Auxiliary dental materials and temporary crowns

Dental materials Dent 305

Objectives of polishing and finishing

Esthetics Smoothening of rough edges and surfaces Remove excess material Reduce corrosion and breakdown

Finishing and polishing

Is to use a diminishing series of abrasives on a surface to contour then smooth and bring a shine to the surface

What affects abrasion?

1. Size, irregularity, and hardness of particles: Diamonds are the most abrasive material in dentistry. Their rate of abrasion depends on particle size, pressure used and speed of rotating device. The larger and coarser the particle, the more abrasive it will be
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Hardness is the ability of the material to resist abrasion. If the polished surface is harder than the abrasive, minimum finishing or polishing will occur Moh scale.

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Abrasive particles are classified from coarse to fine depending on their size (grit) measured in microns
Coarse: 100 m and above Medium: 20-100 m Fine: 20-submicron size

2. Numbers that contact the surface:

1. The more concentrated the abrasive particles on the surface, the more abrasive they are. 2. Lubricants such as saliva and water are used to dilute the abrasive material

3. Speed and pressure:

1. The higher the speed and pressure the greater the abrasive effect 2. Lack of proper control over speed and pressure during abrasion may lead to:
1. Excessive and uncontrolled removal of material or tooth structure 2. Excess heat production

Delivery design of abrasives

Paste abrasives Loose abrasives Coated abrasives Bonded abrasives

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Loose abrasives
Powders and pastes Coarse, medium, fine, superfine grit sizes Applied by brushes, wheels, cups, soft pads The proper grit and dilution should be considered to determine the amount of polishing required

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Bonded abrasives
They are rotary instruments that have an abrasive particle uniformly incorporated in a binder to form the shape of the devise. Comes in many forms, points, disks, cups Usually used for intermediate and initial finishing

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Coated abrasives
Finishing strips and rotary disks The abrasive particles are secured to one side of the disk with an adhesive A mandrel is used to attach the disks on

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Materials used in abrasion

1. Diamond:
1. hardest material and can abrade any surface 2. Expensive and not usually disposable 3. Used as bonded abrasives and can be reused several times before they wear 4. Fine particle diamond paste is used to polish composite and porcelain

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2. Carbide finishing burs

Come in different shapes and number of cutting flutes (7-30) The higher the number of flutes, the finer the finish

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3. Silicon carbide
Hard and efficient abrasive with a 910 on the Moh scale Comes as coated disks and bonded rotary devices

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4. Aluminum oxide
Manufactured as white powder Used in:
Bonded and rotary abrasive devices Sandblasting restorations before cementation Also aluminum oxide impregnated rubber wheels are widely used (Burlew wheels)

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5. Sand
Composed of quartz and silica Rates 7 on Moh scale Coated disks and strips

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6. Silicon dioxide: mainly used in prophylaxis pastes and ranks 6-7 on Moh scale 7. Pumice: manufactured as a loose abrasive from volcanic silica and is extremely fine 8. Rouge: iron oxide found in block form run on a rag wheel to polish precious and semiprecious alloy in lab.

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9. Tin oxide: fine abrasive and used to polish enamel and restorations. Is found as powder mixed with water or glycerin. 10. Calcium carbonate: found in prophylaxis paste and dentifrices

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Preparations used for abrasion

A. Prophylaxis paste, Composition:
Pumice, tin oxide Lubricants Preservatives Flavoring agents Coloring agents Therapeutic agents such as fluoride
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The paste is diluted with a lubricant to control abrasiveness and frictional heat generated, and to prevent hardening of the particles. Supplied as coarse to superfine For polishing, the hardness of the paste should be 1-2 points higher than the polished surface

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The most fine paste should be selected and well lubricated to polish and remove stains and soft deposits

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B. Tooth paste (dentifrices)

Contain abrasives to clean tooth surface and prevent plaque accumulation Contain :
20-40% abrasives Coloring and flavoring agents Therapeutic agents (fluoride)

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C. Denture cleansers
Cleansers used by a tooth brush are used to :
Remove stains Plaque accumulation Food debris

Some cleansers are used by soaking dentures in them to loosen debris and deposits
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Denture cleansers
Requirements:
Non toxic Non abrasive Harmless to the components of the denture

