Surface and Polishing










L-/
Ch
apte
r 10
Surface and
Po
li
sh
in
g
JDrdi
Manauta
Anna
Salat
Interview
with
Ricardo
Mitrani
11
I

''
don't
know
whe
e
the
is
but
I
where
1 is not.
''
Josef
Ajram

352
After completing his degree in
dentistry
from the Technical
University of Mexico, Dr Ricardo Mitrani received a certificate in
prosthodontics
as
well
as
a master's degree from the University of
Washington,
in
Seattle, where
he
served
as
the assistant director of
the graduate prosthodontics programs in 2001.
He
currently holds academic affiliations
at
the University of
Washington, the University of Valencia (Spain), and the National
Autonomous University of Mexico.
He
is a member of the
American College of Prosthodontists, American Academy of Fixed
Prosthodontics, and International College
of
Dentists.
He
also
serves
on
the editorial board of Practical Procedures & Aesthetic
Dentistry
in
the lmplantology section.
Dr Mitrani has authored numerous scientific publications
in
the
fields of implant prosthodontics and esthetic
dentistry
and has
lectured nationally and internationally.
He
maintains a private
practice limited to prosthodontics and implants
in
Mexico City.

Q:
What
is
the importance of surface
and
polishing
in
the correct integration of
an
esthetic restoration?
A:
To
strive for predictable success
when
dealing
with
esth'etic restorations, the clinician (or clinician-
technician team
in
the
case
of indirect restorations)
must
be
able to momentarily isolate the different
dimensions of esthetics in order to
ultimately integrate
them.
Undoubtedly contour and color represent the paramount
dimensions for such
an
endeavor (along with optical
properties such
as
fluorescence, opalescence, and
translucency);
however,
surface texture and luster
could ultimately become the difference between a "nice
restoration" and
an
"inconspicuous restoration."
.
This
is
particularly critical when
we
are
restoring a
single central incisor, regardless of the nature of the
design and materials of the restoration (composite
or
ceramic laminate
veneer,
complete-coverage crown, or
an
implant-supported restoration).
Once
the color
is
matched and the contour
is
mirrored, surface texture
and
luster become the "fingerprint" of the restoration.
I believe that surface texture and luster should
be
regarded
as
the "trademark" of the restoration; they
represent the proprietary irregularities that contribute
to inconspicuous results, not
only because they may
influence the optical properties (light reflection) of the
restorations but
also because they provide a sense of
continuity in the arrangeme.nt of the anterior dentition.
353

-
..
:351
We
always look for excellence
in
color matching and stratification accuracy,
generally spending all of our
time
on
these. With regard to integration with
the
natural dentition, if
we
had to arrange all the factors
to
consider in a
restoration in
their
order of importance, the result probably would
be
the
following:
1.
Shape
2. Opacity/translucency
3. Chroma
4. Surface
5.
Value (only enamel)
6. Intensives (when present)
7.
Characterizations
8.
Opalescence
9. Hue
Despite this very
generalized list,
we
cannot overemphasize that every
property of the tooth affects the
final result. There are innumerable texts
that
classify these properties in a different way;
we
do not want
to
contradict
anyone but rather express the
fruit
of our experience.
A restoration with correct shape and surface texture
is
most likely to achieve
successful integration with the natural dentition,
even
with small color
disparities.
The
surface treatment techniques proposed here are mainly focused
on
the finishing stages with abrasive materials. This is the secret to obtaining
glossy restorations;
it
would
be
impossible
to
polish a material that has not
been
successfully shaped.
.

