Sunday, 27 March 2016

Tubules on Tour: G-Aenial Composite Course

Last week, the Dentinal Tubules Study Club Directors headed over to Leuven in Belgium for the GC G-Aenial Composite course. 


The course which lasted 2 days was fantastic value and ran very smoothly (thanks to the reps Debbie and Patrick). We caught an early Eurostar over to Brussels where it was a short taxi ride over to Leuven and GC's European HQ. And when we weren't perfecting our composite skills, we were sampling the Belgian beers in this quaint university town! 

But what did I learn...?

Anterior Composites


As you can see from the picture above, we restored a class IV restoration on a central incisor - one of the toughest aesthetic challenges. We used the G-Aenial anterior composite

We used a putty stent to help build up the shape (which in practice you can ask your lab for a wax up, see a previous post about this here), but as well as shape, making sure you have the correct SHADE is important! This includes the use of dentine and enamel shades. But how do you do this?
  • Select the enamel shade e.g. junior, adult, senior + special characteristics e.g. incisal or translucent enamel
  • Select the tone from the middle 1/3 of the tooth e.g. yellow, red
  • Select the chroma/saturation from the cervical 1/3 of the tooth e.g. A2, A3
When you are restoring a class IV, build up each layer in order to create a natural looking restoration:
  1. Palatal shell in enamel shade
  2. Dentine opaque shade to disguise the margin so you will not see where the restoration meets the tooth
  3. Dentine shade leaving areas that can mimic mammelons
  4. Add in any stains if you require at this stage e.g. to create an enamel halo
  5. Final layer of enamel shade
Once built up, correct any gross shape discrepancies with SoftFlex/Shofu discs and smooth with an abrasive rubber cone. Then use your preferred polishing protocol finishing with diamond paste to create a shine. You can use pencils to copy characteristics from the adjacent tooth to guide you in you finishing protocol. 



Optiglaze

I've been on a few composite courses before, so the restoration of a class IV isn't that new to me. What was new and changed how I thought I can produce a really natural looking restoration is the use of GLAZES

These are different to stains which you place between the dentine and final enamel layer - glazes have a high ceramic content so are highly resistant to wear. This means that you can paint them on top of your final composite layer so add certain characteristics to teeth. 

You cannot apply glazes to highly polished surfaces, so they need to be applied after any gross finishing and the composite surface should be sand-blasted. You can then do your high polish finish after their application. You also need to add a composite primer to bond the glaze to the resin. 

Characteristics you can add include:
  • Translucency with grey colour
  • Tetracycline like banding with lilac colour
  • Fluorosis, white spots and demineralisation with white colour
  • Micro-cracks and smoking stains with the brown colour
  • Enamel halo with blue colour
Each colour can be diluted with the clear colour and the longer you expose the glaze to the light, the more intense the colour becomes. After painting on each characteristic with a fine paintbrush you cure the glaze and it leaves a high shine. It's amazing what you can achieve with these glazes! 


Resin tooth before and after application of characteristics with Optiglaze.


Posterior Composites


And finally, we briefly worked on a class I restoration using the G-Aenial Universal Flo which despite it's flowableness (is that a word?) has a reasonably high filler content (69%) so can be used for class Is. 

The advantage of using this over conventional composite is that building up each individual cusp is easy using the flowable tip and overall I found it's a much quicker technique! You can still build up each layer as it is available in enamel and dentine shades. I would be wary of using on patients you know to be bruxists however. 


Thanks to GC for making this course so informative and enjoyable and all the fantastic Tubules Team! Having the opportunity to meet and get to know some inspirational individuals in dentistry was incredible...bring on the next #TubulesOnTour!






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