Venus Step by Step Guide - Layering-technique

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Venus Step by Step Guide - Layering-technique
Venus®
Step by Step Guide

Chapter 1
Layering-technique
Contents

           Introduction                         2

           Aesthetic composite restorations:
           General information                  4

           Aesthetic composite restorations:
           Anterior teeth                       5

           Case   studies – anterior teeth
           Case   A                             6
           Case   B                            12
           Case   C                            16

           Aesthetic composite restorations:
           Posterior tooth region              21

           Case studies – posterior teeth
           Case D                              22
           Case E                              27

           Annex
           Shade selection                     32
           Preparation                         33
           Adhesion                            34
           Polymerisation                      35
           Finishing and polishing             36

           References                          37

           Venus® indications                  38
           Venus® shades                       38
           Venus® product outline              39
                                                    3
Introduction

               Heraeus Kulzer invests in research and development of dental
               products since many years. Venus® is the result of all experience
               gained in the development of light-curing composites.

               Excellent aesthetics are not simply a matter of chance or time-
               consuming trial and error with Venus®. The excellent handling
               properties, Color Adaptive Matrix, and 2Layer shade system
               of Venus produce excellent aesthetics easily, quickly and reliably.

               All products from Heraeus Kulzer are developed in cooperation
               with universities worldwide. Only this continuous scientific
               discussion allows the perception of the necessities of dentists and
               patients and the study of the right solutions to these growing
               demands.

2
Out of this originates the formative proposal from Heraeus Kulzer
and the University of Brescia in Italy. Professor Antonio Cerutti,
responsible for the Department of Conservative Dentistry, and
his staff consented to build an informative document that allows
you to go step by step into the details of the restorative dentistry.

Aesthetics are nowadays a primary request from patients in all
dental specialities. To combine a result that is aesthetically
suitable to the patient with the necessary functionality and
longevity of a restoration, requires a deep knowledge of various
ambits: adhesion, stratification, colour, polymerisation, finishing
and polishing.

The Venus® Step by Step Guide supplies in a simple, quick
and intuitive way all those concepts that will lead to appreciable
improvements in the clinical day-to-day work.

Thank you for your attention and loyalty,

Heraeus Kulzer

                                                                        3
Aesthetic composite restorations:
General information

Preparation
The surface of the teeth, which will be treated, should be cleaned     Filling materials shrink during the polymerisation process due to
with a fluoride-free prophylaxis paste and the tartar removed,          their material properties. Davidson introduced the C-factor con-
if necessary. The colour should be selected on the still hydrated      cept. He defined it as the ratio between free and bonded surfaces
teeth. All needed indications for this procedure will be provided in   of a restoration: the greater the number of walls connected by an
a following chapter of this guide. For the moment, only the Venus      increment of composite, the more stress accumulated on the
shade guide made of original material will be used for shade           tooth; a class I will therefore be much more unfavourable than a
selection.                                                             class II. To avoid such a problem, a micro-incremental technique
                                                                       and particular measures will be introduced in this chapter of the
Before starting the restoration, a rubber dam should be placed to      Venus Step by Step Guide.
guarantee the work in a place free of humidity (the greatest enemy
of adhesive materials and composites), a greater concentration on
the operating field, and the highest level of safety for the patient.

The restorations should recreate the portion of the dental tissue
lost due to decay, erosion or trauma. It is therefore very important
to remove the damaged or unsteady tissues (undermined enamel).
In the same way, in the case of previous fillings, whether in
amalgam or composite, the old restoration has to be removed and
the remaining natural structure controlled.

4
Aesthetic composite restorations:
Anterior teeth

For anterior restorations it is suggested, when possible, to take      The restoration should be then completed with a sequence of
an impression and make a study model of the mouth situation.           enamel and incisal masses. During these last shaping the
A diagnostic wax-up, which enables the control before and after        transition lines and a portion of the surface texture should be
the treatment and the discussion of the therapy with the patient,      defined.
should be prepared on this model. A silicone guide mask can
be prepared on the wax-up, which will be helpful for rebuilding        Each single layer of composite has to be cured by using a
the palatal or lingual surfaces (Case A) and incisal edges.            polymerisation lamp (e.g. Translux Power Blue). In the chapter
                                                                       concerning polymerisation further details of the available lamps
After placing the rubber dam, it should be checked if the prepa-       and operational protocols will be described.
ration of the incisal edges complies with the adhesion dictates.
Subsequently, the chosen adhesive system can be applied                Finally, after having removed the rubber dam, the occlusion test,
according to manufacturer’s instructions. A later chapter of the       finishing and polishing follow.
Venus Step by Step Guide will directly deal with the details of
the adhesion process.

