Clinical Corner: Information on Dental Procedures

Articles

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Fast and Smooth - Efficient Crown Preparation With Carbide Instruments
When Advancing the Bur, One Can Feel the Presence of Dentinal Caries
Precision Trimming and Finishing of Current Dental Restorations Using the Safe End Bur System
Indirect Restorative Tooth Preparation: Extreme Efficiency and Accuracy
Creating Maximum Efficiency and Accuracy In Indirect Restorative Tooth Preparation
Preparation Protocol To Ensure Predictable Aesthetic Restorations
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Anatomically Adapted Carbide Finishing Burs - Creating Super-Smooth Composite Surfaces in Two Steps
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"Anatomically Adapted Carbide Finishing Burs - Creating Super-Smooth Composite Surfaces in Two Steps”

Dr. Jan Hermann Koch, Dr. Alexander Fumig, Dr. Michael Leistner

The successful creation of esthetic and glossy composite surfaces depends on the instrument system used. Ideally, the objective should be achievable with only a few instrument changes. With the help of a special kit of carbide finishing burs, composites can be prepared for a high-luster polish in merely two steps. Since these burs are made from a single piece without any seams, they run highly concentrically - and produce super-smooth surfaces.

Perfect esthetics is the result of an interplay of shape, shade and surface morphology. This applies to both ceramic and composite restorations. A systematic approach is indispensable. First. a correct anatomical shape has to be created. A good feeling for tooth anatomy. special matrix techniques and, in the case of extensive reconstructions, silicone indices fabricated with the aid of wax-ups will help to achieve this goal.

Shade selection is a complex task. If composites are applied in several layers, dentists will have to pay attention to all the special features of their shade systems. Depending on the filling type and the product used, composite layering may be a difficult and artistically challenging procedure. The real masterpiece is the incorporation of individual characterizations with the help of stains and the creation of a lively surface
morphology using rotary instruments, for example Arkansas stones. After these steps, the material is polished to a high luster, similar to that of natural enamel.

If the composite is carefully applied, the amount of excess material to be removed with coarse milling or grinding instruments or with scalpels will not be very large. After contouring and finishing, the composite surface receives its high-luster polish. For this work step, a great variety of tools is available, ranging from aluminum-oxide-coated disks and silicone polishing systems, partly used in combination with polishing pastes, to polishing brushes and diamond-coated felt disks.

Figure 1 Original finding: The composite filling in the distal part of tooth 11 did not match the surrounding tooth structure in shade. Besides, it lacked the natural brightness and light scattering effect.	Figure 2 After reconstruction with a composite, excess material was removed from the interproximal area with a long SafeEnd carbide finishing bur (SE9-20). A 10 blade bur of the same length could have been used alternatively.	The most suitable instruments for excess removal and finishing are special tungsten carbide finishing systems available from various manufacturers. Technically speaking, rotary carbide burs are milling cutters whose cutting edges remove material in the form of chips. This working principle ensures particularly smooth and clean surfaces. Diamond burs, by contrast, exert a grinding effect on the surface of the substrate, which can also be described as "shattering and grooving': Dr. Angelika Rzanny of the University of Jena (Germany) therefore concludes that "the use of diamond burs for the trimming of composites is not advisable" (Dtsch Zahniirztl Z 2003).
Figure 3 A shorter finishing bur (SE4-20) was used in the interproximal cervical region.	Figure 4 The final finishing procedure with 20 blade SafeEnd burs prepared the filling for polishing. The instrument versions SE8 and SE9 are anatomically adapted to the long facial surfaces of anterior teeth (''procedure specific'').

While the manufacturers of other carbide finishing systems still recommend using up to three bur configurations (for example with 8, 16 and 30 blades), the SafeEnd carbide finishing burs made by SS White Burs (Freiburg, Germany) require only two variants, with 10 and 20 blades. This elimination of one instrument change saves precious treatment time. When the two configurations are used sequentially, the special blade design will create very smooth surfaces, which can easily be polished to a high luster in the final step.

The excellent smoothness of running and high concentricity of SafeEnd result from the fact that the instruments are not welded or soldered but machined from a single piece. SS White Burs began to develop tungsten carbide burs as early as the 1940s, as the first manufacturer worldwide, and accordingly has extensive experience in this field.

Anatomatically Adapted Lengths

Figure 5 The result before polishing showed a very good shade match. The filling also matched the surrounding tooth structure in brightness and light behavior.

Figure 6 The short SafeEnd burs 5E3 and 5E4 (3 and 4 millimeters in length) are well suited for the area where the anterior or posterior tooth emerges from the gingiva (emergence profile). Their non-cutting tips help to protect the soft tissues.

Figure 7 Depending all the anatomy of the restored tooth, various instrument lengths may be appropriate. For this mandibulor premolar, a SafeEnd SE6-20 bur was used.

The SafeEnd burs offer a number of advantages, as compared to conventional carbide finishers, for example
a variety of lengths - 3, 4, 6, 8 and 9 millimeters - which are adapted to the lengths of the tooth surfaces to be treated ("procedure specific"). This principle was developed by the U.s. esthetics experts Ron Goldstein and
David Garber in the 1980s. The short instruments SE3 and SE4, for instance, are particularly suitable for the area where the tooth emerges from the gingiva. Especially the shorter SE3 is the optimal finisher for transitions between tooth structure and ceramic materials in the cervical region, for example in the case of
veneers or other all-ceramic restorations.

The longer instruments are ideal for the long facial surfaces of anterior teeth (SE8 and SE9] or the interproximal and facial surfaces of canine and posterior teeth (SE6). The SafeEnd system can also be used to finish occlusal contours and transitions. Its special advantage is the fact that the burs have non-cutting,
rounded tips, similar to those of the bud-shaped finishing burs of the 379 Series. This beneficial feature also ensures a very good protection of the soft tissues during finishing procedures in the area of the gingival
sulcus, as compared to instruments with cutting tips.

Applications

SafeEnd carbide finishing burs can be used in the entire field of esthetic filling therapy. This includes composite and compomer fillings, composite-reinforced glass ionomer fillings and composite-based temporaries. They are also highly suitable for the finishing of transitions between tooth structure and all-ceramic restorations (20-blade version]. Generally, the 10 blade version is used for trimming and excess removal, while the 20 blade version is designed for the final finishing step before polishing. In conjunction with all-ceramic restorations, only 20 blade instruments should be used.

Figure 7 The SafeEnd instrument kit contains finishing burs in five different lengths, each in 10 and 20-blade versions. They are designed to trim and finish all tooth-colored filling types used in esthetic dentistry. The burs are also available separately in packs of five.

Another application is the clearing of composite residues from the teeth after the removal of orthodontic brackets. The burs selectively remove the composite material without damaging the enamel. This property also makes them very useful for excess removal in filling therapy.

Conclusion

The SafeEnd carbide finishing system by SS White Burs is an excellent product for the fine trimming and
finishing of tooth-colored fillings. In only two steps, the instruments create very smooth surfaces, which can easily be polished to a high luster. Non-cutting bur tips protect the gingival attachment from damage, and the adaptation of the lengths to the various tooth surfaces helps to meet the specific requirements of each indication. The SafeEnd finishing burs are therefore an important element in systematic esthetic filling therapy.

References

Rzanny A, Diirnbrack M, Welker D, Fachet M.
"Optimierung der Oberfliichenqualitiit von Kompositen unterschiedlicher Indikation"
Dtsch Zahniirztl Z 2003
Sep;58(9):533-537