International Dentistry - Vol. 12, No. 2 - 25
CLINICAL
Figure 1: 12-month recall on upper central composite veneers.
Figure 2: LM Arte Misura, courtesy of Styleitaliano.
Most composite systems on the modern-day market will
allow decent restorations when handled correctly. The most
experienced clinicians will know the materials so well they
will be able to combine various systems together to obtain a
true representation of the surrounding natural anatomy.
restoration. In short, the process for instrument application
over the last 10 years has reduced in need, although new
instruments that have emerged in response to a greater
understanding of composite resin.
Hand instruments
Photography - our opportunity to scrutinise to the next
level
In 1994, Dr Nitzan Bichacho suggested the idea that the
various hand instruments used to manipulate direct
restorations were unnecessary (Bichacho, 1994). With
regards to composite materials, the industry has almost gone
full circle in the last 10 years. Elaborate instrument sets were
- and still are - available to enable the clinician to handle
the material and apply it in an anatomical fashion.
We have learned over the last 10 years that this in fact is
not needed and thus refer back to the work of Dr Bichacho of
more 20 years ago, which suggested the mode of application
of composite increments using a probe and manipulating this
increment to its desired position using high quality micro
brushes. This not only reduces the complexity of instruments
being used, it also enables complete control of polymerisation
contractile forces causing unwanted flexure upon curing.
In more recent years, certain instruments have emerged
that aim to assist in the layering process of enamel and
dentinal composites. Given the fact the refractive index of
enamel composites is generally greater than that of natural
enamel, the final enamel layer tends to be thinner than the
natural tissue would otherwise be.
LM Arte has created the Misura instrument, shown in Figure
2, which highlights 0.5mm thickness of material so as to
ensure over-conturing does not take place, as well as
obtaining an even thickness over the horizontal profile of the
Clinical photography has improved in leaps and bounds over
the last 10 years. Cameras are now more sensitive, and
lighting systems are now more readily available. The ability
to use twin versus ring flash systems enable us to evaluate the
natural form and end restoration with confidence. It remains
essential to utilise clinical photography to document and plan
the direct restoration to maximal extent.
Use of photographical aids, such as contrasters, have also
aided the clinician in terms of incisal edge anatomy,
translucency, dentinal mammelon structure and distribution,
and primary, secondary and tertiary anatomical features.
Figure 3 shows a range of natural features that can be used
when direct composite can not only include such high
features, but be applied in a conservative manner, and
thereby not adding to the tooth tissue loss that has already
occurred. Such skills can also highlight the nature and extent
of developmental white and brown spots on teeth so that
they can either be removed or incorporated within the
restoration.
The explosion of dental clinical photography has aided
the clinician greatly. In reference to direct resin dentistry, it
has enabled us to plan our restorations by taking a series of
clinical shots using a few aids such as retractors and
contrasters to highlight the detail in the natural form, as well
as anatomical feature and morphology.
VOL. 12, NO. 2 INTERNATIONAL DENTISTRY - AUSTRALASIAN EDITION 25
Table of Contents for the Digital Edition of International Dentistry - Vol. 12, No. 2
Contents
International Dentistry - Vol. 12, No. 2 - Cover1
International Dentistry - Vol. 12, No. 2 - Cover2
International Dentistry - Vol. 12, No. 2 - Contents
International Dentistry - Vol. 12, No. 2 - 2
International Dentistry - Vol. 12, No. 2 - 3
International Dentistry - Vol. 12, No. 2 - 4
International Dentistry - Vol. 12, No. 2 - 5
International Dentistry - Vol. 12, No. 2 - 6
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International Dentistry - Vol. 12, No. 2 - Cover3
International Dentistry - Vol. 12, No. 2 - Cover4
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