Oral Health Group
Feature

Can an Instrument Make a Difference?

July 1, 2013
by By Howard S. Glazer, DDS, FAGD


The simple answer is yes. But to truly understand why it can make a difference it is necessary to understand the problem.

There has been a sharp rise in the past decade in the use and direct placement of composite resin restorations. Materials have become stronger, more aesthetic with a wide shade range, and able to be polished to a high degree of luster. With all these advancements, however, no one has been able to overcome the disadvantage of the stickiness attributed to composite resins. That is until now, and the release of Ivoclar Vivadent’s new Optrasculpt Pad modeling instrument (Fig. 1).

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Look in any catalog and you will find a great number of composite placement instruments designed to condense, pack or shape composites into our cavity preparations. Regardless of being metal, Teflon, or silicone, none of these instruments overcame the challenge of the stickiness to the resin and the inherent “pull-back” during compression.1 Surfaces were often left with trapped air bubbles during the layering of an aesthetic buildup, and the flat surfaced instruments caused unwanted indentations in the composite material. This was a natural result since the tooth surface is predominantly curved and our instruments are flat. Such “foot prints” demanded additional steps during our finishing and polishing routine to eliminate them and provide for a smooth highly polished and glossy surface. Optrasculpt Pad’s foam enables compression to the curved surface of the composite resin by mimicking the curved surface (Fig. 2).

Optrasculpt Pad overcomes all these concerns. It is an instrument designed for the adaptation, modeling and surface shaping of non-polymerized composite resins in the Class III, IV and V restorations as well as direct resin veneers. The secret of the instrument is that it uses a disposable, single patient use, non-stick foam pad to adapt the composite materials. These disposable pads, comprised of polyethylene foam and EVA, are available in 4mm diameter and 6mm diameter sizes. They simply snap on to one end of the instrument and can be easily popped off once the procedure is completed and the instrument sent to be autoclaved. The instrument handle itself is quite unique in that the opposite end has a blade configuration which can be used to remove composite from syringes and/or used to “tuck in” the composite into the interproximal areas. Yet another unique feature is the handle that has two millimeter reference scales which can be used to establish tooth symmetries, width proportions, incisal edge lengths, and the angular alignment of restorations. All these elements are geared to providing a highly aesthetic result.

Certainly the economy has had an impact on dental care. Where we used to see more patients requesting indirect porcelain veneer restorations, we now see an increase in direct, composite veneer procedures. This is where the reference scales become invaluable. With direct restorations we don’t have the benefit of a preparation guide, nor the model upon which to build the porcelain. The reference scales allow you to plan and visualize the placement of the composite resin, and shaping of the tooth as you are creating the veneer.

Direct resin restorations such as veneers can be quite time consuming. First you need to place a dentin layer (possibly with opaque first), and then an enamel layer. Thereafter, you may add incisal translucency. Each layer requires compression of the material and shaping the tooth, and as such, if using conventional instruments, there would most likely be indentations or “foot prints” of the instrument. Upon completion of the shaping and characterization of the tooth, more time would be needed to contour, finish and polish the restoration. I typically use two instruments: one with the 4 mm pad and the other with the 6 mm pad. Although these pads are designed to easily “pop out” and “pop on’, it is faster from me to switch instruments. I use the 6mm pad with the initial bulk placement and then the 4mm pad to finesse the shaping of the tooth. Utilization of the Optrasculpt Pad instrument, with its unique foam pads, allows you to greatly reduce the time spent in finishing a polishing since the composite surface is void of any indentations and about 90 percent finished and polished after resin placement and photocuring.

The use of the pad is particularly ideal in Class V restorations, wherein we often have to place our resin at, or below, the gingival margin. Metal instruments can be injurious to the soft tissue whereas the Optrasculpt Pad is atraumatic to the tissue. For direct resin veneers, there is no instrument faster in providing placement and shaping of the resin material to the extent greatly reducing the time needed for finishing a polishing since it leaves the surfaces devoid of indentations and ready for polishing.2

Undoubtedly, the Optrasculpt Pad and its unique foam pads, coupled with the handle’s reference scales, will benefit the dentist and patient alike. The foam is atraumatic to the soft tissue, which is vital in Class V restorations and there is an inherent time-savings in using this instrument. From packing to layering, to finishing and polishing, this instrument will become an invaluable asset in achieving highly aesthetic restorations. Ivoclar Vivadent calls it Optrasculpt Pad, but I call it Foamtastic! OH


Dr. Glazer is a Fellow and Past President of the Academy of General Dentistry, and former Assistant Clinical Professor in Dentistry at the Albert Einstein College of Medicine (Bronx, NY). Additionally, he is a Fellow of the American College of Dentists; International College of Dentists; American Society for Dental Aesthetics, the American Academy of Forensic Sciences, and a Diplomate of the American Board of Aesthetic Dentistry. Dr. Glazer is an Attending Dentist at the Englewood Hospital (Englewood, NJ). He can be reached at hglazer264@gmail.com.  

Oral Health welcomes this original article.

REFERENCES:
1. Terry DA, Leinfelder KF. An integration of composite resin with natural tooth structure: The Class IV restoration. Practical Proceedings in Aesthetic Dentistry. 2004:16(3): 235-42.

2. Ivoclar Vivadent. Optrasculpt Pad: Modeling instrument for composite filling materials. Amherst, NY: Ivoclar Vivadent: 2005: 1-2.


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