The silicone guide mask should be positioned in the mouth and
its borders followed so as to stratify a thin, translucent layer
(shades T1, T2 or T3), which reproduces the palatal/lingual surface.
Being an extremely translucent mass, the thickness of the layer
has to be carefully controlled to avoid taking space away from
the dentine mass.

If the situation does not allow the approach with a silicone mask
(Case B), the first layer has to be applied starting from the bottom
of the cavity. When the use of a dentine mass is needed, the
shaping should be conducted according to the precise anatomic
structure highlighted from the adjacent teeth.

                                                                                                                                           5
Case studies – anterior teeth
Case A

                                                            1

                                                                Colour deterioration in
    This young girl has two discolored restorations on          old fillings on the central
    the central upper incisors. Our aim is to restore the       upper incisors.
    teeth using an anatomical stratification with
    composite.                                                   The shade is selected.

                                                                 A silicone guide mask
                                                                 is fabricated based on
                                                                 the diagnostic wax-up
                                                                 to ensure the best
                                                                 occlusal alignment.

                                                                 The teeth are then
                                                                 isolated with a rubber
                                                                 dam.

6
Case studies – anterior teeth | Case A

2                              3

    The old restorations are                 The silicone guide
    removed.                                 mask is put in posi-
                                             tion and checked for
    The margins are pre-                     accurate fit in relation
    pared with a diamond                     to the adjacent teeth.
    ball bur to produce a
    microchamfer.                            A clear matrix is
                                             placed between the
    The adhesive system                      teeth to optimise the
    is applied according                     reconstruction of the
    to the manufacturer’s                    interproximal zones.
    instructions.

                                                                       7
Case studies – anterior teeth | Case A

    4                                                             5

                                         The palatal layer is         Opaque dentine (e.g.
                                         modelled directly            OA2) is applied on top
                                         against the silicone         of the palatal incre-
                                         guide mask using a           ment. This increment
                                         translucent composite        will mimic the typical
                                         (e.g. T1) to mimic the       incisal edge of the
                                         palatal enamel.              upper incisors. If the
                                                                      defect is large, more
                                         The composite                increments will be
                                         is polymerised for           needed.
                                         20 seconds.
                                                                      Each increment
                                                                      is polymerised for
                                                                      40 seconds.

8
Case studies – anterior teeth | Case A

6                             7

    The interproximal wall                  Incisals are individual-
    is reconstructed in                     ised and, if necessary,
    translucent composite                   effect colours are used
    (in one or more incre-                  to recreate the amber
    ments) using the clear                  or bluish zone.
    matrix to help recreate
    the characteristics of
    the natural tooth.

    Each increment
    is polymerised for
    20 seconds.

                                                                      9
Case studies – anterior teeth | Case A

     8                                                               9

                                         Desaturation begins             The last layer of
                                         by applying layers of           translucent material
                                         enamel starting with            (e.g. T1) is applied to
                                         the deeper colours              simulate the vestibular
                                         (e.g. A3) in the middle         enamel.
                                         third and progressing
                                         to lighter colours (e.g.        The increment
                                         A1) in the incisal third.       is polymerised for
                                         It is very important            20 seconds.
                                         to sculpt the correct
                                         shape during this               Once the restoration of
                                         stage.                          tooth 1.1 is completed,
                                                                         tooth 2.1 is restored
                                         Each increment is               using the same
                                         polymerised.                    methods.

10
Case studies – anterior teeth | Case A

10

     The superficial micro-
     geography is recreated
     using diamond burs.

     The restorations are
     polished with diamond
     burs of decreasing size
     and silicone polishers
     on low speed micro-
     motors.

     After removing the
     rubber dam, the func-
     tional and aesthetic
     properties of the resto-
     rations are checked.

                                                                   11
Case studies – anterior teeth
Case B

                                                       1

                                                           Class III caries lesion
     Restorations of class III cavities in the lower       in 3.1 and serious
     incisors are a challenge, as a number of incre-       discolouring of a pre-
     ments of composite have to be applied in a            vious restoration in 4.1.
     small space.
                                                            The shade is selected.

                                                            The operative field is
                                                            isolated with a rubber
                                                            dam.

12
Case studies – anterior teeth | Case B

2                             3

    The old discoloured                     The first increment of
    restorations are                        composite material is
    completely removed                      opaque (e.g. OA2) to
    using rotary and hand                   mimic the base dentine
    instruments to expose                   colour. This increment
    the healthy dental                      must be the same
    tissue, and the                         size and shape as the
    marginal finishing lines                 original dentine tissue.
    (microchamfer) are                      If the defect is very
    established.                            wide, the composite
                                            may have to be applied
    The cavities are                        in several increments.
    rinsed.
                                            Each individual
    The tissues are                         increment should be
    conditioned with                        polymerised for
    an adhesive system                      40 seconds.
    according to the
    manufacturer’s
    instructions.

