Dental Materials - Finishing and Polishing

**[PURPOSE OF FINISHING AND POLISHING]** - **Purpose of Finishing and Polishing Composite Restorations:** - Create a smooth, uniform surface. - Make the restoration easily cleaned by the patient. - Improve the longevity of the restoration. - Decrease the risk of recurr...

**[PURPOSE OF FINISHING AND POLISHING]** - **Purpose of Finishing and Polishing Composite Restorations:** - Create a smooth, uniform surface. - Make the restoration easily cleaned by the patient. - Improve the longevity of the restoration. - Decrease the risk of recurrent caries. - Promote the health of surrounding tissues. - **Frequency of Polishing vs. Refinishing:** - Composite restorations are typically polished rather than refinished. - Polishing may be needed occasionally, while refinishing is less frequent. A. **Advantages of Finishing and Polishing** - Smooth undetectable margins - Plaque-resistant surface - Healthier gingival tissues - Increased longevity - Enhanced esthetics - Proper contours B. **Methods by Which These Benefits Are Achieved** - **Proper smoothing and polishing** of composite restorations enhance their longevity and function by ensuring smooth cavosurface margins, restoring functional anatomy, and creating a void-free surface that mimics the high gloss of enamel. II. **[EVALUATION OF COMPOSITE RESTORATIONS]** - **Composite restorations** can be finished and polished immediately after placement, unlike amalgam restorations. - **Improper placement** or **incomplete finishing** increases the risk of issues like recurrent caries, plaque buildup, periodontal disease, and restoration failure. - Composite restorations are evaluated during dental exams, and some may require **finishing, polishing, repair, or replacement**. A. INDICATIONS FOR FINISHING AND POLISHING 1. Overextension or flash 2. Premature occlusal contact 3. Overhang 4. Limited stain 5. Limited recontouring of anatomy 6. Small chips or defects B. INDICATIONS FOR REPAIR OR REPLACEMENT 1\. Gross overextension or overhang 2\. Open margin 3\. Fracture 4\. Extensive stain 5\. Recurrent caries 6\. Open proximal contact 7\. Larger defects III. **[FINISHING AND POLISHING CONSIDERATIONS]** - **Finishing and polishing composite restorations** can be seen as two separate procedures or steps in one process. - **Finishing** corrects contours and smooths margins and irregularities. - **Polishing** aims to create a smooth, lustrous finish. - A variety of **products** are available for finishing and polishing, including burs, strips, disks, pastes, and brushes. - The process follows a **coarse to fine abrasive progression**, similar to other materials. - **Heat generation** during finishing and polishing must be controlled to avoid pulpal irritation. 1. Use a **slow-speed handpiece**, **water as coolant**, and **intermittent strokes** to prevent excessive heat. - **Isolation** of the tooth with cotton rolls, dry angles, or a rubber dam is essential to prevent damage to adjacent teeth or soft tissues. IV. **[PROCEDURE FOR COMPOSITE FINISHING AND POLISHING]** 1. EVALUATE RESTORATION 2. **Dry the restored tooth** with a light stream of air from the air-water syringe for better visibility of the composite restoration. 3. Visually **inspect the contours** for proper anatomical form, chips, voids, stains, or defects. 4. **Evaluate occlusal contacts** using articulating paper. 5. **Examine margins** gently with an explorer to check for imperfections. 6. **Check proximal surfaces** with an explorer. 7. **Confirm proper contacts and gingival margins** using dental floss. 2. DISCUSS PROCEDURE WITH PATIENT - **Rationale for Composite Finishing and Polishing**: The goal is to create a smooth, uniform, and aesthetic restoration that mimics natural enamel and is easily cleaned by the patient, enhancing longevity and reducing risks like recurrent caries or plaque retention. - **Review the Procedure with the Patient**: Explain the steps involved in finishing and polishing, including smoothing contours, refining margins, and creating a glossy, enamel-like finish. - **Inform the Patient About Sensations**: Let the patient know they may experience vibrations, mild discomfort, or a warming sensation during the process, particularly when using finishing burs with a low-speed handpiece. 