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Contents
Introduction
Case
Case
Case
Case
6
12
16
21
22
27
Annex
Shade selection
Preparation
Adhesion
Polymerisation
Finishing and polishing
32
33
34
35
36
References
37
Venus indications
Venus shades
Venus product outline
38
38
39
3
Introduction
Preparation
The surface of the teeth, which will be treated, should be cleaned
with a uoride-free prophylaxis paste and the tartar removed,
if necessary. The colour should be selected on the still hydrated
teeth. All needed indications for this procedure will be provided in
a following chapter of this guide. For the moment, only the Venus
shade guide made of original material will be used for shade
selection.
Before starting the restoration, a rubber dam should be placed to
guarantee the work in a place free of humidity (the greatest enemy
of adhesive materials and composites), a greater concentration on
the operating eld, and the highest level of safety for the patient.
The restorations should recreate the portion of the dental tissue
lost due to decay, erosion or trauma. It is therefore very important
to remove the damaged or unsteady tissues (undermined enamel).
In the same way, in the case of previous llings, whether in
amalgam or composite, the old restoration has to be removed and
the remaining natural structure controlled.
Colour deterioration in
old llings on the central
upper incisors.
The shade is selected.
A silicone guide mask
is fabricated based on
the diagnostic wax-up
to ensure the best
occlusal alignment.
The teeth are then
isolated with a rubber
dam.
7
The interproximal wall
is reconstructed in
translucent composite
(in one or more increments) using the clear
matrix to help recreate
the characteristics of
the natural tooth.
Each increment
is polymerised for
20 seconds.
Desaturation begins
by applying layers of
enamel starting with
the deeper colours
(e.g. A3) in the middle
third and progressing
to lighter colours (e.g.
A1) in the incisal third.
It is very important
to sculpt the correct
shape during this
stage.
Each increment is
polymerised.
10
10
11
12
13
Colour desaturation
is the next step with
enamel shades,
starting from darker
shades (e.g. A3) and
progressing to lighter
shade composites
(e.g. A1).
Each increment is
polymerised.
The last increment
consists of a translucent composite
(e.g. T1) to join the
middle third to the
interproximal zones;
it should be remembered that the incisal
edge of lower incisors
is typically translucent.
The increment
is polymerised for
20 seconds.
14
The restoration is
nished and polished.
Once the rubber dam
has been removed,
occlusal marking paper
is used to check that
the correct relationship
between reconstruction
and function has been
achieved.
15
16
17
18
Colour desaturation
is the next step with
enamel shades, starting with darker shades
(e.g. A3) and progressing to lighter shade
composites (e.g. A1).
The increment
is polymerised for
20 seconds.
Each increment is
polymerised.
The interproximal
zones are nished using
hand instruments.
19
The restoration is
nished and polished.
Once the rubber dam
has been removed,
occlusal marking paper
is used to check that
the correct relationship
between reconstruction
and function has been
achieved.
20
Once the new wall has been completed, the rebuilding of the
cavity can be conducted as if it were an occlusal lling (Case D).
First a layer of ow composite (e. g. Venus ow) is applied at the
bottom of the cavity and spread using a probe. The purpose
of this step is to create a uniform liner without air bubbles that
guarantees the best possible contact with the adhesive and acts as
a loading damper. The layer of ow composite should be extremely
thin to not compromise the restorations mechanical properties.
Modern adhesive techniques and composites enable an application beyond this rule (e.g. cusp build-up) as already observed in
several clinical cases.
21
22
Leaking of an amalgam
restoration in 3.6.
The shade is selected.
The morphology and
occlusion are assessed
before isolating the
operative eld. The
tooth involved is isolated with a rubber
dam (the restoration
will not involve the
interproximal zone,
so we can isolate the
single tooth and not
the whole sextant).
23
The stratication
begins with a horizontal increment of
opaque composite
(e.g. OA2) that helps
to mimic the colour
of the tooth to be
reconstructed. If the
cavity is very wide, it
is better to apply this
composite in several
increments.
Each individual
increment is
polymerised for
40 seconds.
24
In order to desaturate
the colour, rst a
darker shade composite (e.g. A3.5) and
then lighter shades of
composite (e.g. A1)
are applied.
Increments are applied
in triangles in order
to reduce stresses on
the cavity walls due to
polymerization shrinkage and to allow better
anatomical modelling.
Stratication concludes
with the application
of a thin increment of
translucent composite
(e.g. T1) along the
edge of the cavity and
along the rst part of
the cuspal surface.
The increment
is polymerised for
20 seconds.