                                                                     13
Case studies – anterior teeth | Case B

     4                                                              5

                                         The characteristic in-         Colour desaturation
                                         cisal edges are formed         is the next step with
                                         and fissures applied            enamel shades,
                                         to the enamel. If effect       starting from darker
                                         colours are to be used,        shades (e.g. A3) and
                                         they are applied now.          progressing to lighter
                                                                        shade composites
                                         Each increment is              (e.g. A1).
                                         polymerised.
                                                                        Each increment is
                                                                        polymerised.

                                                                        The last increment
                                                                        consists of a trans-
                                                                        lucent composite
                                                                        (e.g. T1) to join the
                                                                        middle third to the
                                                                        interproximal zones;
                                                                        it should be remem-
                                                                        bered that the incisal
                                                                        edge of lower incisors
                                                                        is typically translucent.

                                                                        The increment
                                                                        is polymerised for
                                                                        20 seconds.

14
Case studies – anterior teeth | Case B

6

    The restoration is
    finished and polished.

    Once the rubber dam
    has been removed,
    occlusal marking paper
    is used to check that
    the correct relationship
    between reconstruction
    and function has been
    achieved.

                                                                  15
Case studies – anterior teeth
Case C

                                                          1

                                                              Discoloration of the two
     The two central incisors appear discoloured;             upper central incisors
     they had previously been restored with composite         with previous trauma and
     after trauma. Our aim is to restore the aesthetics       composite restorations.
     of both teeth using direct restorations in com-
     posite.                                                   The shade is selected.

                                                               The operative field is
                                                               isolated with a rubber
                                                               dam.

16
Case studies – anterior teeth | Case C

2                              3

    Both teeth had                           The cavities are rinsed
    received endodontic                      and the adhesive
    treatment in two earlier                 system applied accord-
    sessions.                                ing to the manu-
                                             facturer’s instructions.
    The old discoloured
    restorations are                         The post is cemented
    completely removed                       inside the canal using
    with rotary instruments                  dual-cure cement
    to expose healthy                        in accordance with
    dental tissue and the                    normal adhesive
    marginal finishing                        dentistry practice.
    (microchamfer)
    is established.

    On the most badly
    damaged tooth (1.1)
    the canal cavity is pre-
    pared for subsequent
    cementing of a glass
    fibre post to increase
    the area of adhesion.

                                                                      17
Case studies – anterior teeth | Case C

     4                                                            5

                                         The first increment           Superficial characteri-
                                         of opaque composite          zations or fissures are
                                         (e.g. OA2) is applied,       applied to the incisal
                                         to mimic the dentine         edge using effect
                                         basal colour. If the         colours, if appropriate.
                                         defect is very exten-
                                         sive, the composite          The restoration is
                                         should be applied in         polymerised.
                                         several increments.

                                         Each increment
                                         is polymerised for
                                         40 seconds.

18
Case studies – anterior teeth | Case C

6

    Colour desaturation        The increment
    is the next step with      is polymerised for
    enamel shades, start-      20 seconds.
    ing with darker shades
    (e.g. A3) and progress-    The interproximal
    ing to lighter shade       zones are finished using
    composites (e.g. A1).      hand instruments.

    Each increment is          The palatal surface of
    polymerised.               tooth 2.1 is restored
                               following the same
    The last increment         steps used to recon-
    consists of translucent    struct 1.1.
    composite (e.g. T1)
    to join the middle third
    to the interproximal
    zones.

                                                                                            19
Case studies – anterior teeth | Case C

     7

                                         The restoration is
                                         finished and polished.

                                         Once the rubber dam
                                         has been removed,
                                         occlusal marking paper
                                         is used to check that
                                         the correct relationship
                                         between reconstruction
                                         and function has been
                                         achieved.

20
Aesthetic composite restorations:
Posterior tooth region

In the case of a restoration in posterior teeth, the first thing to      Once the new wall has been completed, the rebuilding of the
do is to decide whether the situation requires a direct or indirect     cavity can be conducted as if it were an occlusal filling (Case D).
solution. A simple rule says that a direct restoration should be        First a layer of flow composite (e. g. Venus flow) is applied at the
placed, when the loss of inter-cusped tissue is less than one third     bottom of the cavity and spread using a probe. The purpose
of the tooth. When the lost of tissue lays between one third and        of this step is to create a uniform liner without air bubbles that
one half, there is the possibility to choose between direct and         guarantees the best possible contact with the adhesive and acts as
indirect restorations. And when the loss is greater than one half       a loading damper. The layer of flow composite should be extremely
an indirect restoration is needed.                                      thin to not compromise the restoration’s mechanical properties.