3. GATHER NECESSARY EQUIPMENT - Select instruments based on the restoration and the clinician's preference ARMAMENTARIUM FOR FINISHING & POLISHING COMPOSITE RESTORATIONS:  4. FINISH, EVALUATE, POLISH, AND REEVALUATE RESTORATION V. **[FINISH THE COMPOSITE RESTORATION]** A. PROXIMAL SURFACES 2. **SCALPEL BLADE** - **Curved Scalpel Blade for Removing Overhangs and Flash**: The most effective instrument for removing interproximal overhangs and flash is a curved scalpel blade with a single cutting edge on the inside curve. - **Proper Blade Handling**: The blade should be held at a slight acute angle with the cutting edge in contact with the tooth surface. It should follow the tooth contours, shaving the excess composite material rather than carving it. - **Outer Edge Safety**: The outer edge of the blade, which contacts the gingiva, lacks a cutting edge, reducing the risk of soft tissue trauma. - **Comfort and Scope of Practice**: If the hygienist is not comfortable using the scalpel or if it is not within the scope of practice, an alternative technique should be used or assistance from a dentist should be sought. - **Similar to Root Surface Debridement**: The technique of using a scalpel blade to remove composite overhang is similar to debridement of a root surface with a curette. 2. **FLAME-SHAPED FINISHING BURS** - **Flame-Shaped Finishing Burs**: Used to smooth contours, margins, and remove overhangs. - **Technique**: Move from tooth structure to restoration using smooth, deliberate, intermittent brush strokes. - **Constant Motion**: Keep the finishing bur in constant motion to avoid gouging the restoration or tooth surfaces. 3. **FINISHING DISKS** - **Finishing Disks**: Ideal for restorations extending onto the facial or lingual surface, providing access to those areas. - **Abrasive Disk System**: Some manufacturers offer color-coded disks that progress from coarse to fine abrasives (e.g., Sof-Lex Discs). - **Technique**: Use smooth, deliberate, intermittent brush strokes, starting from tooth structure and moving over the restoration surface to smooth and remove flash. - 3. **FINISHING STRIPS** - **Finishing Strip**: The center of the strip is non-abrasive and should be carefully \"flossed\" through the proximal contact. - **Technique**: Position the strip on both the tooth structure and restoration, gently pulling it over the surface or margin to smooth. - **Precaution**: Ensure the strip is positioned gingival to the proximal contact to avoid opening the contact area. Repeat as needed for smoothness. A. OCCLUSAL SURFACES 3. **EGG OR FOOTBALL SHAPED FINISHING BURS** - **Egg- or Football-Shaped Finishing Burs**: Used for occlusal finishing, guided by existing tooth structure to refine triangular ridges, grooves, and fossae with smooth, intermittent strokes. 3. **FINISHING POINTS AND CUPS** - **Finishing Points and Cups**: Used to smooth surfaces and grooves with deliberate, brush-like strokes over the restoration. B. FACIAL AND LINGUAL SURFACES - **Facial and Lingual Surfaces Finishing**: Involves smoothing margins, refining contours, and removing flash and stains. Common tools include: 8. **Flame-Shaped Finishing Burs**: For contouring and smoothing margins, using smooth, intermittent strokes to prevent gouging. 9. **Egg- or Football-Shaped Finishing Burs**: For lingual surfaces of anterior teeth, guided by tooth structure with smooth strokes. 10. **Finishing Disks, Points, and Cups**: Used on facial and lingual surfaces of anterior teeth, with a combination for posterior teeth. C. EVALUATE THE FINISHING PROCEDURE - **Evaluation of Finishing Procedure**: Ensure all criteria from the Skill Performance Evaluation Sheet are met before proceeding to polishing. Proper finishing is essential for a smooth surface. VI. POLISH THE COMPOSITE RESTORATION - **Polishing Process**: Similar to finishing, but uses fine abrasives, removes less material, and results in a lustrous surface. Some devices are used for both finishing and polishing. - **Polishing Proximal Surfaces**: Fine abrasive disks, strips, or rubber polishing disks/points/cups are used with smooth, deliberate strokes to achieve a high-luster surface. - **Polishing Occlusal Surfaces**: Polishing points or cups are used to polish occlusal surfaces with smooth, deliberate strokes. - **Polishing Facial and Lingual Surfaces**: Similar to occlusal surfaces, polishing points, disks, or cups are used with smooth strokes for final polishing. - **Composite Polishing Pastes**: A rubber cup and polishing paste are sometimes used for the final polishing to create a lustrous finish and improve esthetics. - **Evaluate the Polishing Procedure**: Assess the polished restoration with a mouth mirror, explorer, and Skill Performance Evaluation Sheet. The restoration should be smooth, shiny, and undamaged to adjacent tooth structure. SUMMARY: Composite Finishing and Polishing: ***Finishing*** 1\. Evaluate restoration (margins, occlusion, proximal areas). 