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Why Take This Course? The use of porcelain-metal and all-ceramic restorations to restore teeth that have had many restorations over the patient’s lifetime is a routine procedure. Learn about the materials and techniques you can use for aesthetic management of these restorations.

PaTienT Care—While repairs can be durable, the patient needs to under-stand all the implications of treatment before commit-ting to the intraoral repair.

ConvenienCe—Contin-ue your education without traveling, taking time away from work and family, or paying high tuition, regis-tration, and material costs.

Ce CrediTs—Successful completion of this course earns you 2 Continuing Dental Education Units.

high QualiTy—Authored for dental profes-sionals, by dental profes-sionals, Dental U® continu-ing education courses are engaging, concise, and user-friendly.

Who should Take This Course? Dentists, Dental Assistants, and Dental Hygienists.

These courses have been designed specifically to meet the needs of busy professionals like yourself, who demand efficiency, convenience and value. Begin your Benco educational experience with this course today, and watch the mail for live CE events in your area.

ACCEPTED NATIONAL PROGRAM PROVIDER FAGD/MAGD CREDIT

Current Concepts for Polishing anterior Composite resins2 CONTINUING EDUCATION CREDITS Howard E. Strassler, DMD, FADM, FAGD, Professor Division of Operative DentistryDepartment of Endodontics, Prosthodontics, and Operative DentistryUniversity of Maryland Dental School650 West Baltimore Street, Baltimore, Maryland 21201410-706-7551Email: hstrassler@umaryland.edu

suPervised selF-sTudy Courses FroM BenCo denTal

Course oBjeCTivesAt the completion of this program the partici-pant: will be able to:• describetheindicationsforcrownandbridge

repair• listmaterialsandtechniquesthatcanbeusedtoadheretoexposedmetalofafracturedpor-celain-metal restoration

• list thematerials and techniques that can beusedtoadheretofracturedporcelainofapor-celain-metal restoration

• describethetechniquesforcrownandbridgerepairwithdirectcompositeresin

Course sPonsorBencoDentalisthecoursesponsor.Benco’sADA/CERP recognition runs from November 2009throughDecember2013.Pleasedirectallcoursequestionstothedirector:Dr.RickAdelstein,3401RichmondRd.,Suite210,Beachwood,OH44122.Fax: (216) 595-9300. Phone: (216) 591-1161. email:toothdoc@core.com

sCoring & CrediTs Upon completion of the course, each partici-pantscoring80%orbetter(correctlyanswering16of the20questions)will receive a certificateof completionverifying twoContinuingDentalEducationUnits.The formal continuing educa-tionprogramof thissponsor isacceptedby theAGD for FAGD/MAGD credit. Term of accep-tance:November2009throughDecember2013.Continuingeducationcredits issued forpartici-pationinthisCEactivitymaynotapplytowardlicenserenewalinallstates.Itistheresponsibilityofparticipantstoverifytherequirementsoftheirlicensingboards.

Course Fee/reFundsThefeeforthiscourseis$54.00.Ifyouarenotcom-

pletelysatisfiedwiththiscourse,youmayobtainafullrefundbycontactingBencoDentalinwriting: Benco Dental, Attn: Education Department, 295 CenterPoint Boulevard, Pittston, PA 18640.

ParTiCiPanT CoMMenTsAny participantwishing to contact the authorwithfeedbackregardingthiscoursemaydosothroughthecoursedirector:Dr.RickAdelstein,3401RichmondRd.,Suite210,Beachwood,OH44122.Fax: (216)595-9300.Phone: (216)591-1161.email:toothdoc@core.com

reCord keePingToobtainareportdetailingyourcontinuingeduca-tioncredits,mailyourwrittenrequestto:Dr.RickAdelstein,3401RichmondRd.,Suite210,Beach-wood, OH 44122. Fax: (216) 595-9300. Phone:(216)591-1161.email:toothdoc@core.com

iMPorTanT inForMaTionAny and all statements regarding the efficacyor value of products or companies mentionedinthecoursetextarestrictlytheopinionoftheauthors and do not necessarily reflect those ofBencoDental.Thiscourseisnotintendedtobeasingle,comprehensivesourceofinformationonthegiventopic.Rather,itisdesignedtobetakenaspartofawide-rangingcombinationofcoursesandclinicalexperiencewiththeobjectivebeingtodevelopbroad-basedknowledgeof,andexper-tisein,thesubjectmatter.

Course assessMenTYourfeedbackisimportanttous.PleasecompletethebriefCourseEvaluationsurveyattheendofyourbooklet.Yourresponsewillhelpustobet-terunderstandyourneedssowecantailorfuturecoursesaccordingly.

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Current Concepts for Polishing anterior Composite resins

The esthetic appearance of composite resin is baseduponshape,colorandglossoftherestorationachievedbyfinishingandpolishing.Whencompositeresinswerefirstintroduced in the late 1950’s and early 1960’s they wereself-curedandmacrofilledwithlargefillerparticlesinthe25-50micrometerrange.Inmostcasesthefillerwasmadeofquartz.Thesecompositeresinsoncecontouredhadlittlesurfaceglossandthepatientsensedtheywereroughwhentheirtonguetouchedtherestoration.Theintroductioninthelate1970’sofvisiblelightcuredcompositeresinswithsmallerfillerparticlesmadefromsynthetic,softerglassesmade compositesmore polishablewith improved tooth-like translucency.These restoratives allowed the cliniciantheabilitytoprovidepatientswithmorenaturalandesthet-ictooth-likerestorationsintheanteriorregion.Visible-lightcuredcompositeresinshadchangesinthepolymerizationchemistrythatimprovedthecolorstability.Lightactivationinmostcaseswas initiatedwhenabluewavelength lightwithapeakof460-480nmwasabsorbedbyaphotoinitia-torusuallycamphoroquinone(CQ).TheuseofCQcom-binedwithanorganicamineallowedthechemicalreactionto progress so the composite resin hardened.This light-activatedreactioneliminatedtheneedfortertiaryaminesthatcontributedtounestheticcolorchangesoftheearlierself-curedcompositeresins. Inthelastdecadeandahalfmanufacturershaveintro-ducedawidevarietyofcompositeresinswithvariedap-plications in both the anterior and posterior region. Foranterior restorations microfilled composites and hybridcomposite resins have become accepted as the standard.Microfilledcompositesofferhighpolishabilitywithtooth-like translucency, but unfortunately are radiolucent.Thehighpolishabilityandtheabilitytomaintaintheirlusterofmicrofilledcompositesisduetotheuseofa0.04microm-etercolloidalsilicaparticlesthatcanbewithinthepolymermatrix(homogenousmicrofill)ormixedwiththepolymermatrix,lightcured,andcrushedtomakeaprepolymerfill-erthatisloadedasanorganicfillerwithinthemicrofilledcomposite (heterogenousmicrofill).The smallfillers andresinrichsurfaceallowforhighpolishability.Microfilledcompositesaregenerallyloadedto32-50%byvolume,havegreater polymerization shrinkage, higher water sorptionandahighercoefficientofthermalexpansionandcontrac-tionthanhybridcomposites.(1) Hybridcompositeresinscombinemicrofillerparticles(0.04micrometer fumed silica)withmicrofine glass fill-erswith an average particle size diameter of less than 2micrometers.Typicallythesecompositesareloadedto58-75%byvolumeandareradiopaque.Thismixtureoffillers

accounts for the excellent physical properties with highpolishability when compared to macrofilled composites.

