DT U.S. Edition, October 2010, Vol. 5, No. 21

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Wehkamp j.wehkamp@dental-tribune.com Dental Tribune America, LLC 116 West 23rd Street, Suite 500 New York, NY 10011 Tel.: (212) 244-7181 Fax: (212) 244-7185 Published by Dental Tribune America © 2010 Dental Tribune America, LLC All rights reserved. Cosmetic Tribune strives to maintain utmost accuracy in its news and clini- cal reports. If you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman at r.goodman@dental-tribune.com. Cosmetic Tribune cannot assume respon- sibility for the validity of product claims or for typographical errors. The pub- lisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. fCT page 1C 2C Clinical COSMETIC TRIBUNE | OctOber 2010 based splinting material; • a restorative micro/nano- filled composite material; • a flowable composite mate- rial; and • a bonding agent. The above only highlights the materials required and does not list the armamentarium, which would consist of a number of spe- cial hand instruments to achieve a high quality result and fin- ish. Amongst the materials, the bonding agent and the composite restorative material are depen- dent on the clinician’s preference. The micro- or nano-filled range of products from any of the indus- try leaders in restorative materials are most appropriate. A good flow- able material is also required to create a close fit of the splint mate- rial to the tooth surface, while a sixth or seventh generation bond- ing agent would be able to achieve the desired bond strength. The most critical aspect in achieving the ideal splint outcome is the selection of the fibre used as the substructure. There are a number of options available on the market. I have tested differ- ent splinting fibres throughout my career and quite a number of them has given very good results and lasted for years. Available materials have some favourable properties at the cost of some other undesirable ele- ments and at times the clinician has to choose between sacrificing several of the desired elements in order to gain the others. The ideal substructure fibre material has the following properties: • high strength subsequent to polymerisation; • chemically bondable with composite resin material; • available in a pre-impregnat- ed state; • no thicker than 0.2 mm; • available in varying widths; • easy to trim and cut; and • no memory as regards its form. Of the above, the last property is a critical one. Because of the difficult handling properties of the fibre splint, splinting has been a very technique-sensitive proce- dure thus far. Unless the clinician was extremely conversant with all the requisite steps and also extremely skilful and dexterous in the han- dling of the fibre and composite, the likelihood of a long-term suc- cess would be reduced. Many splint materials have a tendency to a memory, that is the property of returning to orig- inal shape if deformed under load. This memory of a material makes it resistant to being shaped around curves, especially curves that double-back, for example the interproximal areas around the linguals of lower anterior teeth or around the curvature of a maxil- lary premolar. If the material can be fabri- cated in such a way that it bends and adapts around curves without bouncing back, it makes adapt- ing and placing the splint in the oral cavity a far simpler and more accurate task. Glass-based fibres have an inherent tendency to maintain their longitudinal direction. This can easily be observed in any uni- directional fibre splint material. The only way to negate this prop- erty of the fibre is to interweave the fibres in a cross-stitch pattern. This creates a kind of mesh frame- work, thereby making the mate- rial almost free of memory. The term zero memory can then be applied to such a material, which will only minimally maintain any form to which it is subjected (Figs. 7–10). Although the material does pos- sess a certain amount of memory, it becomes practically insignifi- cant as regards clinical applica- tion. For all practical purposes, the material would then have zero memory. My best experience thus far has been with a very new entry in the splinting fibre market: Quartz Splint (Recherches Techniques Dentaires). The basic raw mate- rial used in this product is quartz glass, unlike regular glass fibre. This is the same quartz used to develop endodontic posts, which demonstrate cyclic fatigue resis- tance values that are much higher than desired in the oral cavity. Quartz glass is also homog- enous with the Bis-GMA range of unfilled resin, which makes it ideal for use with restorative composite material, allowing it Figs. 11–14: The near zero memory property of the rope quartz splint demon- strated by distortion into various shapes; the material maintains its distorted position without any polymerisation. Fig. 11 Fig. 12 Fig. 13 Fig. 14 Figs. 7–10: The clinical zero memory effect of the woven quartz splint dem- onstrated by adaptation around the entire curvature of the crown of an extracted molar. The material is not polymerised but stays in the newly adapted position. Fig. 8 Fig. 9 Fig. 7 Fig. 10