisher
OptiDisc sRa: 0.56 µm
2: Polishing
Flame
Minipoint
Minipoint
Enhance + PoGo
HiLusterPLUS Polishing
system
Enhance sRa: 0.6 µm
GlossPLUS sRa: 0.27 µm
PoGo
HiLusterPLUS
Polishing system
Enhance sRa: 0.32 µm
HiLusterPLUS Dia sRa: 0.14 µm
Cup
2: High Gloss
Polishing
HiLusterPlus Dia Polisher
Enhance is a very aggressive polisher, leaving high surface
roughness. PoGo polisher has the ability to smooth the
surface after Enhance but the final surface roughness
sRa = 0.32 µm is not considered as high gloss surface.
A much smoother and high gloss surface of sRa = 0.14 µm
is achieved with 2-step HiLuster Polishing system.
Flame
40
Minipoint
Minipoint
Cup
Your practice is our inspiration.™
All you need is Kerr
Finishing and Polishing
Restorative Procedure
OptiShine
The first concave-shaped polishing brush
Features
• Efficient in practice. The concave shape of the brush is efficient on all tooth surfaces,
also on less accessible surfaces like interproximal and occlusal fissures.
• Universal use. Always produces excellent polishing results for all restorations due
to the concave shape of the brush.
Reduce the surface roughness without changing the anatomical shape and the micro surface texture.
• Excellent polish. The polishing effect is created by polishing particles embedded in the bristles
(silicone carbide), therefore no paste is necessary.
• Durable for multiple use. Autoclavable at 134 °C, at least 3 min.
No effect on the polishing performance.
Good accessibility
due to concave shape
of OptiShine.
Each bristle
is a polishing
instrument.
Specialfibres with
in-built silicon-carbide
abrasive particles.
Not liable to confusion.
Easily recognisable
by the golden shaft.
OShine: sRa=0.25 µm
Good accesses to the fissures and occlusal surfaces.
41
Herculite XRV References
OptiBond FL References
1.
1.
2.
3.
4.
5.
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7.
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20.
Effect of delivering light in specific narrow bandwidths from 394 to 515nm on the micro-hardness of resin
composites. Price RB, Felix CA. Dent Mater. 2009 Feb 23.
Shear strength evaluation of composite-composite resin associations. Ribeiro JC, Gomes PN, Moysés MR,
Dias SC, Pereira LJ, Ribeiro JG. J Dent. 2008 May;36(5):326-30. Epub 2008 Mar 11.
Polymerization stress of resin composites as a function of system compliance. Gonçalves F, Pfeifer CS,
Meira JB, Ballester RY, Lima RG, Braga RR. Dent Mater. 2008 May;24(5):645-52. Epub 2007 Aug 24.
Cytotoxicity of resin composites as a function of interface area. Franz A, König F, Skolka A, Sperr W, Bauer
P, Lucas T, Watts DC, Schedle A. Dent Mater. 2007 Nov;23(11):1438-46. Epub 2007 Aug 3.
The evaluation of direct composite restorations for the worn mandibular anterior dentition - clinical performance and patient satisfaction. Poyser NJ, Briggs PF, Chana HS, Kelleher MG, Porter RW, Patel MM. J Oral
Rehabil. 2007 May;34(5):361-76.
Surface texture of four nanofilled and one hybrid composite after finishing. Jung M, Sehr K, Klimek J. Oper
Dent. 2007 Jan-Feb;32(1):45-52.
Residual stress in composites with the thin-ring-slitting approach. Park JW, Ferracane JL. J Dent Res. 2006
Oct;85(10):945-9.
Effect of light-curing method on marginal adaptation, microleakage, and microhardness of composite
restorations. Ritter AV, Cavalcante LM, Swift EJ Jr, Thompson JY, Pimenta LA. J Biomed Mater Res B Appl
Biomater. 2006 Aug;78(2):302-11.
The effects of thermocycling on the flexural strength and flexural modulus of modern resin-based filling
materials. Janda R, Roulet JF, Latta M, Rüttermann S. Dent Mater. 2006 Dec;22(12):1103-8. Epub 2006 Jan
10.