(2)Regrettablyoneproblemwithhybridcompositeresinsis their inability tomaintaintheirglosswhenexposedtotoothbrushingwithtoothpasteandprophylaxispastes.(3-6) Although microfilled composites maintained theirgloss, inhighstressbearingareas,microfilledcompositestheyweremoresusceptibletofracture.(7)Therewasaneedforahighlypolishablecompositeresinwithoptimalphysi-calpropertiesforuseintheanteriorandposteriorregions. Recently a new generation of hybrid compositeresinhasbeenintroduced.Thesecompositeshavebeencategorizedasnanofilledwithfillerparticleswithadi-ameter ranging from 0.005-0.1 micrometers. The in-troductionofnanofillers allowsmanufacturers to cre-ate hybrid composite resins with physical propertiesequivalenttotheoriginalhybridcompositeresins,goodhandling characteristics and higher polishability.(8-12) Thesenanofilledcompositesofferanalternativetomi-crofilledcompositesintheirabilitytobehighlypolish-ablewith toothlike translucency.(10-13)Manynanofilledhybridcompositeresinshavenotonlythebasicshadeselection, but offer an extended range of opacities,translucencies with dentin, enamel, incisal shades toallowforbuildingandstratifyingarestorationtohaveamoretoothlikeappearance.Withthecurrentgenera-tionofnanofilledcompositesforanteriorandposteriorrestorations,thecliniciancanexpectgoodcolorstabil-ity,stainresistance,lowwear,excellentpolishabilityandlusterretention.(2,810-12,15) With the introductionof these composites,manu-facturershavealsointroducedspecializedshadeguidesand recipes to help the clinician choose the mix ofshades to use in specialized circumstances like thebuildingonClassIVincisaledgefracturesfromthein-sideoutandstratifiedbuildingofcompletedfacialve-neers for esthetic bonding.These stratified compositeresinplacements,usingtherecipeconsistingoftheden-tin,enamelbodyshadesandincisalshadescanbeusedtorestoreanteriorandposteriorteeth.Examplesofthisphilosophyofadhesivebondedcompositeresinresto-rationincludeFiltekSupremePLUS(3M-ESPE)whichincludesacomprehensiveshadeselectionwheelthatisusedoncethebasicshadeisselectedfromaClassicVitaShadeGuide® (Vident) classical shadeguide; IPSEm-pressDirect(Ivoclar-Vivadent)whichutilizes“True-to-Nature”shadeswithfivedifferentlevelsoftranslucencyandnaturalfluorescencetomimicanaturaltoothinap-pearance.ShadesareselectedusingtheIPSEmpressDi-

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rectautoclavableshadeguide.Esthet-XHD(DentsplyCaulk)usesasimilarapproachbyprovidingtheclini-cianwithacomprehensiveshadeguidewithexpandedshades(bleachingshadesandsomedarkershadesthanthetraditionalClassicVitaguide)andreceipesontheback of the shade guide to select enamel, dentin andincisalshades.Nanohybridcompositesarethecurrentstate-of-the-art universal anterior and posterior com-posite resins. These advanced composite resins havebeen formulated to bemore sculptablewithminimalslumpandverylittletackinessforeaseofplacement. Thefinalestheticappearanceofanycompositeresinwillbebasedupontheartisticabilitiesoftheclinicianinchoosingthecorrectshadeorshadesofcompositeresintomimic thecolorandappearanceof the teethand inshapingandcontouringtherestoration.Therestorationsabilitytoimitateinappearancethetoothand/oradjacentteethwillbebasedupontheproperuseofabrasives tofinishandpolishtherestorativetoitshighestluster.Re-searchhasshownthatthetechniqueforpolishingcom-positeresintoitsoptimalsmoothnessandglossisprod-uctspecificandcompositeresinspecific.(10-27)Regardlessofcompositetype,usingdiscssequentiallyfromcoarsesttosmoothestproducedthesmoothestsurfaces. Theprinciplesgoverningthepolishingofcompos-ite resinsare similar to thoseofdentalmetals.Unlikemetals that have homogeneous alloyed surfaces witha uniform hardness, composite resins have a variablecompositionofresinmatrixandfillerparticles.Insomecases the resinmatrix and fillers have different hard-nesses.Metals, due to hardness and composition usedifferent abrasive systems and while composite resinfinishingsystemscanbeusedonmetals,metalfinishersandpolishersshouldnotbeusedforcompositesinor-dertoavoidundesirablestaininganddiscoloration.Theabrasiveparticlesusedtopolishcompositesarematerialspecific.Similartometalpolishing,thesequenceofpol-ishing for composite resin progresses from the coarsest abrasivetothesmoothest.Finishingandpolishingde-vicesandinstrumentscanbeclassifiedas:1. coatedabrasives,e.g.,abrasivefinishingdisksandstrips;2. rotarycuttingdevices,e.g.,carbidefinishingburs;3. rotarysubmicronparticlediamondfinishingabrasives;4. reciprocatingabrasivetips,e.g.,laminatedabrasiveflat

paddles5. rubberizedembeddedabrasives,e.g.,rubberorsilicone

rotarypoints;6. handinstruments;7. abrasivessuspendedinapolishingpaste.

