DENTSPLY Esthet X HD Manual Del Usario página 2

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2. The final shade will ultimately result from an interaction of the thickness of the layer(s) of
restorative composite and surrounding tooth structure (enamel and/or dentin). The
intensity of the shade is related to the thickness or thinness of opacious, body and/or
translucent shade layers of the Esthet•X
approximation to the selected shade tab of the TruMatch
restorations allowing adequate thicknesses of each recipe component, e.g., Class IV,
labial-lingual Class III, etc. For restorations less than 2mm total thickness, e.g.,
conservative cosmetic veneering, and/or where significant shade lightening is desired,
placement of a liquid opaquer may provide a more desirable foundation for subsequent
shade layering.
3. In all cases, the use of a mock-up is an excellent method for shade verification. The
technique includes the use of the shades and opacities as prescribed by the selected
TruMatch
®
shade tab in the appropriate thicknesses to approximate that of the final
Esthet•X
®
HD Restorative material restoration. The materials are placed on the clean,
hydrated unetched tooth in the area of the cavity or restoration on the tooth. Each layer is
applied without etch or bonding agent, then cured thoroughly. Layering and/or altering
shades in varying thickness will allow trial customization of the final shade. The dentist,
patient and ancillary dental support personnel can co-jointly view the shade selection
result. After viewing, the composite material can be removed by the use of a dental
explorer or scaler.
4. Be aware of room and ambient light effects on shade selection; incandescent versus
fluorescent lighting versus natural daylight (ideal light is northern
exposure/outdoors/overcast).
5. Room accessories can influence shade selection as with colored walls/wallpaper
reflection. Also, the patient dental napkin should be removed. Observe tooth shades for
short periods of time, using a blue background to "neutralize" the effect of extended
shade viewing comparisons. Viewing a blue background will have a relaxing effect on the
viewing operator's photo/color optic discrimination. Eyes should be rested. It is useful to
have ancillary corroboration on shade selection by dental personnel as well as by the
dental patient.
3. STEP-BY-STEP INSTRUCTIONS
3.1 Direct Restoration
1. Shade Selection: Before selecting the shade, teeth should be clean, hydrated and free of
extrinsic material or stain. The TruMatch
the Complete Organizer System has been created to simulate the result of layering
specific shades. Select the shade tab that simulates best the final desired result.
Following the recipe on the shade tabs will create the desired shade. Mixing layered
shades and various thicknesses will allow customized shade adjustability. Please refer to
the Optimizing Shade Selection section above. Additionally, use of the Technique Guide
will detail the step-by-step procedure for accurate shade reproduction.
2. Cavity Preparation
2.1 Anterior Restorations: Use conservative cavity preparations for all Class III, IV and
Class V restorations. Refinement of the cavo-surface margin (beveling) for
enhancement of acid-etching, enamel bonding, and finishing procedures is
recommended. Technique Tip: Esthetic masking of underlying intrinsic staining may
require deeper preparation, allowing for adequate restorative material blending.
2.2 Posterior Restorations: Cavity design requirements are essentially a conventional
preparation with refinement of the cavo-surface margin for enhancement of acid
etching. No residual amalgam or other base material should be left in the internal
forms of the preparation which would interfere with light transmission and the
hardening of the restorative.
3. Placement of Matrix: The use of a Mylar, Bimatrix, sectional (e.g. Palodent
Matrix System) or thin matrix band (e.g. AutoMatrix
subsequent burnishing of the matrix band will improve final interproximal contact and
contour. PRE-WEDGING/BiTine
®
RING PLACEMENT IS ADVOCATED TO ACHIEVE
SLIGHT SEPARATION AND FACILITATE ACCEPTABLE PROXIMAL CONTACT.
4. Pulp protection, Tooth Conditioning/Dentin Pretreatment, Adhesive Application: Refer to
adhesive manufacturer's directions for pulp protection, tooth conditioning and/or adhesive
application. Once the surfaces have been properly treated, they must be kept
uncontaminated. Proceed immediately to placement of Esthet•X
material.