Example materials: dilute alkaline or acid preparations Prosthesis with metal parts should not be soaked in acid solutions to prevent corrosion

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Finishing and polishing procedures

Consider the following:
Type and grit size of abrasive used The order in which the abrasives are used The desired anatomic features of the restorations Tooth structure adjacent to the polished restorations Original contour should be recreated Contact areas should not be polished

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Margination and removal of flash

Margination is the removal of excess restoration to bring it flush with the cavosurface tooth structure. This includes removal of:
Feathered flash overhang

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Finishing and polishing amalgam

After 24 hours after insertion Steps that should be followed:
Remove excess amalgam as indicated Finishing: Abrasives used to remove scratches and surface defects. Bonded and coated abrasives (>25 m), multifluted burs are used

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Polishing: done by using bonded , coated or loose abrasives (20submicron particle sizes)

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Finishing and polishing composite

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 Gold alloys: finished and polished using Burlew wheels followed by rouge on a rag wheel. Porcelain: finishing is done in the lab. Diamond burs are used to make adjustments. Rubber points and wheels designed for porcelain are used. Diamond polishing paste is also used.
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Polishing during an oral prophylaxis

Amalgam: benefits from polishing using rubber cup or brush with prophy paste. Composite: polished with aluminum oxide paste. May help in removing stains. Avoid ultrasonic scalers and prophy paste.
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 Composite (continue, ): start with fine paste, if not effective use coarser abrasives and pay attention to restoration margins and surface. use light pressure, light sweeping action under water in less than 30 seconds.

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 Gold and porcelain: use porcelain polishing paste for porcelain and aluminum oxide for gold if surface of these restorations is rough or has scratches on it Resin cement interface: treated as composite.

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Air polishing and abrasion

Use microparticles as a replacement for rotary cutting and polishing instruments Air polishing: uses water, air, Na bicarbonate under pressure to remove stains and debris from enamel surface.
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Air abrasion
Uses compressed air and 27-50 m particles of aluminum oxide. Not recommended for stain removal. Mainly used for:
Cast restorations before cementation Repair for porcelain and composite Tooth surface before bonding

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Safety and infection control

Splatter from pastes can cause eye damage Vapor and aerosols during finishing and polishing can transmit diseases Silica particles and mercury vapor are health risks Personal protective equipments are needed

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Preprocedure antimicrobial mouthrinses are recommended Protective eye wear for patients High volume suction Sterilize used devices and use dry and fresh pastes.

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Patient education
Effective oral hygiene practice Awareness of what causes staining Regular recall appointments Advise on appropriate abrasive agents that maybe used at home

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Temporary crown and bridge resins

Temporary coverage is needed following tooth preparation. Why?
Protect tooth vitality after enamel and dentine removal Prevent gingival overgrowth Prevent supra-eruption of opposing tooth

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Prepared tooth and temporary restoration

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 General outlines of the procedure:

Impression is taken prior to tooth preparation Tooth prepared Temporary crown material mixed and placed in impression or plastic crown then reseated Initial setting impression and material is taken out. Final setting outside the mouth Adjustments and finishing is made then crown is cemented

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Requirements
Non irritant Strong Tooth colored Setting should not yield high temperatures Setting contraction not too high Sufficient working time After seating, quick initial setting (rubbery) for easy removal Quick hardening outside the mouth

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Available materials
Type
Acrylic Acrylic Higher methacrylate Composite Composite

Dispensation method
Powder/liquid Single paste (LC) Powder/liquid Paste/paste Single paste (LC)

Composition
PMMA+ peroxide MMA +activator PMMA+ monomer+ light activator PMMA+ peroxide Isobutylmethacrylate + activator Multi-functional methacrylate + fillers+ initiators + activators Multi-functional methacrylate + fillers+ light activators

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Properties
Setting characteristics:
Composite materials: have a distinct rubbery stage due to multifunctional monomer. Final setting maybe accelerated in hot water Acrylic materials: rubbery stage not as distinct

Setting is exothermic Undergo shrinkage

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Properties
Biocompatibility: monomer is irritant. Solution to protect freshly cut dentine? Mechanical properties: fracture is common in thin areas. Appearance: available in shades

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 Reference: Dental materials, clinical applications for dental assistants and dental hygienists. Chapter 9 Applied dental materials. Chapter 26

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