No matter which abrasives are selected, the rule ofcoarsest to smoothest and then physically debriding thesurfacewithamoistcottonrollbetweenabrasivesmustbefollowed.Foracompletelistingofthewidevarietyoffin-ishingandpolishingburs,diamonds,abrasives,stripsandpastesforcompositeresinrefertotheBencoDentistDeskReferenceasyourresourcefortheseinstruments. Thegoalforplacementofanycompositeresinismini-malfinishingandpolishing.Whilethisisnotdifficultwithroutineanteriorrestorations(ClassIII’sandClassV’s)forlargermoreinvolvedrestorations(ClassIV’sandcompletefacialveneeringespeciallyformultipleteeth)therewillbesignificantlymorecontouringandfinishinginvolved.Typi-cally for these largerrestorationsthesequenceforfinish-ingandpolishinginvolvesgrosscontouring,shapingwithfinishing burs and submicron finishing diamonds witha high-speed handpiece followed by additional finishingwithabrasivediscsand/orrubberpoints.Forlongincisal-gingival restorations, narrow, long finishing burs or dia-mondswithsafe-tippedendsaffordtheabilitytoestablishestheticformtocurvedsurfaces.Whilefinishingbursanddiamondscanbeusedeitherwetordry,theseauthorspre-ferusingthemdrywiththedentalassistantsuctioningthecomposite“dust”duringtheprocedure.Workingwithadryfieldandalighttouchallowsmeforbettervisualizationofshapeandcontourofthecompositeresinsurface.Judicioususeofcoarseandmediumgritfinishingdisksusingonlysmallsectionsofthediskallowsthesamelevelofcontrol.Mostdiskstodayhavesmallermetalhubstoavoidmarringthecompositesurfacebyaccidentallyhittingthecompos-itewith themetalhubsof thedisk.Somemanufacturers(ShofuandBrasseler)haveplaced theirdiskson siliconesheathsthatslipoverthemetalmandreltotallyeliminatingthepotentialofmarringthecompositeresinsurface.Ad-ditionalfinishingoffacialandlingualsurfacescanbeac-complishedwithspecializedrubberizedpolishersinflame,disk and cup shapes.These shapesprovide access to thevariedcontoursofthetooth.Theseareusedonalatch-typecontra-angle handpiece. It is important whenever usingabrasivesystemsthatthesurfaceofthecompositeresinbephysicallydebridedofcompositedebrisandabrasivedebriswithadampcottonrollorgauze.Ifonlyanair-watersprayisused,someoftheabrasivedebriswillremainontheres-torationsurfaceandinterferewithattainingthesmoothestpolishwiththenextfinestabrasivegritwiththenextstep-downinstrument. Interproximalfinishingandpolishingisaccomplishedwithgappedfinishingandpolishingstripscoveredwithaluminumoxideabrasiveparticles.ormetalstripscov-

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Figure 1a: Smile view of discol-ored maxillary anterior teeth due to enamel demineralization occurring dur-ing orthodontic trewatment.Figure 1B: Retracted view of maxiallary anterior teeth.Figure 2: Long, thin composite resin finishing bur (Brasseler) trim-ming the facial surface

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ered with submicron diamond particles. Occasionally,evenwiththeuseofamatrixstrip,therestorationmaybondtotheadjacentteethliterallysplintingthemtogeth-er. In these cases there are specialized accessories thatallowthecliniciantoseparatetheteethwithoutdamag-ingtherestoration.Onecansawtheteethapartusinganultra-thinstainlesssteelsawblademountedinahandle(Cerisaw,Den-Mat).Thismini-hacksawandhandleal-lowsfortotalcontroloftheinstrumentwhilegentlysaw-ingthroughtheinterproximalresin.Whenusingasaw,agingivalwoodenwedgeshouldbeplacedtoprotectthegingivalpapillawhensawingthrough.AxisDentalcom-binesagappeddiamondcontainingmetalfinishingstripwithsawteethonthestrip.Den-Matusesthesamecon-ceptastheCeriSawbyplacingsafesideddiamondstripsintheirCeriSawhandletofinishresinandceramicve-neer interproximalsurfaces.Anotherusefulaidtohelpgetthroughinterproximalcontactsforaccesswithplace-ment ofmatrix strips or gapped finishing strips is theContactDisc®(Centrix).Thisthin,rigiddiskcanbein-sertedfromtheincisal,occlusalorfacialsurfacestoforcetheteethapartwithrapidtoothseparation.Ifthereisex-cesscompositeresinpresent,thediskwillcreatespacetoplaceamatrixstripforrestorationwithouttakingtherisk

ofcausingbleedingthatagingivalwoodenwedgewouldcausetoperformthesametask.Inthepresenceofexcesscompositeresininterproximallythediskwillbreakawayexcessresinwithoutdamaging therestoration.PremierDentalProductshasdevelopedadiamond-impregnatedthindisk,CompDisk®, thatnotonlycreates spacewithrapidseparationbutcanalsobeusedforinterproximalfinishing or cleaning interproximal surfaces before thebondingprocedure. Therearetimesafterplacementofthecompositeres-toration, that margination is best accomplished with ahand instrument or by using a specialized reciprocatinghandpiecewithaflatabrasivepaddle.Carbidetippedhandinstruments(Brasseler),restorativeknives(Hu-Friedy)orscalpelbladeswithshapesthatallowforaccesstotheres-torationmarginallowthecliniciantoremoveoverhangingrestorativematerialinamorecontrolledwaythanwithro-tarybursordiamonds.(17,28)Carbidecarversareespeciallyusefulformarginatingcompositeresinrestorationswhereslightexcessesexist.Inhardtoreachareassuchastheinter-proximalsurfaceatthegingivalmargin,specializedinstru-mentsanddevices,e.g.,areciprocatinghandpiece,Profin™(Dentatus)withaflatLamineer™abrasivetipcanbeused.(28,29)Lamineertipscomeinavarietyofsubmicronabrasivesforfinishingandpolishingcervicalmarginsoftherestora-tion.Theflattipscanalsobeusedtofinishandshapefacialsurfacesandincisalembrasures. Final polish of the composite resin surface to itsmostlustrousfinishcanaccomplishedusingdiskswiththe finest aluminumoxide abrasive.Using a diskwillnotonlysmooththeresinsurface,butitalsoheatsthesurfacecreatingahighluster.Thisheatingofthesurfacecausesthepolymermatrixtoreachitsglasstransitiontemperature. This phenomenon gives the compositeresinaglassyappearance.Also,acompositeresincanbepolishedwithspecializedcompositeresinpolishingpasteswhichcontaineitherveryfinealuminumoxideabrasiveparticlesordiamondparticles.Thisisbestac-complishedwithwithfoamcups,feltmountedondisksorfinegoat’shairbrushes.Ifthesurfaceoftherestora-tionissmoothwithnofaciallobularform,disksworkwell. For facial surfaces of composite resins that haveanatomicvariationof lobular formorstriations,com-positepolishingpastesworkbest. Case rePorT: A18year-oldfemalepresentedwithconcernsabouttheappearanceofhermaxillaryanteriorteeth.Shehadcom-

