Has the Triclip been tested yet? I did a search and came up empty. This unit looks promising as a “one-step” alternative to my GDS and Palodent matrix systems that I’ve been using for the last 10 years. However, Triclip seems to promote a somewhat more extensive prep interproximally. Is it worth purchasing?
The Triclip (www.triclip.com), an all-in-one sectional matrix/ retaining ring/wedge, is certainly an interesting product. We currently have it under evaluation, with its report scheduled for a fall issue of REALITY Now. From a preliminary standpoint, it does seem to offer an alternative to the more conventional sectional matrix systems, but its plastic retaining ring is somewhat bulky compared to the more typical metal rings. On the other hand, its flexible elastic wedge provides adjustable pressure at the gingival margin, which should prevent overhangs. As far as its requiring a more extensive preparation, this should not be an issue. You should only remove carious tooth structure and never enlarge a prep just to use a specific instrument. For numerous clinical examples of various types of Class II preparations, please see our procedures manual, “The Techniques, Volume 1.”
Does Adhese etch and bond to uncut enamel? If not, do you recommend bevels?
Most, if not all, self-etchers do not penetrate well into uncut enamel. We have even researched the technique of pre-etching the enamel with phosphoric acid before you prep. Then, when it is time to restore the tooth, the uncut enamel will already be etched and hopefully the self-etcher will bond to this surface effectively. When we tested three self-etchers, pre-etching lowered microleakage with one product, had an adverse effect with the second product, and did not change the microleakage levels of the third. Therefore, the jury is still out with this technique. Bevels can be a good idea on enamel when it comes to direct restorations, except on gingival margins when the bevel will eliminate any residual enamel. In addition, if you bevel occlusal margins, the thin composite on these bevels may have an increased tendency to fracture.
Is there a company making polycarbonate anterior crowns in bleach shades? When I have a fractured anterior (or premolar) situation requiring a temporary crown, I still prefer the strength and durability of the 3M Ion-type polycarbs. However, in bleached teeth situations, I almost always end up bonding a separate facing for better esthetics. I’ve tried thinning out polycarbs in the past, but I’ve never effectively been able to thin out towards the incisal edge. If I’ve had too much coffee, I end up perforating through the facial and it looks worse. Do you have any suggestions?
I am not aware of any bleach shade polycarb crowns, but if there is a demand, no doubt some manufacturer will take the hint. In the meantime, thinning out the conventional ones and relining them with a bleach shade provisional material to allow the lighter color of the reline material to shine through the thinned-out polycarb should give it a whiter appearance. Try using a sandblaster for this thinning chore. Even though you can still perforate the polycarb, you can reach into the incisal region more effectively. Another alternative is to sandblast the surface of the polycarb and apply a layer of QuikGlaze Temp White, a resin glaze that brightens up most provisionals.
I recently had a chance to handle Voco’s new Grandio nano-hybrid composite material. To date, this has been the best handling/sculpting material I’ve ever tried, and it looks polished directly out of the compule. Has this material been preliminarily tested yet?
Grandio is, indeed, a new nano-hybrid composite marketed for both anterior and posterior use. Average particle size is 1.0µ for the glass filler and 0.05µ for the silica nano filler. It is filled 87 percent by weight and 71.4 percent by volume. It is available in syringes or preloaded tips called Caps. It comes in 13 Vita shades (A1, A2, OA2, A3, A3.5, OA3.5, A4, B2, B3, C2, C3, D3, and D4), plus a bleach shade and one incisal. A2 has enamel-like opacity (58.0 percent), OA2 has dentin-like opacity (71.6 percent), while incisal has a translucency of 43.9 percent, which is more opaque than the incisals of other hybrids. All shades match the Vita shade guide, while A2 matched our test tooth. The shade guide with the kit is made from the material itself. The bleach shade is lighter than B1. It becomes more translucent and lighter after curing. Fluorescence is poor, with the material appearing much darker than natural teeth (a new version, soon to be launched, will have much better fluorescence). It is relatively nonsticky, nonslumping, and sculpts well, but the only polisher that was able to impart a gloss in our initial testing was PoGo. Knoop hardness is 65.5, with a depth of cure of 3 mm. It will cure to 80 percent on the gingival wall, but requires 40 seconds. Volumetric shrinkage is 1.7, which is much lower than the average hybrid score.
There is an increasing number of companies introducing bleaching products that need to be activated/ accelerated by a plasma arc or other lights. Do you have anything new on that issue? Is the light effective? Should we invest in an expensive plasma arc or other light or is it just the gel that bleaches the teeth? Please note that I am not interested in curing composites with the light - just bleaching.
We found some advantages in vitro when a light was used, but it would take a full-blown clinical study to test this variable properly. Nevertheless, we feel that a light, if used properly, has no disadvantages and just might give the power bleaching process a boost. The only exception to this rule is Opalescence Xtra Boost, which performed better in our tests without a light. If you do choose to use a light, our tests found that the Zoom! light is probably your best bet. You should be able to recoup its modest cost in as little as two power bleaching sessions.
Dr. Michael Miller is the publisher of REALITY and REALITY Now, the information source for esthetic dentistry. He is an international lecturer and a fellow of the American Academy of Cosmetic Dentistry, as well as a founding member. He maintains a private practice in Houston. For more information on REALITY and to receive a complimentary issue of his monthly update, REALITY Now, call (800) 544-4999 or visit www.realityesthetics.com.