Physiologic Phenomena










Ch
apte
r 8
Phys iol
og
ic
Phenomena
Jordi
Manauta
Anna
Salat
Interview
with
Serhiy
Radlinsky

'
®®
1 '
. CD
.

Nothing
makes one
·.
;.
: so quickly
as
the
, ,
that
one
Georg Christoph Lichtenberg ·

314
-
Dr Serhiy Radlinsky was born
in
Nemirov, Ukraine, and graduated
with honors
from
the Ukrainian Medical Stomatological Academy
in
Poltava .
After
he
graduated from his postgraduate course, Dr Radlinsky
taught pediatric dentistry. At present,
he
teaches restorative
dentistry
in the Postgraduate Department of the Ukrainian Medical
Stomatological
Academy.
He
heads Apollonia, a private dental
clinic,
studio, and training center in Ukraine and is
editor
of the
dental magazine DentArt. Dr Radlinsky conceived, organized, and
continues to run the
Prisma·Championship project, a series
of
"International Clinical Competitions in the
Art
of Tooth Restoration."
With professional interests focused
on
esthetics and technique
of direct restoration, Dr
Radlinsky is a
member
of the National
Academy of Esthetic Dentistry (Russia),
an
affiliated
member
of
the European Academy of Esthetic Dentistry, Vice President of the
Ukrainian Association of Private Dentists, and an Honored Doctor
of
Tbilisi State Medical University.
He
is
the author of a textbook
and more than
50
clinical and scientific articles
on
restorative
dentistry.

You're Reading a Preview

Become a DentistryKey membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Was this article helpful?