5. Placement of Esthet•X
®
HD Micro Matrix Restorative Material
5.1 Easy•Twist Syringe: Remove the cap from the Easy•Twist syringe by using lateral
force. It is easier to remove the cap in a "snap-off" rather than a "pull-off" motion.
Dispense the necessary amount of Esthet•X
Easy•Twist syringe onto the mix pad by turning the handle slowly in a clockwise
direction. To prevent oozing of the material when dispensing is completed, point the
front tip of the Easy•Twist syringe upwards and turn the handle counter-clockwise
and recap the Easy•Twist syringe. Technique Tip: Protect dispensed Esthet•X
Restorative material from premature polymerization via ambient light while current
increment is adapted and light cured.
5.2 Pre-dosed Compules
®
Tips: Load Compules
Insert a Compules
®
Tip into the notched opening of the Compules
Be certain that the collar on the Compules
cap from the Compules
®
Tip. The Compules
proper angle of entrance into the cavity. To dispense the material into a cavity
preparation, use a slow, steady pressure. Do not use excessive force. To remove the
used Compules
®
Tip, be sure that the Compules
completely by allowing the handle to open to its widest position. Apply a downward
motion to the front end of the Compules
5.3 Optional Flowable Liner: Placement of a compatible flowable liner such as
Esthet•X
®
flow Flowable Restorative or Dyract
separately) prior to placement of Esthet•X
manufacturer's directions for use.
®
HD Restorative material used. Restoration shade
®
shade guide occurs with
®
shade guide included in the Introductory Kit and
®
Sectional
®
Retainerless Matrix System) and
®
HD Restorative
®
HD Restorative material from the
®
Tips Gun with predosed Compules
®
Tips Gun barrel.
®
Tip is inserted first. Remove the colored
®
Tip may be rotated 360° to gain the
®
Tips Gun plunger is pulled back
®
Tip and remove.
®
flow Flowable Compomer (available
®
HD Restorative material is optional. Follow
5.4 Anterior Placement: Dispense Esthet•X
cavity preparation/tooth surface from the Compules
Excessive force is not necessary. Alternatively, material may be expressed onto a
clean pad from the
Compules
®
Tip or Easy•Twist syringe and carried to the preparation with suitable
placement instrument. Adapt, contour and shape with appropriate composite
instruments. Material may be placed and light cured in increments up to 2mm (see
Curing, Step 6). Technique Tip: For esthetic blending of shades, shade layers may be
individually cured to form a foundation for subsequent shade placement.
5.5 Posterior Placement: Dispense Esthet•X
cavity preparation from the Compules
force is not necessary. Alternatively, material may be expressed onto a clean pad from
the Compules
®
Tip or Easy•Twist syringe and carried to the preparation with suitable
placement instrument.
5.5.1 Class I and V: Esthet•X
in 2mm increments, light curing each increment. (See Curing, Step 6)
5.5.2 Class II: Beginning in the proximal box, firmly adapt a 2mm increment of
Esthet•X
®
HD Restorative material to cavity walls and stabilize matrix band by
stepping a clean non-serrated condenser (plugger) from middle to edges,
reducing incorporated air and eliminating voids. Light cure (see Curing, Step
6). The remainder of the preparation may be filled in up to 2mm increments,
each followed by light cure (see Curing, Step 6). Prior to light curing, contour
and shape the final increment with the operator's choice of clean carving and
burnishing instruments. Technique Tips: To minimize finishing time, contour
marginal ridge first before occlusal anatomy. Carve margins and anatomy to
final form. Esthet•X
of the majority of anatomical form prior to visible light curing.