Suggested Armamentarium
·Burs:
Periocare diamond
bur
831-524
(Dentacare)
•Disks:
OptiDisc (Kerr)
Rubber: OneGloss Set (Shofu)
·Brush:
Goat-hair brush
(Micerium)
Felt: Felt wheel
(Micerium)
Pastes: Shiny A (Micerium), Shiny B (Micerium), Shiny C
(Micerium)
Bur: A 75-µm flame-shaped diamond bur is used, at low speed
(10,000
rpm), to
carry
out
90%
of
finishing work, including definition
of shape and
primary
and secondary anatomy.
Disks: Disks are used to define proximal areas and transition angles,
in the areas where the
bur
is not able to reach. These
instruments
also are probably the
most
comfortable and accurate
for
defining
the incisal and proximal shapes. Four
grits
are available: coarse,
medium, fine, and superfine.
We
recommend the medium
grit
for
removing excess and the fine
grit
for subtle modifications.
Rubber tips: These are used to eliminate the grooves
that
the
bur
and the disk
leave.
They have two main functions: When they are
used firmly, a smooth abrasion results on the composite surface,
and when they are used delicately, they are able to prepolish. The
finishing stage is improved with this kind of instrument. The correct
speeds are
10,000
rpm
for
finishing and
5,000
rpm
for polishing.
Brush and paste: When a goat-hair brush rotary
instrument
is
combined with
3-
and 1-µm diamond pastes for the initial shine stage,
the result is a high gloss. The hardness of the brush
permits
the
surface to
be
polished at high speed and deep zones to
be
polished
at
low speed. These brushes generate significant heat; they can
be
used
at
1,000
rpm
with a gentle touch and
without
water and
at
10,000
rpm
under abundant water spray.
Felt and paste: A felt wheel, which is a very soft material, is used with
a 1-µm
aluminum
oxide paste to achieve a very high gloss. These
wheels generate significant heat. They can
be
used at
1,000
rpm with
a gentle touch and
without
water and at
20,000
rpm under abundant
water spray.

Finishing and polishing appliances and
their
alternatives
Q)
>
VI
C'O
....
.c
C'O
....
VI
0
2:
---
Periocare (De ntacare): Bur coated with 75-µm medi-
um-grit
diamond abrasive particles (831 -
524)
.
S
of
-Lex
Pop-on
(3M):
Vinyl disks coated with alumi-
num oxide abrasive particles.
J
OneG loss (Shofu): Silicon polishers with
aluminum
oxide abrasive
particle
s
on
removable stainless steel
mandrels.
356
0
OptiDisc (Kerr): Polyester disks coated with
aluminum
oxide abrasive particles.
Swissflex disks (Diatec): Vinyl double-sided disks coat-
ed
with
aluminum
oxide abrasive particles.
ldentoflex (Kerr): Rubber polishers with diamond abra-
sive particles
on
stainless steel fixed mandrels.

Brownie (Shofu): Synthetic rubber polisher with silicon
carbide abrasive particles.
OptilStep
(Kerr): Synthetic extrahard
rubber
di sks
with
diamond
and
aluminum
oxide abrasive parti-
cles.
Dia-Finish (Renfert): Diamond -im-
pregnated hard
felt
polisher.
Opticlean
(Kerr): Silicon
matrix
polisher
with extrafine
aluminum
oxide abrasive
particles.
Astrobrush (lvoclar): Poly-
amide polisher
with
silicon
carbide abrasive particles.
Shiny G (Micerium): Natural goat-hair brush.
Shiny
F (Micerium): Soft felt disk.
Cerium
(IV) oxide (Generic).
°'
(/)
ro
,,_
..c
ro
-
(/)
ro
°'
...J
357