Each increment is
polymerised.
25
26
Recurrence of caries in
tooth 2.6, previously
restored with amalgam.
The shade is selected.
The morphology and
occlusion are assessed
before isolating the
operative eld.
The tooth involved is
isolated with a rubber
dam (as the interproximal walls have to be
restored, the adjacent
teeth will have to be
isolated as well as the
tooth itself).
27
28
A sectional or ring
matrix is put in position
and xed with a balsa
wedge so that it ts
tightly against the
cervical margin and
the contact area.
The rst vertical increment of translucent
composite (e.g. T1) is
applied to reconstruct
the interproximal wall;
particular care must
be taken to avoid any
gaps in the cervical
margin seal.
The increment is
polymerised for 20
seconds.
The next increment of
translucent composite
completes the reconstruction of the interproximal wall, extending it to the height
of the marginal crest.
The increment
is polymerised for
20 seconds.
29
Stratication begins
with a horizontal increment of opaque composite (e.g. OA2) that
helps to mimic the
colour of the tooth to
be reconstructed. If the
cavity is very wide, it
is better to apply this
composite in several
increments.
Each individual increment is polymerised for
40 seconds.
In order to desaturate
the colour, rst a
darker shade composite (e.g. A3.5) and
then lighter shades of
composite (e.g. A1)
are applied.
Increments are applied
in triangles in order
to reduce stresses on
the cavity walls due to
polymerization shrinkage and to allow better
anatomical modelling.
Each increment is
polymerised.
30
A thin increment of
translucent composite
(e.g. T1) is applied
along the edge of the
cavity and along the
rst part of the cuspal
surface.
The increment
is polymerised for
20 seconds.
The restoration is
nished and polished.
Once the rubber dam
has been removed,
occlusal marking paper
is used to check that
the correct relationship
between reconstruction
and function has been
achieved.
31
Annex
Shade selection:
Natural teeth are made of various kinds of tissue, which strongly
differ aesthetically and optically wise. Dentine, for instance, is
duller when compared to enamel. It is therefore clearly difcult
to restore the original optical properties of a tooth using only one
material when the cavity preparation involves both dentine and
enamel.
The shade selection is to be done before placing the rubber dam.
Once isolated the dental elements structures tend to dehydrate,
what makes the tooth appear more shiny and opaque than normally.
Consequently, just after removing the rubber dam, the restoration
appears darker and too translucent, even if the composite masses
had been properly selected.
A nal evaluation of the combination of masses and layers can
only be done a few days after having completed the restoration;
the composite materials attain their denite optical properties only
after the tooth has been rehydrated.
The shade selection should be done under daylight keeping in mind
that not only the interested tooth but also the adjacent ones have
to be observed. The dentine shade should be selected based on the
mid and cervical thirds of the tooth of concern.
32
At the end, the level of translucence should be dened. A reconstruction will be able to achieve the highest aesthetical level
only if dentine, enamel and translucent incisal shades are used.
An appropriate incisal shade can be selected by determining the
translucency of the incisal third of the tooth. When necessary,
the level of translucency can be changed by using supercial
characterisation (e.g. Cre-active) under the last translucent layer.
Preparation:
The penetration capacity of uid resins or adhesives into the
conditioned dental structures enable the optimisation of the
materials micromechanic linkage and thus the reconstructions
resistance.
The nishing of the margins allows extending the surface to
mordant with acid agents and therefore increases the linkage
between composite and dental structure.
33
Adhesion:
Adhesion is a physical concept, which foresees interaction between two elements, the adhesive and the adherent, through an
interface. In the case of amalgam llings the restoration maintains
a macro-retention relation with the tooth. Restorations based on
the adhesion principle show a reversed concept: a micro-retention
to the tooth is achieved. The extension and shape of the cavity are
in strict correlation with the decayed tissue to be removed. A large
quantity of healthy dental tissue is therefore preserved.
The adhesive systems can be classied according to the approach
in treating dentinal mud (or smear layer). The rst is intended
to fully remove the smear layer through a simultaneous acid conditioning of enamel and dentine (total-etch), while the second
tends to modify the same dentinal mud by incorporating it into the
dentines resin impregnation process.
Both so-called three-steps adhesives (e.g. Gluma Solid Bond)
and those two-steps adhesives (e.g. Gluma Comfort Bond) are
a part of the rst group and differ one another for the association
or not of primer and bonder.
In the second group instead, we can distinguish the so-called
self-etching primers and the new self-etching adhesives or
all-in-one bondings (e.g. iBond). These adhesive systems do
not remove the smear layer but modify it.