6. Curing: Light cure each area of the restoration surface with a suitable visible light curing
unit designed to cure materials containing camphorquinone (CQ) initiator, i.e. spectral
output containing 470nm. Minimum light output must be at least 550mW/cm
for at least 20 seconds. Some advanced performance curing units (e.g. SmartLite
L.E.D. Curing Unit) have been shown to cure 2mm increments of most shades of
Esthet•X
®
HD Restorative material in 10 seconds. Refer to curing light manufacturer's
recommendations for compatibility and curing recommendations. The Esthet•X
Restorative material should be additionally exposed to the curing unit through the
proximal, lingual, and buccal enamel walls following matrix removal for the recommended
time.
7. Finishing and Polishing
7.1 Begin finishing immediately after curing. Gross excess may be removed and general
outline form established with Prisma
finishing instruments. Additional finishing is recommended by the use of Enhance
Finishing System. See manufacturer's complete directions for use.
7.2 To achieve a very high luster on Esthet•X
complete the polishing. PoGo
Prisma
®
•Gloss
Composite Polishing Pastes are recommended. See manufacturer's
complete directions for use. Once polished with PoGo
Prisma
®
•Gloss
pastes, Esthet•X
surface gloss due to its micro matrix technology.
3.2 Fabrication of Indirect inlay/Onlay
1. Shade Selection: Final desired shade selection should be accomplished prior to tooth
preparation. Before selecting the shade, teeth should be clean, hydrated and free of
extrinsic material or stain. The TruMatch
the Complete Organizer System has been created to simulate the result of layering
specific shades. Select the shade tab that simulates best the final desired result.
Following the recipe on the shade tabs will create the desired shade. Mixing layered
shades and various thicknesses will allow customized shade adjustability. Please refer to
the Optimizing Shade Selection section.
2. Cavity Preparation: Cavity design requirements are essentially a conventional preparation.
Rounding of internal angles and refinement of the cavo-surface margin for enhancement
of enamel bonding and finishing procedures is recommended. No residual amalgam or
other base material should be left in the internal forms of the preparation which would
interfere with light transmission and the hardening of the luting cement. Refer to adhesive
and/or luting cement manufacturer's directions for base/liner/pulp protection
requirements.
3. Impression, Master Cast Fabrication
3.1 Make an accurate impression of the preparation following manufacturer's directions
for impression material chosen. A material that allows two pours is recommended.
Alternatively, two impressions may be made.
3.2 Prepare and place provisional restoration on the prepared tooth. Use non-eugenol
®
HD
containing material(s).
3.3 Two casts will be fabricated. One working cast will be indexed and separated, per
usual crown and bridge procedures. The second master cast will be used for final
®
Tip.
contour adjustment. Following impression material manufacturer's instructions for
disinfection and impression casting, use of die stone is recommended for cast
fabrication. Plating of the impression is not recommended. Additionally, an opposing
cast should be prepared and articulated.
4. Restoration Fabrication
4.1 Block out any preparation undercuts present. Apply separating medium and/or die
spacer to separated die. In most cases, the restoration may be fabricated in no more
than 3 increments, each up to 4mm depth.
4.2 Apply first increment/shade, creating restoration body. Adapt to die, staying short of
margins. Recommended light curing is accomplished by placing in Triad
Unit (DENTSPLY Trubyte) for 2 minutes. Apply second, body layer, allowing cut-back
for occlusal anatomy and final proximal contour. Repeat Triad
®
HD Restorative material directly into the
®
Tip using slow, steady pressure.
®
HD Restorative material directly into the
®
Tip using slow, steady pressure. Excessive
®
HD Restorative material may be placed and adapted
®
HD Restorative material resists slumping, allowing carving
®
Finishing Burs or other carbide or diamond
®
HD Restorative material, it is necessary to
®
One Step Diamond Micro-Polisher System and/or
®
polisher and/or both
®
HD Restorative material will maintain its high
®
shade guide included in the Introductory Kit and
®
Light Curing. Prior to
2
exposure
®
iQ
®
HD
®
®
Light Curing
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