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pletedorthodontictreatmenttoalignmentherpermanentdentition. Unfortunately, during treatment, the difficultyincleaningadjacenttothebondedbracketsresultedinde-mineralization.Althoughremineralizationtherapywithaprescriptionfluorides(Prevident5000Plus,Colgate)andtheuseofacaseinphosphopeptides-amorphouscalciumphosphatepaste(CCP-ACP,MiPaste,GCAmerica,Alsip,IL)waseffective,thediscolorationsonthefacialsurfacesof#6-11wereestheticallyunacceptabletothepatientandhermother.(Figure1) During therestorative treatmentconsultation thepa-tientwaspresentedwithtwominimallyinvasivetreatmentchoices-porcelainveneersordirectplacementcompositeresin.Basedupontheageofthepatient,therecommenda-tionforminimallyinvasiveporcelainveneerswasdiscour-agedbecauseofthepotentialfortheanteriorteethtohaveadditionaleruptionandchanges intheheightofthefreemarginalgingivaduetothepatient'sage.Thepatientandher parents followed this clinican's recommendation fordirectbondedcompositeresinveneersfor#6-11.Adiag-nostic“wax-up”wasnotneededbecausethetoothalign-mentandtoothshapeswereestheticallyacceptableforthepatient.Inothercaseswherethepatientdesirestochangetoothshapeandpositionadhesivebondingwithcompos-iteresinandceramicveneerscanbeusedasasuccessfulalternative treatment for esthetic correction of the toothmalpositionintheanteriorarea.(30,31)Whenthepatientac-ceptedtreatment,shewasscheduledforrestorationwithadirectplacementoptimizedparticlenano-hybridcompos-iteresin(N'Durance,Septodont)toestheticallyveneerthemaxillaryincisorsandcanines. Thechoice forN'Durancewasbasedupon thisclini-cian's experience with patients that havemouth breath-ingandleavethesurfaceofthecompositeresindrydur-ingtheirnormalactivities.ThedesiretohaveahighlusterwhentherestorationwasdryandgoodpolishretentionisofferedbytheuniquemonomerchemistryofN'Durancebasedupondimeracidmonomersthatsignificantlyreducepolymerizationshrinkage,shrinkagestressesandincreasedtheinitialdoublebondconcentrationofthemonomerandthedegreeofdoublebondconversionachievedduringpo-lymerization.(32,33)WithN’Durance, theuseofoptimizednano-fillersofYtterbiumFluoride,Bariumglassandsilicamakethiscompositeeasytodistinguishinradiographsandprovideforwearresistancesimilartoexistingnanofilledcomposites.(34-36)With this significantly lower volumetricshrinkage and non-stick formulation with N’Durance,well- adapted composite resin restorations aremore eas-ilyachievable.Sidebenefitsofthisnewchemistryinclude

extremelylowwatersorptionandsolubilitywhichcontrib-utestocolorstability(nocolorshifting),marginalintegrityandstainresistanceof thecomposite.Aclinical researchstudy evaluating theN’Durance to restore anterior teethdemonstratedexcellentclinicalresultsinallthecategoriesevaluatedatoneyear.(37)

CliniCal ProCedure Beforetoothisolation,ashadewasselectedwithaClas-sicVitapan® shadeguide (Vident,Brea,CA).Thepatientwantedtheteethtobeslightlylighterinappearance.Shadeselectionfinalizationwasachievedbyplacinganincrementofcompositeresininthelightershadeontherightcentralincisor, shaping it and light curing that increment. Likemanyofthenewgenerationofnanofilledcompositeresins,N'Durancehasshadechoicesofregularshades,translucentshades, and bleaching shades. Although N'Durance hasverylittlecolorshiftwhenlightcured,somecompositeres-inschangetheirshadesignificantlywhenlightcured.Thiscolorshiftoccursduringlightcuringduetothechemistryofthepolymerizationprocess.Byexposingthecompositeresintothelightsource,ableachingoutoftheorange-yel-lowcoloredphotoinitiator,camphoroquinone,occursandthematerialreachesitsfinalshade.Accurateshadeselec-tion is a critical step when placing anterior composite res-ins.Thepatientwaspleasedwiththelightershadeandwasreadyfortreatment. Theteethwereisolatedusinglipretractors.Sincethetoothshapeandalignmentwereacceptable,aswellas,aminimallytranslucentshadeofN'Durancewasselectedtoblockouttheenameldiscolorations,onlyaminimal-ly invasive preparation of the facial surfaces of #6-11wasneeded.Theteethwereminimallypreparedleavingenameltoadepthof0.3mmusingtheamediumgritflameshapeddiamond(Revelation653-016,SSWhiteBurs)onahighspeedhandpiecewithwaterspray.Sincetherewasnoneedforincisaledgelengthchanges,theincisaledgeswerenotchanged. Whiletherearemanydifferenttechniquestorestore#6-11withdirectcompositeveneers,Ihavefoundthatthefol-lowingsequencegivesmeexcellentcontrolofthecompos-iteshapeandwidthsduringfreehandsculpting.Theteethwererestored,twoteethatatimetocontroltoothshapeandcontour.Thesequenceofrestorationwasthemaxillarycen-tralincisors,therightmaxillarylateralincisorandcanine,andthentheleftmaxillarylateralincisorandcanine.Be-foreacidetching,deadsoftstainlesssteelmetalmatrix,thickness0.001 inch thick (Pulpdent)wasplacedas amatrix. For themaxillary central incisors,my experi-

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Figure 3: Coarse XT Soflex disk (3M-ESPE) shaping incisal edge. Figure 4: Coarse XT Soflex disk (3M-ESPE) shaping incisal embrasure. Figure 5: For another case Vision Flex disk (Brasseler) shaping facial and incisal embrasures. Figure 6: For another case Profin with “S” type Lamineer tip (Dentatus) shaping facial embrasure. Figure 7: For another case safe sided Lamineer tip on Profin reciprocating handpiece, shaping gingival interproximal embrasure. Figure 8: Enhance (Dentsply Caulk) finishing cup smoothing facial surface of composite resin.

