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Video Details
ダイレクトコンポジットレジンを用いての歯の欠損と着色の修正 Part2

Description:
この50年、ダイレクトコンポジットレジンを用いた審美的治療は素早く変化をしてきた。この技術は最近のナノコンポジットの材料によりさらに良くなる。審美歯科では、ここ10年の間にセラミックの材料が広く使用されてきたが、この新しいコンポジットを用いたダイレクトボンディングはさらに高く評価されている治療である。このビデオでは、重度に変色した歯の修正をナノコンポジットの材料を用いて行う。即時のコンポジットレジンボンディングが理想的な修正を可能にし、素晴らしいスマイルをつくり出す。

Date Added:
12/24/2010

Author(s):

Ronald Goldstein, DDS Ronald Goldstein, DDS
Dr. Ronald Goldstein is currently Clinical Professor of Oral Rehabilitation at Georgia Regents University College of Dental Medicine in Augusta, Georgia, Adjunct Clinic...
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Questions & Comments
Ronald Goldstein - (1/23/2012 12:44 PM)

Daniyal, Are you referring to the way I finish porcelain veneers? Not sure if you are questioning my use of the 30 blade carbide (ET 4 usually) to finish subgingival following any necessary contouring of the gingival margin. Ideally no finishing of gingival or subgival margins should be necessary if there is perfect margin and a perfect fit. The simple truth is that most of the margins i have seen done by other dentists are just not perfect and could have been considerably improved with subgingival finishing. Does this answer your question or if not please resubmit it and i will try to answer.

Ronald Goldstein - (1/23/2012 12:33 PM)

Farhan, Using a mylar strip does give the appearance of a better shine because the surface becomes 'all resin' and therefore appears smoother and has a gloss. However, the resin surface is more fragile and suseptible to wear more than a polished surface. It is a good technique to test a shade of composite on the tooth when deciding what shade to use but I prefer in all restorations to polish the composite. In fact if you use the mylar in class 3 composite restorations you have less ability to match the curve of the labio distal or mesial tooth surface. Finally, my technique of the beveled overlay for composite restorations would also be diminished if I were to use the mylar strip. I will also be reviewing my technique of finishing restorations in another comment.

FARHAN DURRANI492 - (1/22/2012 9:14 AM)

DEAR DR GOLDSTEIN I READ IN RESTORATIVE DENTISTRY BOOKS TO COVER COMPOSITES WITH MYLAR STRIPS AND THEN CURE ,IT GIVES BETTER SHINE ,PLEASE GIVE YOUR OPINION

Daniyal Dzafic - (8/28/2011 2:26 PM)

thank you for excellent job, why you use in these case composite in stade porcelain veneers. Best regards Dr. Daniyal

Ronald Goldstein - (12/30/2010 12:10 PM)

Englin...your point is well taken. The treatment required in creating a 3 dimension type direct composite veneer is certainly both time consuming and artistry required. So I have no problem with your analogy. However there is a laboratory fee and two appointment procedure to take into consideration plus the warranty given to the patient. A direct composite veneer can be more easily repaired than a porcelain laminate for long term so there are reasons why a crown or ceramic veneer is priced more. In my office the fee for ceramic is about 40 to 100% more depending on the difficulty of the situation, artistry required and the other conditions mentioned in every fee range estimate in Change Your Smile. Hope this helps and best wishes for the New Year....

Ronald Goldstein - (12/30/2010 12:10 PM)

Englin...your point is well taken. The treatment required in creating a 3 dimension type direct composite veneer is certainly both time consuming and artistry required. So I have no problem with your analogy. However there is a laboratory fee and two appointment procedure to take into consideration plus the warranty given to the patient. A direct composite veneer can be more easily repaired than a porcelain laminate for long term so there are reasons why a crown or ceramic veneer is priced more. In my office the fee for ceramic is about 40 to 100% more depending on the difficulty of the situation, artistry required and the other conditions mentioned in every fee range estimate in Change Your Smile. Hope this helps and best wishes for the New Year....

engin taviloglu - (12/29/2010 4:30 PM)

Thank you Mr. Goldstein, waiting for part 3. My opinion is, a composite veneer (direct or indirect) properly done by layering technique can't be signifcantly less expensive than the porcelain laminate veneer. Engin Taviloglu, Istanbul

Ronald Goldstein - (12/26/2010 10:57 PM)

First let me answer Hyacinth's question...about controlling moisture. When I am bonding anterior teeth I need to make sure the tissue is in good health by sufficient oral disease control weeks before the bonding if at all possible. In the event I need to bond and the tissue is not in good health I will be forced to utilize some form of moisture control... typical rubber dam, cotton cord displacement, or paint on rubber dam. I think it is crucial to use instruments as thin as the Hu-Friedy # 3 or #4 as I pointed out in the video so I do not cause bleeding or seepage when I go subgingivally. The questions that Sharon asks regarding lengthening the teeth depend on the occlusal pathways and the ability to do cosmetic contouring on the opposing arch to allow for lengthening. However the translucent effect is also accomplished by indenting the composite in the incisal areas and either put a very small and sometimes diluted blue or grey effect stains or even a translucent or clear composite in these areas to pick up the natural light effects that come from texturing the final layer during polishing. Ideally to mask dark stains a minimum of .8 to an ideal of 1mm is desired but if the stain still is apparent after this amount of composite then certainly reduce the preparation to allow for more room without overbuilding the restoration. I suggest applying the chosen shades without etching the tooth and polymerizing (which I did) to see if the masking will be sufficient. Also a spot etch and trial smile veneers can be done to show the patient's spouse, family or friend is certainly in order but does add to the cost of the procedure. I hope this answers your questions. Ronald Goldstein The question of using indirect veneers (ideally porcelain) if the dentist does not feel he or she has the artistic sculpting ability, is a good one and I would definitely recommend this course of action.

John Nickell - (12/26/2010 9:39 PM)

where's part 3?

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