Modern adhesive techniques and composites enable an appli-              Now the layering of dentine and enamel masses can be started.
cation beyond this rule (e.g. cusp build-up) as already observed in     To offset the contraction caused by polymerisation, the composite
several clinical cases.                                                 is placed in “angles”, in other words, by starting to place small
                                                                        increments in triangular shape; two walls will be in contact with
In preparing a direct restoration rubber dam should be placed,          the polymerised composite and the natural tooth, while the third
the compromised tissue removed and the cavity prepared as               will be free counteracting the unfavourable C-factor. In this way
mentioned. Once the adhesive system is applied, the real resto-         the tensions on the tooth can be reduced as the contraction devel-
ration can be started.                                                  ops towards the centre of the mass.

The missing mesial or distal surfaces should be restored first in a      Characterizations, if needed, and incisal masses should be placed
class II restoration (Case E). The stratification should begin from      to end the restoration. To close, the occlusion is checked and the
the margin for a better control of the contact area. A pre-adapted      restoration finished and polished.
metallic matrix and a balsa wedge should be placed to guarantee
the best continuity with the walls of the remaining tooth structure
and to create a proper contact area with the adjacent tooth. A thin
wall is applied with incisal shades until the height of the occlusive
area. The approximal surface and the contact area are controlled
with a dental floss after removing the matrix (leaving the wedge to
avoid bleedings). The operation should be carried out at this point,
because the wall can be quickly destroyed and rebuilt, if there
should be any errors.

                                                                                                                                         21
Case studies – posterior teeth
Case D

                                                          1

                                                              Leaking of an amalgam
     An old amalgam vestibular/occlusal restoration           restoration in 3.6.
     that presents leakage and secondary caries.
     The latest generation composite materials can             The shade is selected.
     replace amalgam even in posterior sectors, improv-
     ing the aesthetic properties and maintaining              The morphology and
     optimum biomechanical characteristics.                    occlusion are assessed
                                                               before isolating the
                                                               operative field. The
                                                               tooth involved is iso-
                                                               lated with a rubber
                                                               dam (the restoration
                                                               will not involve the
                                                               interproximal zone,
                                                               so we can isolate the
                                                               single tooth and not
                                                               the whole sextant).

22
Case studies – posterior teeth | Case D

2                             3

    The amalgam filling is                   The first translucent
    removed with a multi-                   increment of com-
    fluted bur mounted on                    posite (e.g. T1) is
    a turbine, ultrasonic                   applied to seal the
    scaling tips and hand                   vestibular surface of
    instruments, to mini-                   the cavity perimeter.
    mize the amount of
    healthy dental tissue                   The increment
    sacrificed.                              is polymerised for
                                            20 seconds.
    Caries detecting so-
    lution can be used to
    ensure that all carious
    tissue is removed.

    The marginal finishing
    line (microchamfer)
    is established with a
    012 ball bur mounted
    on a turbine.

    Tissues are then
    hybridized with an
    adhesive system
    following the
    manufacturer’s
    instructions.

                                                                      23
Case studies – posterior teeth | Case D

     4                                                              5

                                          The first translucent          The stratification
                                          increment of composite        begins with a horizon-
                                          (e.g. T1) is applied to       tal increment of
                                          seal the vestibular           opaque composite
                                          surface of the cavity         (e.g. OA2) that helps
                                          perimeter.                    to mimic the colour
                                                                        of the tooth to be
                                          The increment                 reconstructed. If the
                                          is polymerised for            cavity is very wide, it
                                          20 seconds.                   is better to apply this
                                                                        composite in several
                                                                        increments.

                                                                        Each individual
                                                                        increment is
                                                                        polymerised for
                                                                        40 seconds.

24
Case studies – posterior teeth | Case D

6                             7

    In order to desaturate                 Stratification concludes
    the colour, first a                     with the application
    darker shade compos-                   of a thin increment of
    ite (e.g. A3.5) and                    translucent composite
    then lighter shades of                 (e.g. T1) along the
    composite (e.g. A1)                    edge of the cavity and
    are applied.                           along the first part of
                                           the cuspal surface.
    Increments are applied
    in triangles in order                  The increment
    to reduce stresses on                  is polymerised for
    the cavity walls due to                20 seconds.
    polymerization shrink-
    age and to allow better
    anatomical modelling.

    Each increment is
    polymerised.

                                                                      25
Case studies – posterior teeth | Case D

     8

                                          The restoration is then
                                          finished and polished.