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encehasbeenthatusingaTofflemirestainlesssteelrigidmatrix (0.002 inch thick) cut into a small rectangularstrip placed between the central incisors provides forthecorrectorientationofthemidlinetotheinterpupil-laryplane.Followingtheplanforrestorationtwoteethatatime,thefacialtoothsurfacesandslightlyovertheincisaledgewereetchedfor15secondswitha32per-centphosphoricacidetchantand thenrinsedwithanair-water spray for 15 seconds.The etched tooth sur-facesweredried,leavingaslightlyfrostyappearancetotheenamel.A5thgenerationadhesive(Septobond,Sep-todont)waspaintedonthefacialsurfaceoftheetchedenamelandthenlightcuredfor10secondswithahighintensityLEDcuringlight(BluePhase20i,Ivoclar-Viva-dent).The nano-hybrid composite resin (N'Durance)wasplacedonthefacialsurfacesofbothcentralincisorsand sculpted with a thin, broad plastic filling instru-ment (PFIAB1,HuFriedy).This instrumentallows forsmoothshapingofthebroadfacialareasofincisors.Theinstrumentwaslightlywettedwithacoatingofadhesiveresintopreventthecompositeresinfromstickingtotheinstrumentandpullingawayfromtheenamelsurface.Thecompositeresinwaslight-curedfor20seconds.Af-ter placement of the composite resin on the central inci-sors, theother teethwerewere restored following thesequencedescribedandthesameprotocol.

Finishing and Polishing: Manymanufacturersprovidekitscontainingfinishingburs, diamond abrasives, rubberized abrasives and disksthatprovidetheclinicianwithanorderlyarrangementoffinishingandpolishinginstruments.Intheseauthors’ex-periences all these kits havemerit.There is certainly noonewaytofinishandpolishcompositeresinbutnomat-terwhatsetofinstrumentsareselectedtheoperatordoesneedtofollowtheorderofcoarsesttofinesttoattainthebestfinishandpolishforcomposites.Forthiscasethefacialsurfaceswerecontouredusingalong,narrowsafe-ended,multiflutedfinishingbur(ET-9F,Brasseler)(Figure2)butasubmicrondiamondabrasivewithasimilarshapecouldalsobeused.Thegingivalmarginwascontouredandmar-ginatedwith a shorter, thin-needle shapedfinishing bur.OtherpopularchoicesforshapingfacialsurfacesofveneersandClassIV’saretheSafe-endedseriesoffinishingbursfromSSWhiteBursandfinishingbursfromAxisDental.Thechoiceoffinishingburanddiamondabrasiveisusuallyadecisionmadebythepractitionerbasedupontheirabilitytocontroltheinstrumentwithoutnotchingtherestoration.Finishingburscanhaveasfewas8and12bladesforgrossreduction. For finer finishing 16-bladed and 30 bladedfinishingbursareavailable.Diamondcompositefinishersusuallyhavediamondparticlesizesofapproximately30-40micronsforfinegrit,15micronsforextra-finegritand8

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Figure 9: Egg-shaped finishing bur (SSWhite Burs) marginating and shaping lingual surface of composite restoration.Figure 10: Goat's hair polishing brush (Ultradent) with composite polishing paste bringing the composite resin to a highly polished surface. Figure 11: Complet-ed restorations smile view (N'Durance Dimer Nano-hybrid, Septodont)

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micronsforultra-finegrit.Athin,brand-newfinishingburcancuttooaggressivelyintoafacialsurface.Ihavefoundthatacompositeresinfinishingburdullsappropriatelyaf-ter twosequencesofautoclavingthusenhancingcontrol.Tofurthermarginateandfinishthegingivalmarginaflameshapedfinefinishingdiamond(862-016,SSWhiteBurs)wasusedbecauseitallowsforbetteraccesstothegingivalmarginwithoutmarringtherootsurfaceofthetooth.ThefacialsurfacewasalsoshapedwithacoarseXTSoflexdisk(#2381C,3M-ESPE). Theincisaledgewasshapedandthelengthdeterminedusingapop-onmandrelwithacoarsedisk(SoflexXTdisk,3M-ESPE)(Figure3).Thebest technique for shaping theincisaledgeistohavethepatientseatedinanuprightposi-tionthatmimicshowtheincisaledgesarevisualized.Thedisk should be oriented with a slight lingual inclinationfollowingthechiselshapeof the incisaledgeofanintactincisor.Theincisalembrasuresandfacialembrasureswereestablishedusingathesamedisk.(Figure4)Thin,flexiblediamonddiskscanalsobeused,e.g.,theVisionFlexDisc,Brasseler)(Figure5)Theseareascanalsobeshapedwithareciprocatinghandpiece,Profin,andan“S”seriesknifeedgeLamineertip(Figure6).Onceshapedtheareaswerefinishedusingsuccessivelysmootherdisksfromamediumtofineandtofinestgrit. Oneofthemostdifficultareastoaccesswhenfinish-inganyestheticrestorationisthegingivalinterproximalmargin. Finishing strips do notworkwell due to thedifficultyofattemptingtoaccessthesemargins.InthiscasetheProfin™withaLamineer™tipwasusedinthegingival interproximal areasbecause it affordedafinecontrolthatthereciprocatinghandpieceallowswithitsback and forthmotion to safely finish and polish therootsurfaceswithoutfearofnotching.(Figure7)Fin-ishingbursonahighspeedhandpiece,ifnotusedcor-rectly,caneasilynotcharootsurface.Eventhethinnestoffinishingbursorsubmicrondiamondsareroundedandcannotchrootsurfaces.TheLamineertipsaresafesidedandcomeindecreasingdiamondabrasivegritstofinishandthenpolishthegingivoproximalsurfaces. Thereare timeswhena rotary instrumentorevena reciprocating instrument does not have completeaccess to the interproximal surface. For these specialsituations, ahand instrument allows forfine control ,precision placement and effective removal of excesscompositeresin.Handinstrumentsforthisuseincludecarbidetippedcompositeinstruments(withspecializedshapes to access different tooth surfaces), compositecarvingknivesanda#12scalpelblade.(28)

The finishing and polishing of the interproximalsurfaces of composite resin restorations require thesame attentiongiven accessible surfaces.Care shouldbe takennot to aggressivelyfinish interproximal sur-facesbyremovingexcessivecompositeresinresultinginanopenproximalcontact.Interproximalstripscanbeusedtoshapeandcontourtheinterproximalcontactthus maintaining the proximal contact. When usingfinishingstrips,alwaysproceedfrommediumabrasivegrittofinegrittothefinestgritstrips.Gappedfinish-ingstripsworkbestastheyallowtheoperatoreaseofplacementbetweentheteeth.Ifthereisdifficultyget-tingthestripthroughthecontact,thiscanbeaccom-plishedusingaplasticfillinginstrumenttorapidlysep-aratetheteethandthenslidingthefinishingstripbelowtheinterproximalcontactarea.Iftheoperatorwantstouseadiamondabrasivegapped strip, (e.g.,Opencen-tered lightening strips,Miltex) , additional caremustbetakentonotremovetoothstructurewhenfinishingthe interproximal areas.These diamond impregnatedstrips work well in removing stain on interproximaltoothsurfacesbeforethebondingprocedure.