A clinical evaluation of posterior composite restorations: 17-year findings. da Rosa Rodolpho PA, Cenci MS,
Donassollo TA, Loguércio AD, Demarco FF. J Dent. 2006 Aug;34(7):427-35. Epub 2005 Nov 28.
Polishing occlusal surfaces of direct Class II composite restorations in vivo. Jung M, Hornung K, Klimek J.
Oper Dent. 2005 Mar-Apr;30(2):139-46.
The survival and clinical performance of resin-based composite restorations used to treat localised anterior
tooth wear. Redman CD, Hemmings KW, Good JA. Br Dent J. 2003 May 24;194(10):566-72; discussion 559.
In vivo comparison of a microfilled and a hybrid minifilled composite resin in Class III restorations: 2-year
follow-up. Reusens B, D'hoore W, Vreven J. Clin Oral Investig. 1999 Jun;3(2):62-9.
Tooth wear treated with direct composite restorations at an increased vertical dimension: results at 30
months. Hemmings KW, Darbar UR, Vaughan S. J Prosthet Dent. 2000 Mar;83(3):287-93.
A 4-year retrospective clinical study of Class I and Class II composite restorations. Geurtsen W, Schoeler U.
J Dent. 1997 May-Jul;25(3-4):229-32.
Stratification of composite restorations: systematic and durable replication of natural aesthetics. Magne P,
Holz J. Pract Periodontics Aesthet Dent. 1996 Jan-Feb;8(1):61-8; quiz 70.
A clinical evaluation of posterior composite resin restorations. Bryant RW, Hodge KL. Aust Dent J. 1994
Apr;39(2):77-81.
Clinical evaluation of a highly wear resistant composite. Dickinson GL, Gerbo LR, Leinfelder KF. Am J Dent.
1993 Apr;6(2):85-7.
Two-year evaluation in vivo and in vitro of Class 2 composites. Fuks AB, Chosack A, Eidelman E. Oper
Dent. 1990 Nov-Dec;15(6):219-23.
Cuspal deformation and fracture resistance of teeth with dentin adhesives and composites. Sheth JJ, Fuller
JL, Jensen ME. J Prosthet Dent. 1988 Nov;60(5):560-9.
2.
3.
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7.
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42
A randomized controlled clinical trial of a HEMA-free all-in-one adhesive in non-carious cervical
lesions at 1 year. Van Landuyt KL, Peumans M, Fieuws S, De Munck J, Cardoso MV, Ermis RB, Lambrechts
P, Van Meerbeek B. J Dent. 2008 Oct;36(10):847-55.
In vitro cytotoxicity of different desensitizers under simulated pulpal flow conditions. Wiegand A, Buchholz
K, Werner C, Attin T. J Adhes Dent. 2008 Jun;10(3):227-32.
Bonding effectiveness and interfacial characterization of a HEMA/TEGDMA-free three-step etch&rinse
adhesive. Mine A, De Munck J, Van Landuyt KL, Poitevin A, Kuboki T, Yoshida Y, Suzuki K, Lambrechts P,
Van Meerbeek B. J Dent. 2008 Oct;36(10):767-73.
Direct dentin bonding technique sensitivity when using air/suction drying steps. Magne P, Mahallati R,
Bazos P, So WS. J Esthet Restor Dent. 2008;20(2):130-8
Micropermeability of current self-etching and etch-and-rinse adhesives bonded to deep dentine: a comparison study using a double-staining/confocal microscopy technique. Sauro S, Pashley DH, Mannocci F, Tay
FR, Pilecki P, Sherriff M, Watson TF. Eur J Oral Sci. 2008 Apr;116(2):184-93.
Marginal integrity: is the clinical performance of bonded restorations predictable in vitro? Frankenberger R,
Krämer N, Lohbauer U, Nikolaenko SA, Reich SM. J Adhes Dent. 2007;9 Suppl 1:107-16. Erratum in: J
Adhes Dent. 2007 Dec;9(6):546.