                                          Once the rubber dam
                                          has been removed,
                                          occlusal marking paper
                                          is used to check that
                                          the correct relationship
                                          between reconstruction
                                          and function has been
                                          achieved.

26
Case studies – posterior teeth
Case E

                                                       1

                                                           Recurrence of caries in
 Recurrence of caries in this upper molar, which           tooth 2.6, previously
 had previously been filled using amalgam; the              restored with amalgam.
 treatment plan is to remove the old restoration and
 replace it with a composite filling.                        The shade is selected.

                                                            The morphology and
                                                            occlusion are assessed
                                                            before isolating the
                                                            operative field.

                                                            The tooth involved is
                                                            isolated with a rubber
                                                            dam (as the interproxi-
                                                            mal walls have to be
                                                            restored, the adjacent
                                                            teeth will have to be
                                                            isolated as well as the
                                                            tooth itself).

                                                                                 27
Case studies – posterior teeth | Case E

     2                                                              3

                                          The amalgam filling is         A sectional or ring
                                          removed with a multi-         matrix is put in position
                                          fluted bur mounted on          and fixed with a balsa
                                          a turbine, ultrasonic         wedge so that it fits
                                          scaling tips and hand         tightly against the
                                          instruments, to mini-         cervical margin and
                                          mize the amount of            the contact area.
                                          healthy dental tissue
                                          sacrificed.                    The first vertical incre-
                                                                        ment of translucent
                                          Caries detecting so-          composite (e.g. T1) is
                                          lution can be used to         applied to reconstruct
                                          ensure that all carious       the interproximal wall;
                                          tissue is removed.            particular care must
                                                                        be taken to avoid any
                                          The marginal finishing         gaps in the cervical
                                          line (microchamfer)           margin seal.
                                          is established with a
                                          012 ball bur mounted
                                          on a turbine.

                                          Tissues are then
                                          hybridized with an
                                          adhesive system
                                          following the
                                          manufacturer’s
                                          instructions.

28
Case studies – posterior teeth | Case E

                          4

The increment is                       The matrix is removed
polymerised for 20                     (not the wedge, to
seconds.                               avoid bleeding) and
                                       dental floss is used to
The next increment of                  check that there is
translucent composite                  sufficient contact area.
completes the recon-                   If this is not the case,
struction of the inter-                the increments applied
proximal wall, extend-                 must be removed, the
ing it to the height                   matrix must be repos-
of the marginal crest.                 itioned and the inter-
                                       proximal wall must be
The increment                          reconstructed.
is polymerised for
20 seconds.                            A layer of about
                                       0.5 mm of Venus flow
                                       is then applied and
                                       spread with a probe
                                       to eliminate any air
                                       bubbles.

                                       The layer is
                                       polymerised.

                                                                  29
Case studies – posterior teeth | Case E

     5                                                               6

                                          Stratification begins           In order to desaturate
                                          with a horizontal incre-       the colour, first a
                                          ment of opaque com-            darker shade compo-
                                          posite (e.g. OA2) that         site (e.g. A3.5) and
                                          helps to mimic the             then lighter shades of
                                          colour of the tooth to         composite (e.g. A1)
                                          be reconstructed. If the       are applied.
                                          cavity is very wide, it
                                          is better to apply this        Increments are applied
                                          composite in several           in triangles in order
                                          increments.                    to reduce stresses on
                                                                         the cavity walls due to
                                          Each individual incre-         polymerization shrink-
                                          ment is polymerised for        age and to allow better
                                          40 seconds.                    anatomical modelling.

                                                                         Each increment is
                                                                         polymerised.

30
Case studies – posterior teeth | Case E

7                             8

    A thin increment of                    The restoration is
    translucent composite                  finished and polished.
    (e.g. T1) is applied
    along the edge of the                  Once the rubber dam
    cavity and along the                   has been removed,
    first part of the cuspal                occlusal marking paper
    surface.                               is used to check that
                                           the correct relationship
    The increment                          between reconstruction
    is polymerised for                     and function has been
    20 seconds.                            achieved.

                                                                      31
Annex

Shade selection:
Natural teeth are made of various kinds of tissue, which strongly      At the end, the level of translucence should be defined. A recon-
differ aesthetically and optically wise. Dentine, for instance, is     struction will be able to achieve the highest aesthetical level
duller when compared to enamel. It is therefore clearly difficult       only if dentine, enamel and translucent incisal shades are used.
to restore the original optical properties of a tooth using only one   An appropriate incisal shade can be selected by determining the
material when the cavity preparation involves both dentine and         translucency of the incisal third of the tooth. When necessary,
enamel.                                                                the level of translucency can be changed by using superficial
                                                                       characterisation (e.g. Cre-active) under the last translucent layer.
The shade selection is to be done before placing the rubber dam.
Once isolated the dental element’s structures tend to dehydrate,
what makes the tooth appear more shiny and opaque than normally.
Consequently, just after removing the rubber dam, the restoration
appears darker and too translucent, even if the composite masses
had been properly selected.