358

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L-/ Chapter 10 Surface and Polishing JDrdi Manauta • Anna Salat Interview with Ricardo Mitrani 11 I '' don't know whe e the is but I where 1 is not. '' Josef Ajram 352 After completing his degree in dentistry from the Technical University of Mexico, Dr Ricardo Mitrani received a certificate in prosthodontics as well as a master's degree from the University of Washington, in Seattle, where he served as the assistant director of the graduate prosthodontics programs in 2001. He currently holds academic affiliations at the University of Washington, the University of Valencia (Spain), and the National Autonomous University of Mexico. He is a member of the American College of Prosthodontists, American Academy of Fixed Prosthodontics, and International College of Dentists. He also serves on the editorial board of Practical Procedures & Aesthetic Dentistry in the lmplantology section. Dr Mitrani has authored numerous scientific publications in the fields of implant prosthodontics and esthetic dentistry and has lectured nationally and internationally. He maintains a private practice limited to prosthodontics and implants in Mexico City. Q: What is the importance of surface and polishing in the correct integration of an esthetic restoration? A: To strive for predictable success when dealing with esth'etic restorations, the clinician (or clinician-technician team in the case of indirect restorations) must be able to momentarily isolate the different dimensions of esthetics in order to ultimately integrate them. Undoubtedly contour and color represent the paramount dimensions for such an endeavor (along with optical properties such as fluorescence, opalescence, and translucency); however, surface texture and luster could ultimately become the difference between a "nice restoration" and an "inconspicuous restoration." . This is particularly critical when we are restoring a single central incisor, regardless of the nature of the design and materials of the restoration (composite or ceramic laminate veneer, complete-coverage crown, or an implant-supported restoration). Once the color is matched and the contour is mirrored, surface texture and luster become the "fingerprint" of the restoration. I believe that surface texture and luster should be regarded as the "trademark" of the restoration; they represent the proprietary irregularities that contribute to inconspicuous results, not only because they may influence the optical properties (light reflection) of the restorations but also because they provide a sense of continuity in the arrangeme.nt of the anterior dentition. 353 '· -.. :351 We always look for excellence in color matching and stratification accuracy, generally spending all of our time on these. With regard to integration with the natural dentition, if we had to arrange all the factors to consider in a restoration in their order of importance, the result probably would be the following: 1. Shape 2. Opacity/translucency 3. Chroma 4. Surface 5. Value (only enamel) 6. Intensives (when present) 7. Characterizations 8. Opalescence 9. Hue Despite this very generalized list, we cannot overemphasize that every property of the tooth affects the final result. There are innumerable texts that classify these properties in a different way; we do not want to contradict anyone but rather express the fruit of our experience. A restoration with correct shape and surface texture is most likely to achieve successful integration with the natural dentition, even with small color disparities. The surface treatment techniques proposed here are mainly focused on the finishing stages with abrasive materials. This is the secret to obtaining glossy restorations; it would be impossible to polish a material that has not been successfully shaped. -· . Suggested Armamentarium ·Burs: Periocare diamond bur 831-524 (Dentacare) •Disks: OptiDisc (Kerr) • Rubber: OneGloss Set (Shofu) ·Brush: Goat-hair brush (Micerium) • Felt: Felt wheel (Micerium) • Pastes: Shiny A (Micerium), Shiny B (Micerium), Shiny C (Micerium) Bur: A 75-µm flame-shaped diamond bur is used, at low speed (10,000 rpm), to carry out 90% of finishing work, including definition of shape and primary and secondary anatomy. Disks: Disks are used to define proximal areas and transition angles, in the areas where the bur is not able to reach. These instruments also are probably the most comfortable and accurate for defining the incisal and proximal shapes. Four grits are available: coarse, medium, fine, and superfine. We recommend the medium grit for removing excess and the fine grit for subtle modifications. Rubber tips: These are used to eliminate the grooves that the bur and the disk leave. They have two main functions: When they are used firmly, a