Chapter 8 Phys iologic Phenomena Jordi Manauta • Anna Salat Interview with Serhiy Radlinsky ' ®® 1 ' • . CD . Nothing makes one ·. ;. : so quickly as the , , that one Georg Christoph Lichtenberg · 314 -Dr Serhiy Radlinsky was born in Nemirov, Ukraine, and graduated with honors from the Ukrainian Medical Stomatological Academy in Poltava . After he graduated from his postgraduate course, Dr Radlinsky taught pediatric dentistry. At present, he teaches restorative dentistry in the Postgraduate Department of the Ukrainian Medical Stomatological Academy. He heads Apollonia, a private dental clinic, studio, and training center in Ukraine and is editor of the dental magazine DentArt. Dr Radlinsky conceived, organized, and continues to run the Prisma·Championship project, a series of "International Clinical Competitions in the Art of Tooth Restoration." With professional interests focused on esthetics and technique of direct restoration, Dr Radlinsky is a member of the National Academy of Esthetic Dentistry (Russia), an affiliated member of the European Academy of Esthetic Dentistry, Vice President of the Ukrainian Association of Private Dentists, and an Honored Doctor of Tbilisi State Medical University. He is the author of a textbook and more than 50 clinical and scientific articles on restorative dentistry. Q: For complete integration of esthetic restorations, sometimes physiologic defects of teeth must be repro-duced. In which cases do you think this is the correct approach? A: The terms physiologic defects and even further reproduction of physiologic defects are rather confusing. Any defects are pathologic conditions per se. The term age-related physiologic changes seems to be more appropriate. These changes are only physiologic when there is no interference with tooth integrity or periodontal health (changes in the tooth color, enamel wear, or gingival recession). A dental restoration is a result of cooperation between the dentist and the patient. The patient presents his or her expectations. The dentist, being both a smile designer and a·clinician, presents the range of possible restorative solutions. All patients understandably want to look younger. However, this may contradict the principles of minimal intervention when it comes to dental restorations. When we perform a dental restoration, we need to match the artificial part of the tooth to the natural tissues and so reproduce age-related physiologic changes. Do we need to reproduce the "physiologic defects"? My answer is "Yes, by all means!" I am happy that my patients are not interested in having the teeth from a magazine cover. 315 / 316 Physiologic Phenomena This chapter makes no attempt to classify these phenomena of the teeth. However, we believe that many of these phenomena play a key role in the patient's appearance when they are visible and sometimes must be reproduced in our stratification, if we do not seek to eliminate these defects from all natural teeth. The phenomena shown are those that occur with the "use" of the teeth, at a physiologic level. These include wear, abrasion, attrition, erosion, and pigmentation: • Wear: Loss of tooth substance as a result of friction against another dental element. • Abrasion: Loss of tooth substance as a result of friction against a foreign oral element. • Attrition: Microdetachment of tooth substance as a result of flexion and compression of the teeth. • Erosion: Loss of tooth substance as a result of chemical action, from either the inside or outside of the organism. • P igmentation: Accumulation of chromatic substances as a result of any of these phenomena or aging. Reasons for reproduction of age-related Materials required: changes: •To match the remaining natural teeth •To attain a thorough understanding of color and stratification • For artistic reasons (costumes, movies, theater) • Opaque composite dentin (A2D Filtek Supreme, 3M) • Natural Opalescent composite (HFO enamel OBN, Micerium) • Dark brown, brown, and orange stains (brown, ocher, and orange; Chromazone, Kuraray) • Mixing palette with light protection (Compo Cubo, Smile Line) _I Delicate mixing will generate two indispensable colors, opaque orange and opalescent brown. More colors can be generated depending on the case, although these two colors will suffice for the majority of cases. • e Q 0 .. To create opaque orange, ocher and orange are mixed with the A2D den-tin. A mixture of brown stain and OBN opalescent is used for the opalescent brown. Composite resin storage Mixtures should turn out homogenous and must be very well protected from light. The shelf-life of the mixes is lim-ited. Usually they will last 2 weeks, at most, if stored in ideal conditions. Several solutions are available for composite resin storage. The most important thing is to prevent light exposure. The solution we normally recommend consists of black compartments, preferably with different functions, to isolate composite completely from light (Compo Cubo). White trays do not protect composites correctly, even with black covers. Tray for primer/bonding, modeling liquid, and a brush dryer. Mixing tray. Stains tray. All of our composites correctly stored. 317 JI 318 Cervical defects: Attrition, Abrasion , and P igmentation After the palatal enamel is layered, a small dentin increment is placed and polymerized to act as a base for the "pigmented pulp," which is constructed with a brown opales-cent mass. This base is covered with a highly chromatic dentin composite (A5). This dark feature is efficiently masked by just a subtle layer of dentin. These features are clinically dif-ficult to apply; these defects are reproduced as an exercise to learn the color properties of the teeth and for other reasons previously mentioned. By following the layering technique correctly, we can easily create a cervical defect with a diamond disk. This milling will uncover the deep chromatic layers and achieve the color effects we are seeking. The remaining dentinal body is finished with the chosen base col-or. The previously layered internal characterizations will be uncov-ered afterward. L-/ I Natural opalescent is layered in the free space left in the incisal and proximal areas. ',,, .... The final enamel layer must be smooth and as close as possible to the final desired shape. Still during the finishing stage, a sharp diamond laboratory disk is used to cut a wedge out of the cer-vical area. The finishing stage defines the pri-mary and secondary anatomy. The remaining debris is removed during the polishing stage. 