A final evaluation of the combination of masses and layers can
only be done a few days after having completed the restoration;
the composite materials attain their definite optical properties only
after the tooth has been rehydrated.

The shade selection should be done under daylight keeping in mind
that not only the interested tooth but also the adjacent ones have
to be observed. The dentine shade should be selected based on the
mid and cervical thirds of the tooth of concern.

32
Preparation:
The penetration capacity of fluid resins or adhesives into the           At the cervical level manual instruments should be used, because
conditioned dental structures enable the optimisation of the            it is difficult to use the rotating instrument oriented at 45° without
material’s micromechanic linkage and thus the reconstruction’s          causing dents. Deep class II cavities are the most difficult area.
resistance.                                                             Here at least 1 mm must be left before the amelo-cement junction
                                                                        to assure the success of a direct restoration (a marginal finishing
The finishing of the margins allows extending the surface to             at 90° should be avoided to decrease the risk of fracture).
mordant with acid agents and therefore increases the linkage
between composite and dental structure.

Internal corners and sharp angles should be rounded off. The
direction of the enamel’s prisms which, during their centrifugal
growth, place themselves in a radial manner as regards to the
tooth’s axe, should also be considered. If the cavity wall shows
prisms directed transversally with respect to their axe, they will be
very resistant to traction. If, instead, the cavity wall shows prisms
directed in a parallel direction with respect to their axe, their
resistance to traction will be low.

Therefore, the marginal preparation should be done using a
45° oriented chamfer or a microchamfer (finishing ball bur 012
diameter) so as to transversally cut the prisms.

                                                                                                                                           33
Adhesion:
Adhesion is a physical concept, which foresees interaction be-
tween two elements, the adhesive and the adherent, through an
interface. In the case of amalgam fillings the restoration maintains
a macro-retention relation with the tooth. Restorations based on
the adhesion principle show a reversed concept: a micro-retention
to the tooth is achieved. The extension and shape of the cavity are
in strict correlation with the decayed tissue to be removed. A large
quantity of healthy dental tissue is therefore preserved.

The adhesive systems can be classified according to the approach
in treating dentinal mud (or smear layer). The first is intended
to fully remove the smear layer through a simultaneous acid con-
ditioning of enamel and dentine (total-etch), while the second
tends to modify the same dentinal mud by incorporating it into the
dentine’s resin impregnation process.

Both so-called “three-steps” adhesives (e.g. Gluma Solid Bond)
and those “two-steps” adhesives (e.g. Gluma Comfort Bond) are
a part of the first group and differ one another for the association
or not of primer and bonder.

In the second group instead, we can distinguish the so-called
self-etching primers and the new self-etching adhesives or
“all-in-one” bondings (e.g. iBond). These adhesive systems do
not remove the smear layer but modify it.

34
Polymerisation:
Composites are made of a resin matrix with scattered filling
particles. Resins are monomers, which, following a proper photo-
treatment, reach their final mechanical properties through
polymerisation. The photo-polymerisation process is therefore
very delicate and important in order to achieve a good
predictability of the restoration.

It is always recommended to observe the composite
manufacturer’s instructions and polymerisation times.
Polymerisation times for Venus and Venus flow are:

 A1, A2, A3, A3.5,     Curing time with     20 seconds
 B1, B2, C2, D2,       halogen or LED
 T1, T2, T3, SB1,      curing light
 SB2, HKA2.5
 A4, B3, C3, C4,       Curing time with     40 seconds
 D3, OA2, OA3,         halogen or LED
 OA3.5, OB2, OC3,      curing light
 OD2, SBO, HKA5,
 Baseliner
 All shades            Maximum layer        2 mm
                       thickness

                                                                   35
Finishing and polishing:
The finishing step, for removing composite excesses and model-         At the specific chapter we will deal in detail with different instru-
ling the anatomic shape, is done using fine grain diamond burs         ments and techniques to be used during the finishing and
mounted on a turbine.                                                 polishing process, highlight the differences between finishing of
                                                                      anterior and posterior teeth, and the importance of a proper
It is important to work at a low number of revolutions to avoid       polishing for both aesthetical and microbiological integration
damaging the composite’s resin matrix, which would turn opaque.       reasons.
During the same operational phase a correct replication of the
macro- and micro-surface texture and tooth’s morphology should
be achieved.