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Intermediate finishing of the facial surface was ac-complished with a cup-shaped, rubber finisher, e.g,Astropol, Ivoclar-Vivadent; Jazz, SS White Burs, andEnhance, Dentsply-Caulk) For this case a cup shape(Enhance) affords access to the gingival facial marginand contours the facial surface. (Figure 8) If lobularfacial formisdesiredintherestoration, thiscanbeac-complished once the facial surface has been smoothedbyusingadiskshapedrubberizedabrasive.Thelingualsurfacewasfinishedwithanegg-shapedfinishingbur(SSWhiteBurs)(Figure9).Thesurfacewasthensmoothedwithaflameshapedpoint(Jazz,SSWhiteBurs)Occlu-sionwascheckedbeforethefinalpolishwascompleted. Thefinalpolishwasaccomplishedwithacompositeresin polishing paste (Sparkle, Pulpdent) using a goatshairpolishingwheel(Jiffy®GoatBrush,Ultradent)(Fig-ure 10). Foam cups (Luminescence™, Premier DentalProductsandEnhancefoamcups,Dentsply-Caulk)canalso be used effectivelywith composite resin polishingpastes.Anothertechniqueforattainingasmooth,highlusterisusingthefinestgritaluminumoxidediskavail-ableorthefinestgritofrubberpolishingpoint.Runningthe finest abrasive disk or rubber point above 18,000rpm’s creates a highly lustrous surface.This is due toboththepolishingeffectofthediskandthefactthatthediskheatstheresinsurfacecreatingaglassyappearance.Interproxmal areas can be further polishedwith smallwidthgappedfineabrasivefinishingstripsorcompositeresinpolishingpasteonaLamineerplasticpolishingtip(Dentatus)withthereciprocatinghandpiece.Thepatientwaspleasedwiththefinalresult.(Figure11)

disCussion: Theclinicalsuccessoffinishingandpolishingtech-niquescanbestbeseenduringtherecallappointmentsofpatient’srestorations.Whilethecurrentgenerationofcomposite resins ishighlypolishable, thismaynothold true forallcases.Thehighlypolishedsurfaceofresin-richmicrofills are still prone to staining(38).Thepotentialstainingofcompositeresinsurfacesisdirectlyrelatedtoapatient’soralhabitsincludingapatient’sdiet(coffee, iced tea, wine and other alcoholic beverages,colabeverages, tea),aswellasotherhabits(smoking,chewtobacco,andtheuseofalcoholcontainingmouthrinses).The staining due to coffee, tea and smokingarisesfromthedepositionofstainfromtheoffendingagent.Alcoholicbeverages andhighpercentage alco-holcontainingmouthrinsescausecompositestainingbysofteningtheresinmatrixofthecompositeresin.(39-

42)Thissoftenedpolymermatrixallowsthepatienttoabradeawaythematrixleavingexposedfillerparticlesandaslightlyroughenedcompositeresinsurfacesus-ceptibletostaining.Ithasalsobeendemonstratedthatacidulatedfluoridescanhaveanetchingeffectonglassfillerparticlesleavingcompositesrougheraswell.(43,44) Oralmaintenanceofrestorationsandoralhealthcanalsohaveanimpactontheappearanceofcompositeres-ins.Asstatedearlier,highconcentrationalcoholmouthrinsescansoftentheresinmatrixleavingthecompos-itesusceptibletotoothbrushwithtoothpasteabrasion.Evenwithoutalcoholmouthrinses,toothpastescanaf-fectcompositesmoothness.(3-5)Forpatientswithsignifi-cantstaining,somehygienistsuseairpowderabrasiveinstruments to remove stain.The sodiumbicarbonateabrasivepowderusedtoremovetoothstainscansignif-icantly roughen composite resin restorations.(45) Care mustbetakenwhenusingthesedevices. Theglossofthecompositeresincontributestotheoverallestheticappearanceoftherestoration.Itispos-siblethatevenfollowingall therecommendationsforfinishingandpolishingcompositeresinstotheirhigh-est luster,thatoutsideinfluencescanhavedeleteriouseffects on the smooth composite surface. Because ofthesepotential adverse effects, composite resin resto-rationsneed tobe reassessed for repolishingat everyrecall.Thedentalhygienistneedstobeawareofpoten-tiallydamagingeffectsofthepastesandstainremovaldevices theyuse.Also, thedentalhygienistshouldbeinstructedwith techniques for repolishing compositeresinrestorationsusingfineabrasivealuminumoxidecompositeresinpolishingpastesanddisks.

ConClusion: Duringthelastseveralyearsmorepolishablenano-filledcompositeresinshavebecomeavailablewiththephysical properties of hybrid composite resins.Withthese new composites have come new polishing sys-temstoincluderubberizedabrasives.Manyofthein-strumentsthathavepreviouslyusedtofinishcompositeresinsarestillveryusefulwiththenewercomposites.Inordertoattaintheoptimalfinishforcompositeresinsitisimportanttofollowmanufacturer’srecommenda-tions.Usingasystematictechniquefromfinishingbursanddiamonds,abrasivedisks,rubberizedabrasivesandcompositeresinpolishingpaste,youshouldbeabletoimpartanenamel-likelustertoyourcompositeresins.Caremustbetakentoreevaluatetheserestorationsateveryrecallandrepolishthemasneeded.

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RefeRences 1. PowersJM.Compositerestorativematerials.InRestorativeDentalMa-

terialseditedbyCraigRGandPowersJM.Edition11,MosbyPublish-ing,2002;p.232-258.

2. StrasslerHE,Polishingcompositeresins.JEsthetDent,1992;4:177-179.3. StrasslerHE,MoffittW.Thesurfacetextureofcompositeresinafterpol-

ishingwithcommerciallyavailabletoothpastes.CompendContinEducDent1988;8:826-830.

4. SerioFG,StrasslerHE,LitkowskiL,etal.Theeffectofpolishingpastesoncompositeresinsurfaces.JPeriodont1988;59:838-840.

5. Roulet JF, Roulet-Mjehrens TK.The surface roughness of restorativematerialsanddentaltissuesafterpolishingwithprophylaxisandpolish-ingpastes.JPeriodont1982;53:257-266.

