cosmetic dentistry_ beauty & science

10 I I CE article _ bioactive materials materialswithpreviouslyunimaginedapplications and properties. Several studies17,18 have shown that the inclu- sion of these types of nano-fillers and nano-fibers into the dental materials (dental composites and bonding agents) can improve the physical proper- ties byincreasing the strength, polishability, wear resistance, esthetics and bond strengths in many dental applications. It is also envisioned that the incorporation and utilization of these nanoparticles in the form of nanorods, nanofibers, nanospheres, nanotubes and ormocers (organically modified ceramics) into dental restorative and bonding agents can create more biomimetic (life-like) restorations. This will notonlyenablethesematerialstomimicthephys- ical characteristics of the tooth structure, but will also be able to facilitate the remineralization of that structure. As Saunders states in his conclusion, “such nanorestorative biomaterials could very credibly be the next transformative clinical leap” in resto- rative dentistry. _Giomers In that vein, an exciting advancement in bioac- tive materials is the development of giomer prod- ucts (SHOFU Dental, Beautifil II, and Beautifil Flow Plus). These giomers are resin-based composites that contain pre-reacted glass ionomer particles (S-PRG). These particles are made of fluorosilicate glass reacted with polyacrylic acid (just like a GIC), just before being incorporated into the resin. This creates a new type of bioactive material. These giomer products display properties in a manner similar to GICs19: They release ions and recharge with ions from the oral cavity, inhibit plaque formation and neutralize and buffer the acids of the mouth.20 No other composite mate- rial has this property to date. I use these giomers instead of traditionalnano-hybridcom- posites in my restorations because of these properties. They complete the entire bio- mimetic and bioactive nature of all the co-cure procedures that I create. The Beautifil Flow Plus product line has also ex- panded the way that I create restorations due to their unique viscosities. These materials can be stacked (Fig. 15) and used in a restorative process I call the “modified resin cone technique” (Fig. 16). They can also be applied to create direct com- posite veneers that can be easily placed, sculpted and highly polished (Fig 17). Easy placement, the ability to stack and maintain position and shape, plus their bioactive nature, make these materials a “game changer.” _Resin-modified, light-cured bonding agents Another advancement that I have been work- ing with is a product that is a resin-modified, light-cured bonding agent (SDI, North America: Riva Bond LC). This product is a specially formu- lated liquid RMGIC that can be used to bond com- posite restorations in the traditional sense, used in traditional sandwich and modified sandwich techniques and, of course, used in the Co-Cure Technique. This concept is especially appealing in light of the research that indicates RMGICs provide quite good marginal seal when used as a bonding agent on cut dentin surfaces.14 I especially like to use it with the Co-Cure Technique and when doing anterior restorations. Using this technique I am able to get a com- pletely biomimetic, bioactive restoration in both situations because of the bioactive nature of the materials used. The technique for use of this RMGIC bonding agent with composite is as follows: 1) Etch with 37 per cent phosphoric acid for five seconds. 2) Wash and dry but do not desiccate. 3) Triturate and apply the RMGIC bonding agent cosmeticdentistry 1_2013 Fig. 14 Fig. 15