The polishing stage will follow, paying attention to the superficial
micro-morphology of the restoration. Pre-polishing is conducted
with coarse and thin grain points, polishing with silicone rubber
polishers to achieve a high gloss surface (e.g. iPol). All the
polishing processes should be carried out under a powerful air or
water jet to avoid overheating of the tooth.

Once polishing is completed, fluid resin (bonding agent) can be
applied on the restoration, spread using a soft air jet, and
cured for 20 seconds. This allows sealing possible cracks caused
by polymerisation contraction and enables a full cure of the
last composite layer.

36
References

Davidson CL, de Gee AJ. Relaxation of polymerization contraction
stresses by flow in dental composites. J Dent Res 1984;63:
146 –148

Ernst C-P. Komposit als Höckerersatz. DZW 6/06:10 –11

Feilzer AJ, De Gee AJ, Davidson CL. Setting stress in composite
resin in relation to configuration of the restoration. J Dent Res
1987;66:1636–1639

Grandini R, Rengo S, Strohmenger L. Odontoiatria Restaurativa.
Ed. UTET (To) 1999

Roberson T, Heymann HO, Swift EJ. Sturdevant’s Art and Science
of Operative Dentistry. Ed. Elsevier 2006

Vanini L, Mangani F. Il Restauro Conservativo dei Denti Anteriori.
Ed. Promodent 2003

Conception:
Raquel Neumann
Heraeus Kulzer GmbH

                                                                     37
Venus® indications                                                   Venus® shades

 Indication              Venus   Venus flow                                                    A1            B1    C2    D2    SB1*
                                                                                              A2            B2    C3    D3    SB2*
 Class I cavities        •       •                                                            A3            B3    C4
                                 (not subject to chewing pressure)    Enamel shades
                                                                      (higher                 A3.5
 Class II cavities       •       •                                    transparency)           A4
                                 (not subject to chewing pressure)
                                                                                              HKA2.5*
 Class III cavities      •       •                                                            HKA5*
                                 (slightly subject to strain)
                                                                      Enamel shades           T1
 Class IV cavities       •       •                                    (very high
                                                                      transparency)
                                                                                              T2
                                                                                              T3
 Class V cavities        •       •                                                            OA2           OB2   OC3   OD2   SBO
                                                                      Dentine shades
 Inlays
 (direct and indirect)
                         •                                            (low                    OA3
                                                                      transparency)
                                                                                              OA3.5
 Onlays
 (direct and indirect)
                         •                                           Venus shades are matched to Vita® shades.
                                                                     *Heraeus Kulzer shades
 Veneers
 (direct and indirect)
                         •
                                                                     The Venus® tones are tuned to the Vita® colours.
 Crown build-ups         •       •
 Posts and cores         •       •                                   Customised shades for whitened teeth:
 Adhesive luting                 •                                   Shade SB1: Super Bleach (warm), light incisal shade
                                 (Only veneers, light cured)

 Temporary               •       •                                   Shade SB2: Super Bleach (cold), light incisal shade with a
 restorations
                                                                     slightly cool blue hue effect
 Fissure and                     •
 pit sealing                                                         Shade SBO: Super Bleach Opaque, light dentine shade,
 Cavity linings                  •                                   low transparency

38
Venus® product outline

Venus® Masters Kit                                   Venus® Basic Kit           Venus® flow Assortment      2Layer Shade Guide

This kit was developed                               This kit contains the      Venus flow shades are       Hand layered, made
for dentists, who want to                            6 most commonly used       perfectly matched to       from original material.
make clinical use of                                 enamel and dentine         the Venus shades. You
the complete range of                                shades, as well as the     have a choice between
Venus shades and be                                  incisal shade T1           14 Venus flow shades.
ready for all cases.                                 “cool blue”. It is ideal   This assortment contains
                                                     as a starter set.          the 4 most popular ones.

Venus PLTs* 10 x 0.25 g                              Venus syringes 4 g or      Venus flow syringes 1,8 g   shades A1, A2,
shades A1, A2, HK A2.5, A3, A3.5,                    PLTs* 10 x 0.25 g          shades A1, A2, A3,         HKA25, A3, A3.5, A4,
B1, B                                                shades A2, A3, OA2, OA3,   Baseliner White            HKA5, B1, B2, B3,
                                                     T1, HKA2.5                                            C2, C3, C4, D2, D3,
Venus PLTs* 5 x 0.25 g                                                          Accessories                SB1, SB2, T1, T2, T3
shades A4, HK A5, B3, C2, C3, C4,                    Venus shade guide
D2, D3, OA2, OA3, OA3.5, OB2, OC3,                   Accessories
OD2, SB1, SB2, SBO, T1, T2, T3

Venus flow syringe 1.8 g
shades A2, Baseliner

Gluma Desensitizer 1ml
Venus shade guide
Venus shade guide with
6 empty tabs
Venus DVD Master’s Aesthetic Series
Accessories

Art. No. 66013214                                    Art. No. 66013214          Art. No. 66014561          Art. No. 66008711

*PLTs = pre-loaded capsules for direct application

                                                                                                                                39
Venus® product outline

Product                     Art. No.   Product                     Art. No.   Product                        Art. No.