Bond strength of self-etch adhesives to dentin prepared with three different diamond burs. Ermis RB, De
Munck J, Cardoso MV, Coutinho E, Van Landuyt KL, Poitevin A, Lambrechts P, Van Meerbeek B. Dent
Mater. 2008 Jul;24(7):978-85.
Bonding BisGMA to dentin--a proof of concept for hydrophobic dentin bonding. Tay FR, Pashley DH, Kapur
RR, Carrilho MR, Hur YB, Garrett LV, Tay KC. J Dent Res. 2007 Nov;86(11):1034-9.
Immediate dentin sealing supports delayed restoration placement. Magne P, So WS, Cascione D. J Prosthet
Dent. 2007 Sep;98(3):166-74.
Influence of dentin cavity surface finishing on micro-tensile bond strength of adhesives. Cardoso MV,
Coutinho E, Ermis RB, Poitevin A, Van Landuyt K, De Munck J, Carvalho RC, Van Meerbeek B. Dent Mater.
2008 Apr;24(4):492-501.
Marginal integrity of class V restorations: SEM versus dye penetration. Ernst CP, Galler P, Willershausen B,
Haller B. Dent Mater. 2008 Mar;24(3):319-27.
Bonding to ground versus unground enamel in fluorosed teeth. Ermis RB, De Munck J, Cardoso MV,
Coutinho E, Van Landuyt KL, Poitevin A, Lambrechts P, Van Meerbeek B. Dent Mater. 2007
Oct;23(10):1250-5.
Polymerization kinetics of dental adhesives cured with LED: correlation between extent of conversion and
permeability. Breschi L, Cadenaro M, Antoniolli F, Sauro S, Biasotto M, Prati C, Tay FR, Di Lenarda R. Dent
Mater. 2007 Sep;23(9):1066-72.
Restoring cervical lesions with flexible composites. Peumans M, De Munck J, Van Landuyt KL, Kanumilli P,
Yoshida Y, Inoue S, Lambrechts P, Van Meerbeek B. Dent Mater. 2007 Jun;23(6):749-54.
Effect of water storage on the bonding effectiveness of 6 adhesives to Class I cavity dentin. De Munck J,
Shirai K, Yoshida Y, Inoue S, Van Landuyt K, Lambrechts P, Suzuki K, Shintani H, Van Meerbeek B. Oper
Dent. 2006 Jul-Aug;31(4):456-65.
Immediate dentin sealing of onlay preparations: thickness of pre-cured Dentin Bonding Agent and effect of
surface cleaning. Stavridakis MM, Krejci I, Magne P. Oper Dent. 2005 Nov-Dec;30(6):747-57.
Degree of conversion and permeability of dental adhesives. Cadenaro M, Antoniolli F, Sauro S, Tay FR, Di
Lenarda R, Prati C, Biasotto M, Contardo L, Breschi L. Eur J Oral Sci. 2005 Dec;113(6):525-30.
Self-etch vs etch-and-rinse adhesives: effect of thermo-mechanical fatigue loading on marginal quality of
bonded resin composite restorations. Frankenberger R, Tay FR. Dent Mater. 2005 May;21(5):397-412.
Influence of c-factor and layering technique on microtensile bond strength to dentin. Nikolaenko SA,
Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Frankenberger R. Dent Mater. 2004 Jul;20(6):579-85.
Your practice is our inspiration.™
All you need is Kerr
Authors Biographies
in alphabetic order
Prof. Martin Jung, DDS
Policlinic for Conservative and Preventive Dentistry
Faculty of Dentistry, Justus-Liebig University, Giessen, Germany
[email protected]
Dr. Nick Silikas, BSc, MPhil, PhD, FADM
Lecturer in Dental Biomaterials Science
University of Manchester, UK
[email protected]
Study of Dentistry at the Justus-Liebig-University, Giessen, Germany, 1979-1984.
Approbation for Dentistry, 1984.
Scientific Assistant in the Policlinic for Conservative and Preventive Dentistry at the Faculty
of Dentistry, Justus-Liebig-University in Giessen, Germany, 1985.
Promovation (thesis: “effects of rotary instrumentation on surface of human teeth”) 1989.
