Finishing and Polishing of Direct Posterior (Morgan)
Finishing and Polishing of Direct Posterior (Morgan)
Finishing and Polishing of Direct Posterior (Morgan)
MORGAN
Michael Morgan, DDS*
16
3
APRIL
Direct composite resin materials have revolutionized the delivery of minimally inva-
sive treatment in the posterior region. Contemporary resin formulations provide
improved strength, wear resistance, and aesthetics. Microhybrid formulations have
also been associated with enhanced polishability. Development of an optimal surface
polish in turn reduces stain and plaque accumulation, minimizes wear, and enhances
the appearance of the definitive restoration. This article presents a simplified technique
and protocol for finishing and polishing composite resin materials following restora-
tion of the posterior region.
Learning Objectives:
This article discusses techniques and a protocol for finishing and polishing poste-
rior direct resin restorations. Upon reading this article, the reader should:
• Understand the clinical protocol necessary to create direct posterior resin
restorations that require minimal finishing.
• Be able to select appropriate instrumentation for direct posterior resin
finishing and polishing procedures.
• Understand the importance of correct finishing and polishing on plaque
accumulation, stain resistance, and wear resistance.
*Private practice,
Michael Morgan, DDS, 638 N. Edgewood, La Grange Park, Illinois 60526
Tel: 708-246-3592 • Fax: 708-354-1938 • E-mail: [email protected]
Clinical Protocol
A complete and thorough radiographic, photographic,
and clinical examination must precede discussion of the
patient’s treatment alternatives. The relative advantages
Figure 6. The lingual enamel increment was
placed following fossa characterization.
and disadvantages of posterior direct resin restorations
must be thoroughly discussed with the patient. Once
patient goals and expectations have been assessed, treat-
ment can be initiated.
Proper occlusal and proximal morphology of the
final resin restoration is paramount in minimizing finish-
ing and polishing. Creating a restoration that is in har-
mony with the existing dentition and occlusion eliminates
excessive postoperative finishing.
Overcontouring is one of the most common errors
in fabrication of direct resin restorations. As a result,
intricate anatomy and detailed color are compromised
during occlusal adjustment and reduction. Marginal and
Figure 7. Buccal enamel margins were smoothed surface integrity are jeopardized,20 and finishing is sig-
with an artist’s brush. nificantly increased as compared to resins built to con-
tour. To prevent overcontouring, three parameters of
occlusion must be observed. The occlusal surface and
anatomy of the existing restoration must be carefully
inspected, and the adjacent teeth must also be evalu-
ated. The patient’s opposing dentition and overall occlu-
sion should also be observed. These parameters provide
the clinician with guidelines for the final contours and
anatomy of the direct resin restorations.
Proper shade selection is necessary prior to isolation
in order to ensure aesthetic harmony (Figure 1). A
prefabricated or custom-fabricated shade guide may be
Figure 8. Glycerin gel was placed over com- used. Examining the cervical third of adjacent or contra-
pleted restoration prior to final light curing. lateral teeth will indicate the appropriate dentin shade.
PPAD 213
Practical Procedures & AESTHETIC DENTISTRY
Figure 9. A finishing disk was used to open the interproxi- Figure 10. The gingival margins were finished and excess
mal embrasures with the matrix remaining to protect the resin was removed with a 12B scalpel.
adjacent marginal ridge.
Figure 12. A super-fine finishing diamond was used to Figure 14. A surface-penetrating sealant was placed once
remove excess resin on the occlusal surface. acid etching was completed.
PPAD 215
Practical Procedures & AESTHETIC DENTISTRY
PPAD 217
CONTINUING EDUCATION CE X
CONTINUING EDUCATION
The 10 multiple-choice questions for this Continuing Education (CE) exercise are based on the article “Finishing and polishing of direct
posterior resin restorations,” by Michael Morgan, DDS. This article is on Pages 211-216.
1. Rubber dam isolation is: 6. The use of a surface sealant as the last step of polishing:
a. Never required during direct restoration. a. Has demonstrated long-term efficacy on the resin surface.
b. Mandatory to achieve proper isolation. b. Reseals microcracks caused during finishing procedures.
c. Ineffective in moisture prevention. c. May decrease surface wear and increase the longevity
d. Required to facilitate placement of floss ligatures. of direct resin restorations.
d. Both b and c are correct.
2. Proper shade selection:
a. Is required prior to tooth isolation. 7. Occlusal and proximal morphology of the definitive resin
b. Can be performed using a prefabricated or custom restoration:
resin shade guide. a. Should be properly developed to minimize finishing and
c. Can be ensured by examining the cervical third of polishing.
adjacent or contralateral teeth. b. Eliminates excessive finishing after placement.
d. All of the above. c. Should not be overcontoured.
d. All of the above.
3. Incorrect surface polishing can result in:
8. Intricate anatomy and detailed color:
a. Reduced microcracks.
a. Can be compromised by overcontouring of the
b. Reduced surface roughness.
restoration.
c. Decreased long-term wear resistance for posterior direct
b. Can be developed during occlusal adjustment and
resin restorations.
reduction.
d. All of the above.
c. Can be enhanced by additional finishing to ensure
4. When restoring Class II defects in the posterior region: marginal and surface integrity.
d. None of the above.
a. The primary challenge is the creation of a functional,
predictable proximal contact. 9. Based on the procedures outlined in this article, place-
b. Restoration of the multifactorial structures to be restored ment of a matrix band should be:
is performed within an easily accessible operative site. a. Placed to ensure proper overcontouring of the marginal
c. Proper finishing and polishing is facilitated due to the ridge.
increased access and visibility within the operative field. b. Performed prior to the adhesive process.
d. None of the above. c. Without placement of a guide to approximate the
height of the adjacent marginal ridge.
5. The dentin shade of comoposite should be:
d. Following the placement of flowable resin along the
a. Soft-cured incrementally to within 1 mm of the cavosur- margins of the proximal box.
face margin.
b. Cured to eliminate excess stresses along the cavosur- 10. Ideal posterior direct resin restorations should:
face margins, thus limiting development of microgaps. a. Require minimal finishing and polishing.
c. Incrementally layered to eliminate white lines at the b. Never contain supragingival margins.
enamel-composite interface. c. Only be used as a provisional option.
d. All of the above. d. None of the above.