smooth abrasion results on the composite surface, and when they are used delicately, they are able to prepolish. The finishing stage is improved with this kind of instrument. The correct speeds are 10,000 rpm for finishing and 5,000 rpm for polishing. Brush and paste: When a goat-hair brush rotary instrument is combined with 3-and 1-µm diamond pastes for the initial shine stage, the result is a high gloss. The hardness of the brush permits the surface to be polished at high speed and deep zones to be polished at low speed. These brushes generate significant heat; they can be used at 1,000 rpm with a gentle touch and without water and at 10,000 rpm under abundant water spray. Felt and paste: A felt wheel, which is a very soft material, is used with a 1-µm aluminum oxide paste to achieve a very high gloss. These wheels generate significant heat. They can be used at 1,000 rpm with a gentle touch and without water and at 20,000 rpm under abundant water spray. Finishing and polishing appliances and their alternatives Q) > VI C'O .... .c C'O .... VI 0 2: ---Periocare (De ntacare): Bur coated with 75-µm medi-um-grit diamond abrasive particles (831 -524) . Sof-Lex Pop-on (3M): Vinyl disks coated with alumi-num oxide abrasive particles. J OneG loss (Shofu): Silicon polishers with aluminum oxide abrasive particles on removable stainless steel mandrels. 356 0 OptiDisc (Kerr): Polyester disks coated with aluminum oxide abrasive particles. • Swissflex disks (Diatec): Vinyl double-sided disks coat-ed with aluminum oxide abrasive particles. ldentoflex (Kerr): Rubber polishers with diamond abra-sive particles on stainless steel fixed mandrels. Brownie (Shofu): Synthetic rubber polisher with silicon carbide abrasive particles. OptilStep (Kerr): Synthetic extrahard rubber di sks with diamond and aluminum oxide abrasive parti-cles. Dia-Finish (Renfert): Diamond -im-pregnated hard felt polisher. Opticlean (Kerr): Silicon matrix polisher with extrafine aluminum oxide abrasive particles. Astrobrush (lvoclar): Poly-amide polisher with silicon carbide abrasive particles. Shiny G (Micerium): Natural goat-hair brush. Shiny F (Micerium): Soft felt disk. Cerium (IV) oxide (Generic). °' (/) ro ,,_ ..c ro -(/) ro °' ...J 357 358 Tooth morphology (1) Outline: The tooth's physical limit is responsible for determining the global tooth shape and is closely related to the primary anatomy. (2) Primary anatomy: The anatomical crown shape given by the transition angles determines the curvature and the fine tooth shape. (3) Secondary anatomy: This is the macrosurface, a consequence of tooth development. Growth lobes become evident on the surface as large, undulating areas that cover the entire enamel. This is also known as vertical texture, but the wide horizontal texture also involve the secondary anatomy. (4) Tertiary anatomy: This is the microsurface, where the developmental grooves become evident as small lines that cross the buccal surface horizontally. It is known as horizontal texture as well. 359 Ovoid tooth Properties: • Rounded ridges ·Rounded proximal areas • Straight/oval cervix • Short appearance • Strong texture • Rounded, uneven incisal edge • Rounded angles Associated with: • Young teeth • Feminine t eeth • Nonworn teeth ·Textured teeth Ceramist: Alberto Villanueva, Zaragoza, Spain. 360 Rectangular tooth Properties: • Parallel ridges • Parallel proximal areas • Straight cervi x • Short appearance • Soft texture • Flat incisal edge • Straight angles Associated with: • Older teeth • Masc ulirre teeth · Worn teeth •Slight texture Ceramist: Alberto Villanueva, Zaragoza, Spain. 362 \ Triangular tooth Properties: • Converging ridges • Converging proximal areas • Rounded cervix • Long appearance • Soft and smooth texture • Flat incisal edge • Straight and rounded angles Related to: • Adult teeth • Feminine·teeth • Large teeth • Gingival loss Ceramist: Alberto Villanueva, Zaragoza, Spain . 364 Basic Polishing Procedures Fini shing and polishing a restoration is undoubt-edly the secret for successful integration and longevity. Fortunately composite materials per-mit "reinterventions," not only regarding color and layers but for surface texture as well. One of the most difficult tasks related to polish-ing is to obtain a regular and smooth surface. We have found that having a huge variety of pol -ishing instruments is not the secret to obtaining glossy restorations; paradoxically the secret is a comprehensive and accurate finishing stage, that is, the "rough" stage. A white composite tooth with a nonideal surface has been cre -ated for didactic purposes. The finishing phase will begin after complete polymerization. A regular and smooth surface is obtained with only the use of the diamond bur. As expected, the surface is not shiny yet, but it is meticulously even. Once the desired preliminary surface is achieved, abrasive rubber points are used to eliminate the grooves result-ing from the diamond bur and abrasive disks and to obtain an initial shine. 