2\. Discuss the procedure with the patient. 3\. Isolate the area with cotton rolls or rubber dam 4\. Smooth proximal surfaces if necessary (with burs, disks, strips). 5\. Remove occlusal excess and eliminate flash with burs. 6\. Define occlusal anatomy with burs. 7\. Smooth cavosurface margins and occlusal surface. 8\. Smooth facial and lingual surfaces. ***Polishing*** 1\. Use fine abrasive disks, strips, cups, and points to polish occlusal, proximal, facial, and lingual surfaces. 2\. Rinse, dry, and evacuate composite restoration.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ REVIEW QUESTIONS: Question 1. The most effective method to prevent overheating of the pulp when polishing a composite is to: - Maintain a moist tooth and composite Question 2. Ideally, composite restorations should be finished - At the placement appointment Question 3. During composite finishing and polishing, coarser abrasive disks should be followed by finer abrasive disks. This allows for initially more rapid removal of larger scratches in the composite surface followed by less aggressive removal of material containing the smaller scratches. - Both statements are true. Question 4. Finishing and polishing composite restorations improves all of the following except one. Which one is the EXCEPTION? - Excessive corrosion Question 5. When finishing the lingual of a composite restoration in an anterior tooth, the most effective abrasive would be a: - Egg-/football-shaped finishing bur \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ 1. **Difference between polishing and finishing** - **Polishing** refers to the process of creating a smooth, glossy surface on a material, typically to reduce roughness or imperfections. It is the final step after finishing. **Finishing**, on the other hand, is the process of shaping or smoothing a material to the desired contour or size. Finishing typically precedes polishing and is used to refine the shape before achieving a high-quality surface. 2. **Purpose of polishing and finishing** - The main purpose of **polishing** and **finishing** is to improve the appearance and functionality of a material. **Finishing** enhances the shape and smoothness of the material, ensuring that it fits well or is structurally sound. **Polishing** enhances the aesthetics by giving the material a shiny, smooth surface, which is often desirable in both aesthetic and functional contexts. 3. **Discuss the significance of dental materials** - **Dental materials** are crucial for creating durable, functional, and aesthetically pleasing dental restorations. These materials need to meet specific criteria, such as biocompatibility, strength, and resistance to wear. They also need to mimic the appearance of natural teeth, as well as be able to withstand the stresses of biting and chewing. The choice and use of dental materials directly affect the longevity and success of dental procedures like fillings, crowns, and implants. To avoid heat generation during processes like polishing, finishing, or working with dental materials, you can follow these tips: 1. **Use Low-Speed Tools:**\ High-speed tools generate more heat, so using lower-speed equipment can help reduce heat buildup. 2. **Use Water or Cooling Agents:**\ Applying water or a cooling spray while working on the material helps to dissipate heat and keep the surface cool. 3. **Work in Small Sections:**\ Instead of applying continuous pressure, work in smaller areas to avoid overheating a particular spot. 4. **Use Proper Tool Techniques:**\ Avoid pressing too hard or working for too long in one place. Gentle, consistent motion helps prevent heat buildup. 5. **Choose Appropriate Materials:**\ Some materials are better at handling heat and dissipating it. Using heat-resistant materials can help manage heat better. 6. **Take Breaks:**\ Periodically stop working to let the tool and material cool down before continuing.