Dental Tribune United Kingdom Edition

17Cosmetic TribuneJuly 11-17, 2011United Kingdom Edition page 18DTà have recently been introduced to cater for darker and discol- oured teeth and more complex aesthetic cases. The individual shades of the different levels of translucency are freely combinable. Alterna- tively, the best corresponding translucency level can also be obtained from an overview ta- ble or directly from the shade guide. Venus Diamond has four incisal shades: clear, amber, clear opal and yellow opal. As with Venus, the 2-Layer shade guide consists of layered origi- nal material and therefore enables realistic shade selec- tion. The shades of the flowable Venus Diamond Flow, which has been adapted to the sys- tem, are matched exactly to Ve- nus Diamond and can be easily combined. The combination of the opaque dentine shade and the appropriate universal shade is generally sufficient for the aes- thetic res-toration of Class I-V defects. The incisal shades are mainly required for the incisal edges of adolescent or very translucent teeth. In the case of small restorations it is often sufficient to use only the Uni- versal shade due to the shade adaptive effect of Venus Dia- mond. With demanding larger restorations in the anterior re- gion it is recommended to build up using shades of different translucency to attain a highly aesthetic result. It is also pos- sible to produce attractive res- torations in the posterior region when using only one shade. Venus Diamond: Clinical case A 29-year-old male patient pre- sented with a radiologically confirmed diagnosis of proxi- mal caries distally on tooth 25. The tooth had been previously restored occlusally and mesial- ly with an adhesive composite restoration due to a carious de- fect. The existing restoration ap- peared clinically sufficient, but was also to be replaced during treatment for the new restora- tion to avoid a transitional zone and therefore a potential high- risk weak spot. (Fig. 1). Based on the positive experience of the patient with composite restorations and the aesthetic appearance, it was decided to build up a direct composite us- ing Venus Diamond. Following anaesthesia and tooth clean- ing with a fluoride-free paste, the shade was first selected us- ing the Venus Diamond shade guide for the composites to be used; Venus Diamond and Ve- nus Diamond Flow. The shade systems of the two materials are identical, ie the shades match exactly. The shade guide is layered using Opaque shade (dentine) and Universal shade (enamel). The operator consequently sees the result of the ideal layering of two levels of opaque during shade selection. Tooth shade A2 was se- lected as the final shade dur- ing shade determination, ie the opaque dentine sec- tion was to be built up us- ing shade OM and the enamel using A2. The incisal shade is not generally required in the posterior region. Venus Dia- mond Flow A2 or Baseliner can be used as a cavity liner instead. The existing restoration and the region infected with car- ies on tooth 25 were removed using a minimally invasive tech-nique. Figure 2 clearly shows the dentine caries and the demineralised enamel ar- eas). All affected areas were excavated, including dark dis- coloured sections of den-tine. The preparation depth and the bucco-palatal extent of the cavity were kept as small as possible to conserve the maxi- mum amount of tooth struc- ture. Figure 3 shows the total structure loss. The functional occlusal surface as well as the marginal ridges and proxi- mal regions had to be recon- structed. Following thorough clean- ing using a water spray, the cav- ity was cleared of surplus water and, beginning at the enamel, conditioned according to the etch-and-rinse technique using the 35 per cent phosphoric gel iBOND Etch 35 (Fig. 4). The re- action time on the enamel was 30 seconds and 15 seconds on dentine. All areas of the cavity were then thoroughly rinsed and cleared of surplus water according to the rules of moist bonding. During drying, care was taken not to overdry the sensi- tive dentine to avoid collapsing the exposed collagen network and resulting insufficient ad- hesive penetration. The con- ditioned enamel and dentine areas were pre-treated using the nano-adhesive iBOND Total Etch according to the total-bond technique (Fig. 5). The adhesive was applied in one layer to the enamel and dentine, in accordance with the manufacturer’s instructions. The solvent was then air dried and the adhesive film polymer- ised. The cavity floor was then lined with a thin layer of Venus Diamond Flow A2 (Fig. 6). Ve- nus Diamond Flow improves the adaptation of the compos- ite to the tooth structure, as it smoothes rough irregularities created by the minimally inva- sive preparation and lines any undercuts, which are difficult to access for a universal com- posite (Fig. 7). Various studies also verify that the flowable composite Fig.6: Venus Diamond Flow A2 was ap-plied as a liner. The flowable composite lines undercuts and acts as a stress breaker. ‘The combination of the opaque dentine shade and the appropriate universal shade is generally sufficient for the aesthetic res- toration of Class I-V defects’ Fig.8: Sculpting the occlusal surface using Venus Diamond A2. The composite is position- ally stable; fissures, marginal ridges and cusp slopes can be easily contoured. Fig.9: Preparation of the occlusal surface using superfinish diamonds.