6. NemeAL, FrazierKB,Roeder LB,DebnerTL. Effect of prophylacticpolishingprotocolsonthesurfaceroughnessofestheticrestorativema-terials.OperDent2002;27:50-58.

7. GoldmanM.Fracturepropertiesofcompositeandglassionomerdentalrestorativematerials.JBiomedMaterRes,1985;19:771-783.

8. CRANewsletter2003;27(1):1-2.9. Peyton JH. Direct restoration of anterior teeth: review of clinical

technique and case presentation. Pract Proced Aesthet Dent 2002;14(3):203-210.

10. SenawongseP,PongprueksaP.Surfaceroughnessofnanofilandnana-hybridresincompositesafterpolishingandbrushing. JEsthetRestorDent.2007;19:265-73.

11. AlmeidaGS,PoskusLT,GuimaraesJG,daSilvaEM.12. SensiLG,StrasslerHE,WebleyW.Clinicalmaterialsreview:directcom-

positeresins.InsideDent.2007;3(7):76-79.13. StanfordWB,FanPL,WozniakWT,StanfordJW.Effectoffinishingon

color andglossof compositeswithdifferentfillers. JAmDentAssoc1985;110:211-213.

14. DaCostaJ,FerracaneJ,ParavinaRD,etal.Theeffectofdifferentpolish-ingsystemsonsurfaceroughnessandglossofvariousresincomposites.JEsthetRestorDent.2007;19:214-24.

15. KorkmazY,OzelE,AttarN,AksoyG.Theinfluenceofone-steppolish-ingsystemsonthesurfaceroughnessandmicrohardnessofnanocom-posites.OperDent.2008;33:44-50.

16. BarghiN.Surfacepolishingofnewcompositeresins.CompendContEducDent2001;22:918-924.

17. Duke ES. Finishing and polishing techniques for composite resins.CompendContEducDent2001;22:392-396.

18. Barghi N. A guide to polishing direct composite resin restorations.CompendContEducDent2000;21:138-144.

19. OzgunaltayG,YaziciAR,Gorucu J. Effect of finishing andpolishingprocedures on the surface roughness of new tooth-coloured restor-atives.JOralRehabil2003;30:218-224.

20. ReisAF,GianniniM,LovadinoJR,dosSantosDiasCT.Theeffectofsixpolishingsystemsonthesurfaceroughnessoftwopackableresin-basedcomposites.AmJDent2002;15:193-197.

21. PrattenDH,JohnsonGH.Anevaluationoffinishinginstrumentsforananteriorandaposteriorcomposite.JProsthetDent1988;60:154-158.

22. Jefferies SR,BarkmeierWW,GwinnettAJ.Three composite finishingsystems:amultisiteinvitroevaluation.JEsthetDent1992;4:181-185.

23. BarkmeierWW,CooleyRL.Evaluationofsurfacefinishofmicrofilledresins.JEsthetDent1989;1:139-143.

24. HoelscherDC,NemeAM,PinkFE,HughesPJ.Theeffectofthreefinishingsystemsonfourestheticrestorativematerials.OperDent1998;23:36-42.

25. SetcosJC,TarimB,SuzukiS.Surfacefinishproducedonresincompos-itesbynewpolishingsystems.QuintessenceInt1999;30:169-173.

26. BottaAC,DuarteJuniorS,PaulinFilhoPI,GhenoSM,PowersJM.Sur-faceroughnessofenamelandfourresincomposites.AmJDent.2009;22:252-4.

27. deMaraiesRR,GoncalvesLde S,LancellottiAC, et al. Nanohybridresincomposites:nanofillerloadedmaterialsortraditionalmicrohybridresins.OperDent.2009;34:551-7.

28. Strassler HE. Interproximal finishing of esthetic restorations. MSDAJournal1997;40(3):105-107.

29. StrasslerHE,BrownC.Periodontalsplintingwithathinhigh-moduluspolyethyleneribbon.CompendContinEducDent2001;22:696-702.

30. HelveyGA.Usingpressableceramicstoachieveorthodonticcorrection.PractPeriodandAesthetDent2002;14:223-227.

31. Lowe RA. Instant orthodontics: an alternative esthetic option. DentProdReport2002;36(7):50-52.

32. GeJ,LemonMT,LuH,StansburyJW.Dimeracid-deriveddimethac-rylatesasdiluentsmonomersinrestorativeresins.JDentRes(SpecialIssueA);2005;84:abstractno.1470.

33. LuH,NewmanSM,BowmanCN,Stansbury JW.Dimeracidderiveddimethacrylateforternarydentalrestorativeresins.JDentRes(SpecialIssueA).2006;85:abstractno.32.

34. Bracho-TroconisC,RudolphS,BouldenJ,WongN,etal.Characteriza-tionofanewdimeracidbasedresinnano-hybridcomposite.JDentRes(SpecialIssueA).2008;87:abstractno.81.

35. Bracho-Troconis C, Rudolph S, Garnhart A, Boulden J. New low-shrinkagedimeracidbasedmicrohybridcompositephysicalproperties.JDentRes(SpecialIssueA).2007;86:abstractno.1290.

36. BurgessJ.Comparisonpolishingofnanofilledcomposites.CompendContinDentEduc(Supplement).2010;31(2):9-11.

37. RitterH,LeeSS. Clinical evaluationofN’Durancenano-dimer con-versiontechnologydentalcompositeJDentRes.2009;89(SpecialIssueIADRAbstracts):Abstract1006.

38. LuceMS,CampbellCE.Stainpotentialoffourmicrofilledcomposites.JProsthetDent1988;60:151-154.

39. McKinneyJE,WuW.Chemicalsofteningandwearofdentalcompos-ites.JDentRes1985;64:1326-1331.

40. SettembriniL,PenugondaB,SchererW,StrasslerH,HittelmanE.Al-coholcontainingmouthwashes:effectoncompositecolor.OperDent1995;20:14-17.

41. PenugondaB,SettembriniL,SchererW,HittelmanE,StrasslerH.Alco-hol-containingmouthwashes:effectoncompositehardness.JClinDent1994;5:60-62.

42. Almeida GS, Poskus LT, Guimaraes JG, Da Silva EM.The effect ofmouthrinsesonsalivaryabsorption,solubilityandsurfacedegradationofananofilledandahybridresincomposite.OperDent.2010;35:105-11.