Assistant Medical Director in the Policlinic for Conservative and Preventive Dentistry, 1992.
Habilitation (“Finishing and polishing of indirect ceramic- and composite-inlays in-vitro and
in-vivo”) at the Faculty of Dentistry, Justus-Liebig-University, 1999.
Professor for Conservative Dentistry, 2005.
Specialist for Clinical endodontics, 2006.
Main scientific activities: dental materials, surface quality of restorative materials, oral
hygiene products, endodontics.
Dr. Nick Silikas is currently a Lecturer in Dental Biomaterials Science in the School of
Dentistry at The University of Manchester. He was born in Greece but has completed all
his Higher Education studies in Manchester where he obtained a BSc (Hons) in Chemistry,
an MPhil in Pharmacy, and a PhD in Dental Biomaterials.
He is an Editorial Advisor of Dental Materials-Journal for Oral and Craniofacial Biomaterials
Sciences [Elsevier Science]. He is a Fellow of the Academy of Dental Materials (FADM) and
a member of the International Association of Dental Research (IADR).
His research interests lie in surface Imaging & Analysis. His expertises are in characterizing
interfaces using several techniques like Atomic Force Microscopy (AFM), X-ray
Photoelctron Spectroscopy (XPS), FEG-SEM, Fourier Transform Infra-Red Spectroscopy
(FTIR) etc. He is also involved in studying mechanical properties of materials using nanoindentation and traditional mechanical testing (3-point bending, compression, flexure etc.).
Prof. Angelo Putignano, MD, DDS
Professor of Restorative Dentistry, Head of Endodontic and Operative Dentistry Dept.,
Dean School of Dental Hygienist
Polytechnic University of Marche, Ancona, Italy
[email protected]; [email protected]
Prof. David Watts, DSc, PhD, FInstP, FRSC, FADM
Head of Biomaterials/Biomechanics Research Group
University of Manchester, UK
[email protected]
M.D. degree and D.D.S. post graduate certificate from the University of Ancona, Italy.
Full professor in Restorative Dentistry at School of Dentistry Polytechnic University of
Marche, Ancona.
Head of the Operative Dentistry and Endodontic department at School of Dentistry
Polytechnic University of Marche, Ancona.
Dean School of Dental Hygienist Polytechnic University of Marche, Ancona.
Active Member of the Italian Society of Operative Dentistry (SIDOC), as well as of the
European Academy of Esthetic Dentistry (EAED).
Founding Member of the Academy of Minimally Invasive Dentistry (ACAMID).
Private practice in Restorative Dentistry, in Ancona.
Co-author of the book “Adhesive Dentistry: the Key to success” edited by Quintessence
International.
Professor David Watts, PhD leads the internationally-reputed Biomaterials/Biomechanics
Research Group in the University of Manchester, School of Dentistry, investigating basic
hard-tissue structure/properties, biomimetic-composites, new scientific instruments,
photon science and developments with dental/orthopaedic industries. He has successfully
supervised 40 PhD Theses and has 250+ peer-reviewed research papers. Professor Watts
holds Fellowships of the Royal Society of Chemistry, the Institute of Physics and the
Academy of Dental Materials and is also Research Professor at Oregon Health and
Sciences University, USA. He received a Doctorate of Science from the University of
Athens and the 2003 IADR Distinguished Scientist [Souder] Award for research in dental
biomaterials. He became Editor-in-Chief of Dental Materials – Journal for Oral and
Craniofacial Biomaterials Sciences [Elsevier] in 1998. Since 1986 he has served as UK
Principal Expert to International Standards Organization TC 106 (Dentistry), on ceramics,
resin-composites and photo-polymerization.
I wish to thank sincerely our eminent authors, Prof. Martin Jung, Prof. Angelo Putignano,
Dr. Nick Silikas and Prof. David Watts for the valuable support, scientific contribution and
guidance to the realization of the Kerr Restorative Clinical Booklet.
Heartfelt thanks also to the Kerr Innovation and Product Management Teams for the
significant input and collaboration.
Manuela Brusoni
Clinical Affairs Manager Europe
[email protected]
43
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