34
Polymerisation:
Composites are made of a resin matrix with scattered lling
particles. Resins are monomers, which, following a proper phototreatment, reach their nal mechanical properties through
polymerisation. The photo-polymerisation process is therefore
very delicate and important in order to achieve a good
predictability of the restoration.
It is always recommended to observe the composite
manufacturers instructions and polymerisation times.
Polymerisation times for Venus and Venus ow are:
20 seconds
40 seconds
All shades
Maximum layer
thickness
2 mm
35
36
At the specic chapter we will deal in detail with different instruments and techniques to be used during the nishing and
polishing process, highlight the differences between nishing of
anterior and posterior teeth, and the importance of a proper
polishing for both aesthetical and microbiological integration
reasons.
References
Conception:
Raquel Neumann
Heraeus Kulzer GmbH
37
Venus indications
Indication
Class I cavities
Venus
Venus shades
Venus ow
Class II cavities
Enamel shades
(higher
transparency)
Class IV cavities
Class V cavities
Inlays
(direct and indirect)
Onlays
(direct and indirect)
Veneers
(direct and indirect)
Crown build-ups
Posts and cores
D2
SB1*
C3
D3
SB2*
A3
B3
C4
OB2
OC3
OD2
SBO
A3.5
A4
HKA5*
Enamel shades
(very high
transparency)
T1
Dentine shades
(low
transparency)
OA2
T2
T3
OA3
OA3.5
Fissure and
pit sealing
Cavity linings
38
C2
B2
Adhesive luting
Temporary
restorations
B1
A2
HKA2.5*
A1
Venus ow Assortment
Venus syringes 4 g or
PLTs* 10 x 0.25 g
shades A2, A3, OA2, OA3,
T1, HKA2.5
39
Product
Venus
PLTs contents 20 x 0.25 g
PLT A1
PLT A2
PLT A3
PLT A3.5
PLT B1
PLT B2
PLT C2
PLT OA2
PLT HKA2.5
PLTs contents 10 x 0.25 g
PLT A4
PLT B3
PLT C3
PLT C4
PLT D2
PLT D3
PLT OA3
PLT OA3.5
PLT OB2
PLT OC3
PLT OD2
PLT SB1
PLT SB2
PLT SBO
PLT T1
PLT T2
PLT T3
PLT HKA5
40
Art. No.
66007979
66007981
66007983
66007985
66007988
66008000
66007989
66008012
66007996
66008159
66008001
66008089
66008003
66007992
66008095
66008016
66007997
66007999
66008002
66008004
66008008
66008009
66008014
66007995
66008005
66008006
66007998
Product
Venus
Each syringe contains 4 g
SYR A1
SYR A2
SYR A3
SYR A3.5
SYR A4
SYR B1
SYR B2
SYR B3
SYR C2
SYR C3
SYR C4
SYR D2
SYR D3
SYR OA2
SYR OA3
SYR OA3.5
SYR OB2
SYR OC3
SYR OC2
SYR SB1
SYR SB2
SYR SBO
SYR T1
SYR T2
SYR T3
SYR HKA2.5
SYR HKA5
Art. No.
66007366
66007367
66007368
66007369
66008156
66007370
66007600
66007601
66007371
66008086
66007603
66007372
66008092
66007410
66008098
66007597
66007599
66007602
66007604
66007608
66007609
66007411
66007373
66007605
66007606
66007596
66007598
Product
Art. No.
Venus flow
Each syringe contains 1.8 g
Venus flow A1
Venus flow A2
Venus flow A3
Venus flow A3.5
Venus flow A4
Venus flow B2
Venus flow B3
Venus flow OA2
Venus flow SB1
Venus flow SB2
Venus flow SBO
Venus flow T2
Venus flow Baseliner White
Venus flow HKA2.5
66014562
66014563
66014565
66014566
66014567
66014568
66014569
66014570
66014571
66014572
66014573
66014575
66014574
66014564
XXXXXXXX 00 02.08 GB
Conception:
Heraeus Kulzer GmbH
Thanks to:
Prof. Antonio Cerutti
Nicola Barabanti
Stefano Sicura
University Brescia, Italy
Heraeus Kulzer srl
Contact in Germany
Contact in Australia
Grner Weg 11
63450 Hanau
info.dent@heraeus.com
Mail: sales@kulzer.com.au
www.heraeus-kulzer.de
Mail: sales@kulzer.uk
www.kulzer.com.au
www.heraeus-kulzer.com
In compliance with the European guideline 93/42/EWG our medical devices are CE-marked according to the classi cations.