43. Kula K, Nelson S, Kula T,ThompsonV. In vitro effect of acidulatedphosphatefluoridegelonthesurfaceofcompositewithdifferentfillerparticles.JProsthetDent1986;56:161-167.

44. SoenoK,MatsumuraH,AtsutaM,KawasakiK.Influenceofacidulatedphosphatefluorideagentandeffectivenessofsubsequentpolishingoncompositematerialsurfaces.OperDent2002;27:305-310.

45. CooleyRL,LubowRM,PatrissiGA.Theeffectofanair-powderabrasiveinstrumentoncompositeresin.JAmDentAssoc1986;112:362-364.

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test questions

1. Usually the photoinitiator used for light cured composites is

a. silaneb. glassfillersc. camphoroquinoned. Bis-GMA

2. Microfilled composites offer high polishability with tooth-like translucency, but unfortunately are radiolucent. The high polishability and the ability to maintain their luster of microfilled composites is due to the use of colloidal silica particles that can be within the polymer matrix (homogenous microfill) or mixed with the polymer matrix, light cured, and crushed to make a prepolymer filler that is loaded as an organic filler within the microfilled composite (heterogenous microfill). The filler particle size of the colloidal silica particles is

a. 0.04micrometersb. 0.4-0.9micrometersc. 1-3micrometersd. 5-15micrometers

3. A new class of nanofilled composite resins offer the clinician a combination of improved physical properties and

a. betterflowtoadapttomarginsb. higherpolishabilityc. expandedshadesforimprovedshadeselection

andtheabilitytomatchincial,enamelanddentinshades.

d. bandc

4. Nanofilled composites have filler particles with a diameter ranging from

a. 0.005-0.1micrometersb. 0.5-5micrometersc. 5-10micrometersb. 20-50micrometers

5. All the following are nanofilled composite resins EXCEPT. The EXCEPTION is

a. IPSEmpressDirectb. Esthet-XHDc. N’Duranced. Smoothy

6. The restorations ability to imitate in appearance the tooth and/or adjacent teeth will be based upon the proper use of abrasives to finish and polish the restorative to its highest luster. Research has shown that the technique for polishing composite resin to its optimal smoothness and gloss is product specific and composite resin specific.

a. Bothstatementsaretrueb. Thefirststatementistrue,thesecondstatementis

falsec. Bothstatementsarefalsed. Thefirststatementisfalse,thesecondstatementis

true

7. All the following are instruments or devices to finish and polish composite resins EXCEPT. The EXCEPTION is

a. coatedabrasives,e.g,abrasivefinishingdisksandstrips

b. ultrasonicscalingtipsc. carbidefinishingbursd. submicrondiamondabrasives

8. Gross finishing and contouring can easily be accomplished with

a. finishingbursb. submicronfinishingdiamondsc. coarseandmediumgritdisksd. alltheabove

9. There are times when placing an anterior composite resin that an excess at the gingival interproximal margin needs to be removed. This excess can be removed using

a. aProfinreciprocatinghandpiecewithaLamineertipabrasivetip

b. afinishingdiskc. #12scalpelbladed. aandc

10. Finishing of interproximal surfaces as described in this article include all the following EXCEPT. The EXCEPTION is

a. gappedfinishingandpolishingstripscoveredwithaluminumoxideabrasiveparticles

b. metalstripswithsubmicrondiamondsc. dentalflosswithzironiaabrasive

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11. Occasionally when placing interproximal restorations with composite resins, the adjacent teeth may bond together. A technique described in the article to separate the teeth using an intraoral

a. jackhammerb. routerc. sawd. hammer

12. To achieve the highest luster for a composite resin, one method for the final step of polishing would be a

a. finishingburb. submicronfinishingdiamondc. compositeresinpolishingpasted. airabrasion

13. Final polish of the composite resin surface to its most lustrous finish can accomplished using disks with the finest aluminum oxide abrasive. Using a disk will not only smooth the resin surface, but it also heats the surface creating a high luster. This heating of the surface causes the polymer matrix to reach its_______________________________. This phenomenon gives the composite resin a glassy appearance.

a. waxedsmoothnessb. glasstransitiontemperaturec. fillermosaicpolishd. polymermatrixinterstitialflexure

14. The patient treated with direct esthetic bonding in this article had tooth discoloration due to

a. tetracyclinestainingb. demineralizationduetobacterialplaqueretainedby

orthodonticbracketsc. endodonticstainingd. hypoplasticwhitespots

15. The choice of composite resin to restore the anterior teeth for the patient in the case report is a low shrinkage composite with a high degree of double bond conversion that has a unique composite chemistry based upon

a. dimeracidmonomersb. glyomonersc. resinomersd. pleobisphenoldimethacrylate

16. The addition of optimized nanofillers of what type make N’Durance composite resin easy to distinguish in radiographs and provide for wear resistance.

a. Ytterbiumfluorideb. bariumglassc. silicad. alltheabove

17. The potential staining of composite resin surfaces is directly related to a patient’s oral habits including a patient’s diet (coffee, iced tea, wine and other alcoholic beverages, cola beverages, tea), as well as other habits (smoking, chew tobacco, and the use of alcohol containing mouth rinses). The staining due to coffee, tea and smoking arises from the deposition of stain from the offending agent.

a. Bothstatementsaretrueb. Thefirststatementistrue,thesecondstatementisfalsec. Bothstatementsarefalsed. Thefirststatementisfalse,thesecondstatementistrue

18. Alcoholic beverages and high content alcohol containing mouthrinses can make a composite resin susceptible to staining because they

a. causelossoffillerparticlesthroughchemicaldissolution

b. softenthepolymermatrixofthecompositeresinmakingthemmoresusceptibletowearandsurfaceroughening

c. causemicrofracturesinthecompositeresinsurfaced. causeachangeinchemicalpolarityofthecomposite

surfacemakingitmoresusceptibletoattractstain

19. During dental prophylaxis appointments, the dental hygienist can roughen composite resin surfaces making them susceptible to staining by

a. usingprophylaxispasteswithaprophylaxiscupb. usingaair-powder(sodiumbicarbonateabrasive

particle)abrasiontoremovesurfacestainsc. usinganacidulatedfluoridethatcanetchglassfiller

particles d. alltheabove

20. The dental hygienist can help maintain the luster and polish of composite resins by

a. polishingthesurfacewithprophylaxispastes.b. polishingthecompositerestorationswithfineabrasive

aluminumoxidecompositeresinpastesanddisks.c. cleaningthecompositeswithdiamondairabrasion

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ansWer key Course Order Number [0000-000]

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