CDE0111

12 I I clinical technique _ fractured maxillary central incisors 1 µm, which is similar to natural enamel surface roughness of Ra 0.3 µm to 0.5 µm. Many methods have been advocated for finishing and polishing composite restorations, including multi-fluted (16 to 30) tungsten car- bide burs, fine grit (<25 µm) diamond burs, aluminium oxide (Al2O3) coated abrasive discs, silicone and rubber points, felt discs with dia- mond paste, and unfilled resins to coat the surface layer of the restoration. The type of polishing system depends on the type of com- posite, the degree of contouring required for aesthetics and occlusion, and the operator’s ex- perience and familiarity with a specific finishing system. Generally, micro-filled and nano-filled com- posites can be polished to a very high gross finish compared to hybrid and condensable va- rieties. If the contours of the restoration require extensive alteration, a diamond bur is preferable (rather than a fluted carbide) followed by sili- cone tips, discs and polishing pastes. Conversely, if the morphology and surface topography re- quire little modification, the ideal starting point is with fluted carbide burs, followed by silicone tips, discs and polishing pastes. Also, conden- sable composites may require more abrasive instruments compared to micro-filled or nano- filled composites. Clinical technique The polishing system used for this case study was the Hawe Composite Surface Treatment Kit (KerrHawe SA) consisting of OptiDisc, Al2O3- coated inter-proximal strips (Fig. 44), fluted finishing burs, HiLuster tips, and brushes for diamond polishing paste. The sequence was as follows: _Step 1: All rotary instruments were copiously irrigated with water at a speed not exceeding 50,000 min–1 and gingival retraction cord was placed around the teeth to prevent laceration of the soft tissues. Excess composite was re- moved and the anatomy refined with OptiDisc, starting with the black centre super coarse disc and ending with the blue centre coarse/ medium disc. The discs were also used to create the incisal lobes of the build-up on the left central incisor, guided by the incisal lobes of the reattached fragment on the right central incisor. _Step 2: The facial and palatal topography (un- dulations)wasformedwiththeflutedfinishing burs and polished with the HiLuster tips. _Step 3: Inter-proximal composite excess and overhangs were smoothed with Al2O3-coated inter-proximal strips of varying coarseness. _Step 4: The restoration was polished with dia- mond paste for a high gloss and lustre. The finished and polished restoration dem- onstrates correct anatomical form; seamless colour transition between the composite build- up/reattached fragment and the remaining tooth structure; incisal lobes on the left central incisor, mimicking those of the incisal edge of the right central incisor; and correct lustre and texture (Fig. 45). The patient was supplied with Fig. 38_Removal of the fractured segment on the right central incisor. Fig. 39_After re-hydration, the fragment is correctly located in position with the silicone index. Fig. 40_Facial view of the fragment secured to the existing tooth with Herculite XRV Ultra Incisal shade. Fig. 41_Incisal view of the fragment secured to the existing tooth with Herculite XRV Ultra Incisal shade. Fig. 42_Facial view of reattached fragment with remaining tooth substrate. Observe the seamless colour transition. Fig. 43_Incisal view of reattached fragment with remaining tooth substrate. Observe that the cornhusk at the cervical gingival margin of the left central incisor has been removed (compare with Fig. 37). cosmeticdentistry 1_2011 Fig. 39 Fig. 40Fig. 38 Fig. 42 Fig. 43Fig. 41