366 A 3-µm diamond paste is em-ployed with a natural goat-hair . brush used at 1,000 rpm with no water and at 10,000 rpm with abundant water. A high gloss should be noticeable after this step. Prophylaxis brushes are not suitable for this task. A 1-µm diamond paste is em-ployed with a natural goat-hair brush used at 1,000 rpm with no water and at 10,000 rpm with abundant water. If no high gloss is evident after complete removal of the paste, we must return to the abrasive rubber points. To emphasize the tooth surface and what we have achieved, the tooth has been coated with silver powder to make surface texture evident. In this case, a flat tooth was created. A 1-µm aluminum oxide paste is employed with a felt wheel used at 1,000 rpm with no wa-ter and at 20,000 to 30,000 rpm with abundant water. An extremely high gloss should be evident after th is step. If it is not, we must return to previous stages. The result is plainly evident: a perfectly polished composite restoration that will resist the passage of time and the hos-tile oral environment more ef-fectively. 367 368 b.O c: ..c: (/) c: ..... Advanced pol is hi ng step by step A white composite tooth with a nonideal surface has been created for di-dactic purposes. The fin-ishing phase will begin after complete polymer-ization. The transition angles are contoured, preferably with a diamond bur when proximal areas are eas-ily accessible. If proximal areas are not accessible, disks and polishing strips should be used. The critical phase con-sists of smoothing the surface until an even sur-face is achieved. This is al-ways accomplished with a 75-µm diamond bur used ,at 10,000 rpm. Disks are useful for proximal areas. Contouring of the incisal edge is imperative. Once the precise shape is drawn with a pencil, the contour-ing is accomplished with the bur and disks. At this point, transition angles are drawn. Their direction and curvature depends on the desired shape. The incisal edge is shaped with the abrasive disks and the diamond bur. Low speed and delicate move-ments are necessary for high precision. b.O c: (/) (/) 0 The next step is to start reproducing the second-ary anatomy, in this case the division of the lobes. A rubber point can be used to smooth the rough texture left by the bur. After the pencil is erased the restoration must have the desired look, or the next steps should not be undertaken. The. lobes can be divided with a fine disk or a modi -fied bur (page 298). The same rubber point is used to give an initial gloss to the restoration. The restoration is pol -ished with 3-µm diamond paste applied with a natu-ral goat-hair brush used at 1,000 and 10,000 rpm. The secondary anatomy is drawn with a pencil. The grooves and depressions of the lobes are shown. A pencil is used to draw some developmen-tal grooves: parallel, nar-row, and winding. The restoration is pol -ished with 1-µm diamond paste applied with a natu-ral goat-hair brush used at 1,000 and 10,000 rpm. It is possible to generate grooves with the diamond bur, moved gently from mesial to distal. The pencil lines are re-produced, one by one, with the bur tip, which is moved carefully, following the same horizontal path. The restoration is pol-ished with 1-µm alumi-num oxide paste applied with a felt wheel used at 1,000 and 10,000 rpm. 369 370 The final appearance shows the high gloss we can achieve with hybrid composite resin, presumed by many authors to be "not poli.shable." It is said that hybrid composite resins are difficult to polish and maintain. The clinical reality is that it is possible to obtain ideal surfaces with such materials, and , because of their composition, they provide optimal stability over time. It is true that a hybrid composite requires more time and attention during polishing stages. It is not easy to obtain a high gloss, but, once a high gloss is obtained, hybrid materials have been shown to be more stable than microfilled and nanofilled composites. Silver powder evidences the anatomy, surface, curvatures, and subtle textures. The natural appearance of a restoration is largely determined by the surface morphology. The way in which light interacts with a smooth surface is completely different from the way in which it interacts with a texturized surface. A smooth surface will let light pass through easily, while a textured surface will create more reflections, therefore significantly influencing the color appearance of the tooth . The manufacturer does not recomend the intraoral use of this powder. 