Venus                                  Venus                                  Venus flow
PLTs contents 20 x 0.25 g              Each syringe contains 4 g              Each syringe contains 1.8 g
■ PLT – A1                  66007979   ■ SYR – A1                  66007366   ■ Venus flow – A1              66014562
■ PLT – A2                  66007981   ■ SYR – A2                  66007367   ■ Venus flow – A2              66014563
■ PLT – A3                  66007983   ■ SYR – A3                  66007368   ■ Venus flow – A3              66014565
■ PLT – A3.5                66007985   ■ SYR – A3.5                66007369   ■ Venus flow – A3.5            66014566
■ PLT – B1                  66007988   ■ SYR – A4                  66008156   ■ Venus flow – A4              66014567
■ PLT – B2                  66008000   ■ SYR – B1                  66007370   ■ Venus flow – B2              66014568
■ PLT – C2                  66007989   ■ SYR – B2                  66007600   ■ Venus flow – B3              66014569
■ PLT – OA2                 66008012   ■ SYR – B3                  66007601   ■ Venus flow – OA2             66014570
■ PLT – HKA2.5              66007996   ■ SYR – C2                  66007371   ■ Venus flow – SB1             66014571
PLTs contents 10 x 0.25 g              ■ SYR – C3                  66008086   ■ Venus flow – SB2             66014572
■ PLT – A4                  66008159   ■ SYR – C4                  66007603   ■ Venus flow – SBO             66014573
■ PLT – B3                  66008001   ■ SYR – D2                  66007372   ■ Venus flow – T2              66014575
■ PLT – C3                  66008089   ■ SYR – D3                  66008092   ■ Venus flow Baseliner White   66014574
■ PLT – C4                  66008003   ■ SYR – OA2                 66007410   ■ Venus flow – HKA2.5          66014564
■ PLT – D2                  66007992   ■ SYR – OA3                 66008098
■ PLT – D3                  66008095   ■ SYR – OA3.5               66007597
■ PLT – OA3                 66008016   ■ SYR – OB2                 66007599
■ PLT – OA3.5               66007997   ■ SYR – OC3                 66007602
■ PLT – OB2                 66007999   ■ SYR – OC2                 66007604
■ PLT – OC3                 66008002   ■ SYR – SB1                 66007608
■ PLT – OD2                 66008004   ■ SYR – SB2                 66007609
■ PLT – SB1                 66008008   ■ SYR – SBO                 66007411
■ PLT – SB2                 66008009   ■ SYR – T1                  66007373
■ PLT – SBO                 66008014   ■ SYR – T2                  66007605
■ PLT – T1                  66007995   ■ SYR – T3                  66007606
■ PLT – T2                  66008005   ■ SYR – HKA2.5              66007596
■ PLT – T3                  66008006   ■ SYR – HKA5                66007598
■ PLT – HKA5                66007998
40
XXXXXXXX 00 02.08 GB
Conception:                                                              Thanks to:
Heraeus Kulzer GmbH                                                      Prof. Antonio Cerutti
                                                                         Nicola Barabanti
                                                                         Stefano Sicura
                                                                         University Brescia, Italy

                                                                         Heraeus Kulzer srl

Contact in Germany                                                       Contact in the United Kingdom                    Contact in Australia
Heraeus Kulzer GmbH                                                      Heraeus Kulzer Ltd.                              Heraeus Kulzer Australia Pty. Ltd.
Grüner Weg 11                                                            Heraeus House, Albert Road                       Locked Bag 750
63450 Hanau                                                              Northbrook Street, Newbury                       Roseville NSW 2069
Phone +49 (0) 6181 355 444                                               Berkshire, RG14 1DL                              Phone +61 29 417 8411
Fax +49 (0) 6181 353 461                                                 Phone +44 (0) 1635 30500                         Fax +61 29 417 5093
info.dent@heraeus.com                                                    Fax +44 (0) 1635 30606                           Mail: sales@kulzer.com.au
www.heraeus-kulzer.de                                                    Mail: sales@kulzer.uk                            www.kulzer.com.au
                                                                         www.heraeus-kulzer.com

In compliance with the European guideline 93/42/EWG our medical devices are CE-marked according to the classifi cations.
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