Dr. Matt Parson presents the different types of Renamel composites and the importance of following the correct procedures when using them.
As the use of composite becomes increasingly prominent in restorative dentistry, it is not only becoming a necessity to know the different types available at hand, but also to understand the distinct characteristics that make them suitable for specific uses.
Broadly speaking, there are three different types of composite:
- Microfilled composite
- Hybrid composite
- Nano-filled composite
What characteristics do these have?
Microfilled composites tend to have much easier handling characteristics and longer polish life, allowing for long-lasting aesthetic results. However, they are not as strong in terms of tensile strength and are much more prone to fracture. Hybrid composites, on the other hand, are more durable. This makes them more suitable for lower incisors, palatal aspects of upper incisors, posterior teeth, etc. However, this comes with a trade-off. What you gain in strength and durability is fracture It comes with its own aesthetic limitations, meaning they are not as easy to polish. Even though you spend a significant amount of time during treatment focusing on the final polish, they will gradually dull over time, unlike a microfill.
Renamel composite system
With the Renamel composite system you have access to nano-hybrid, microhybrid, as well as true microfill composite. The beauty of this toolkit is that you have a few different types of composites that you can use in any situation. They are all built around the same shade system, so whether it is an A1 microhybrid, nanohybrid or A1 microfill, you will definitely have an option for your particular case. For example, if you are doing a class four restoration in shade A1, you may decide to use A1 microhybrid or nanohybrid for the palatal shelf to achieve strength and longevity. But as I mentioned, there is a trade-off and you will compromise aesthetics when using only these materials.
To get the best of both worlds, you can combine this with A1 microfill over the labial aspect and still maintain a polished appearance. The restoration will be durable enough that the patient will not experience fractures every six months, and you will still maintain a long-lasting shine with the microfill. So when you see a patient for a check-up at 6 or 12 months, you are unlikely to notice any lightening or dulling of the teeth.
My experience with the Renamel system
I have been using the Renamel system for the past 13 months, and when patients return for their check-ups, I expect to need to refine the existing restorations and reapply polish to return the teeth to their original condition.
“It’s not just about before and after photos in show biz.”
But in many cases, I have been surprised by how well some restorations have held up and require no additional work. As a dentist, it is reassuring to know that with these different types of composites available, you can produce predictable results that will not only please the patient when they leave the office, but will also look great 12 months from now. It's important to have such confidence in the longevity of your results because it doesn't come cheap for patients and sometimes it's not all about show biz before and after photos.
Some tips
One of the biggest lessons I learned from gluing edges and applying composite veneers is to take your time. Keep in mind that, often, it is a long appointment for both you and the patient and there is a chance that things will not go according to plan. You may find that the patient is struggling to keep their mouth open and is feeling restless, a light bulb has gone out and it is darker than you would like in the office, or any number of other distractions that can increase your stress level. Unconsciously, this can cause you to rush the procedure and overlook some essential steps. It is important to remember that once you have cured the composite layer, although you can still change the rough shape of the material, it becomes increasingly difficult to make subtle changes.
Let's look at the angles of the lines
Once you've introduced a line angle, you may realize you've gone too far and decide to push it out a little and bring it back in until you find the perfect finish. If you do this with a brush, while the composite remains wet, you can always go back and forth until you get it just right before you cure it in its final position. But if you decide to cure the composite prematurely before implementing the finer details and rely on the help of the discs to correct them at a later stage, your job will become much more difficult.
With discs you can only go in one direction; you can only remove the composite, and if you remove too much of it, you will have to resort to using a sandblaster to add it back in.
What to remember
The lesson here is to be patient in these initial stages and to be meticulous with details. As tempting as it may be to polymerize the composite at an earlier stage to save a few minutes, this greatly limits the margin for error and can actually extend the procedure by 15-20 minutes if mistakes are made.
“Tools you can use to hone and refine, rather than let them define the shape of your composite.”
You should take your time with the brush and carvings to get the most of the work done., and this will make your life much easier. Look at the rubber discs and dams as tools that you can use to hone and refine rather than letting them define the shape of your composite.
Ultimately, as restorative dentists, we want to help our patients. Our goal is to provide minimally invasive treatments that help people be happier and more confident in their smiles. The more confident we are in providing these treatments, the more cases we will do and the more patients we can help. In order to become confident in performing treatments, we need to forget that fear that things will go wrong. Don't rush things at first and develop your skill set. Going to courses and learning from lecturers like Dipesh Parmar can greatly increase your confidence and improve your clinical knowledge. If you study and practice adequately, it will only be a matter of time before you can ensure that your patients walk away from their appointments with long-lasting results.
Source: enlightensmiles.com
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