371 372 Polishing and color Immediately after stratification, a tooth may seem correct at first glance. However, the last layer, which is in contact with oxygen , is not completely polymerized until it has been polished; therefore, polishing is mandatory. The importance of the finishing steps with abrasive materials, in this case applied with a diamond bur used at low speed, cannot be overemphasized . Only after we have obtained an ideal preliminary surface can we start thinking about further specific details. The secondary anatomy is es-tablished, in the form of ver-tical grooves. They are made with gentle, balanced move-ments from mesial to distal to create a true depression and to avoid creation of a notch. After the secondary anatomy is created, the bur marks must be erased with an abrasive rubber point, which is applied gently to erase the marks effi-ciently and give an initial gloss. Vertical grooves can be as long as needed and can be made bit by bit. Horizontal anatomy also can be shaped at this time. There is an alternative way to produce the tertiary anatomy. A coarse diamond bur is passed manually (with the fingers) in a horizontal direction, scratching the surface. This process will leave beautiful microgrooves. 373 L 371 Goat-hair brush + 3-µm diamond Goat-hair brush + 1-µm diamond The next step is to the carry out progressive polishing with polish (ng pastes. This technique allows the achieve-ment of a high polish without the risk of ruining the previously developed microtexture, as frequently hap-pens if rotary abrasive materials, such as fine disks, are used. In other words, after reproduction of surface texture, it is not ideal to use abrasive devices. Felt wheel + 1-µm aluminum oxide The initial situation shows a fake gloss that corresponds to the oxygen-inhibited layer; the raw composite resin on the surface degrades extremely fast. After polishing, the restoration shows a high gloss and a natural texture. Volume loss from mechanical finishing and polishing should be minimal. Silver powder highlights the surface and texture, which play a fundamental role in the integration of the restoration. 375 A stone cast ready to receive the esthetic wax-up. It is important to have a well -trimmed and well· presented type 4 stone prepared. Diagnostic Wax-up As a Tool for Morphology and Layering 376 The first layer, which corresponds to the internal dentinal body, con-sists of an opaque chromatic wax (Creation Wax Set, Yeti Dental). This layer, which establishes primary morphology, is applied at high tern· perature with an electric spatula (120°C). The second layer establishes the shape of the dentinal mamelons with a lighter dentin material. In the cervical area , a high-Chroma cervi· cal wax will be placed at 120°C. / / Wax-up: Luis Alberto Villanueva, Zaragoza, Spain. 377 -· 375 Surface dentin with amber and white (characterization 1) provides color to the mamelons. This is done at low temperature (108°C). A highly transparent wax (clear enamel wax) between mamelons and an incisal edge portion (opalescence 2) are incorporated at low tempera-ture (108°C). Medium-Value enamel is placed at a very low temperature (98°C) so it melts delicately with the underlying dentin. Once cooled, the wax-up is contoured with a sharp, hard spatula (Nystrom 11, LM Dental). Proximal areas are defined with a No. 11 scalpel. The initial gloss is obtained with a toothbrush and wax lubricant (Microfilm, Kerr). For the high gloss, a dry microfiber cloth is passed over the surface. l I, .. I Wax-up: Luis Alberto Villanueva, Zaragoza, Spain. 379 Wax-up: Luis Alberto Villanueva, Zaragoza, Spain: 380 Esthetic Wax-up "Mimicking the tooth's natural morphology and internal characterization is challenging. It becomes even more difficult when color is added to the equation. An accu-rate esthetic wax-up not only serves as a diagnostic tool, but it can also be used to inform and even impress the patient." Tyler P. Lasseigne "Once you master wax-ups, working on any other mate-rial becomes an achievable craft." Luis Alberto Villanueva "Diagnostic wax-up is, at the same time, the beginning and the end of a successful treatment." Daniele Rondoni "Wax figures sometimes speak." Jordi Manauta 381 382 Conclus ions 1. The final appearance of a restoration is directly affected by its shape and surface. 2. Instrument -selection is related to a simple protocol. The fewer instruments used, the easier it is to master and improve the polishing technique. 3. Progressive polishing is the key to avoiding damage to the restoration's texture and surface characteristics. 4. The use of polishers, brushes, and pastes without an excellent finishing stage is useless, and the surface is condemned to failure. In the majority of cases, the finishing and polishing protocol is carried out in exactly the same order. 383

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