319 Cervical Defects: Erosion and Pigmentation 320 Hybrid composite resin masses mixed with brown (lOa) and orange (lOb) stains. The exercise is started from a completely strati-fied tooth (1). A rounded diamond bur is used to create a cervical defect (2), and the resulting de-bris is removed with mod-eling liquid and air (3). When the cavity is ready, a small increment of opaque orange (lOb) is placed ( 4 ). After polymerization, more opaque orange is placed obliquely toward the incisal region (5). Then transparent brown (lOa) is placed from incisal to cervical (6). The opalescent brown (lOa) can be placed in one or two layers (7). The defect margins can be covered slightly with the same enamel as the facial wall (8). The finishing and polishing should leave the defect especially glossy (9). This exercise is started from a completely strati-fied tooth (11 ). A rounded diamond bur is used to create a cervical defect (12), and the resulting de-bris is removed with mod-eling liquid and air (13). To create a decalcified enamel area, a milky ef-fect is layered (14). Some blue opalescent is layered on the cervical wall of the cavity to reproduce scle-rotic dentin (15). Opaque orange (20b) is placed obliquely from cervical to incisal (16). Opalescent brown (20a) is placed in an incisal to cer-vical direction (17). The finishing stage (18) and polishing stage are com-pleted, leaving the defect especially smooth (19). Cervical Defects: Erosion, Pigmentation, and Incipient Caries Hybrid composite resin masses mixed with brown (20a) and orange (20b) stains. 321 Worn lncisal Edge Stratification A dentin core of the de-The palatal wall is creat-sired color is obtained. ed with a medium-Value enamel. Corrections can be made Debris produced during to obtain a thinner and correction is removed more precise structure. with modeling liquid and air. A chromatic dentin (A6) is placed, and a groove is modeled in the center. 322 A dark brown stain is placed to fill the groove. While the remaining walls are built, the dentin core should be surrounded by the incisal enamel. A small increment of nat-ural opalescent is applied as a thin internal screen. The incisal edge is filled with the modified opaque orange dentin. The walls can be increased more if necessary. This layer is important because it will provide a transparent halo effect and will act as a light de-flector. • Modified opaque dentin masses play an impor-tant role in increasing the chromaticity of the ex-posed dentin. The effect is highly dynamic when the tooth is illuminated frontally (12a) or from different angles (12b). The buccal aspect of the incisal edge is shown (13a). When opalescent masses are used as a "screen," the chromatic masses placed in the inside are not revealed through the buccal enam-el composite (13b). The palatal view o.f the in-cisal edge shows a correct morphology and natural-looking defect (14a), but the strong color is not evi-dent through the enamel composite (14b). 323 The first step to de-velop an erosion de-fect is to obtain a molar using the usu-al stratification tech-nique. After the milling de-bris is removed, if stratification was car-ried out correctly, the erosion effects should be subtle and suffi-cient. 32'\ Erosion Typically, the first signs of dental erosion by intracorporeal chemi-cals (acid reflux or chronic vomiting) are small depressions in the cusp tips of the mandibular molars. Paradoxically, the most mineralized structures are located in this area; mineralized dental substances are more susceptible to acid attack. Dentin is three times more acid resistant than the enamel. A rounded diamond bur is used to pre-pare a cavity of ap-proximately 1.5-mm depth on the tip of every cusp. If a stronger effect is needed, a small amount of opaque orange dentin can be layered inside the cavity. Pigmentation Natural teeth acquire pigments and are infiltrated by stains while aging; substance loss can contribute to this phenomenon. This pigmentation usually occurs at the cervical region, at the incisal edge, and less frequently in some areas of the buccal surface. From a conventional stratifica· tion, an aged tooth with some of its typical features is ere· ated. A brown modified opalescent is placed on the incisal edge, and some soft white intensives are placed around it. The fissure is closed with the remaining facial enamel. Once the composite is polymerized, the modified opalescent brown will be placed in the cervical area. While the final enamel layer is modeled, a brown fissure will be developed with a dark brown stain. A high-gloss polish must be achieved. The absence of tex· tures and incisal irregular· ity are important to replicate aged teeth. 325 326 Conclusions The ability to analyze the natural dentition is fundamental to reproducing its most intimate features. Modification of hybrid composite resins with stains opens a huge potential for esthetic integration of restorations. 3. With the existing materials stains should not be used to paint; instead they must be integrated in the restoration structure. Reproduction of small defects can ensure complete integration of a restoration and prevent overtreatment. 5. Stratification of dental defects is the best training to increase understanding of color and layering. 327

Related Articles

Leave A Comment?