Finishing and polishing

Finishing amalgam\\ removing

marginal irregularities defining anatomical contours and smoothing surface roughness of restoration Polishing \\ to obtain smooth shiny luster on surface of amalgam NB\\finishing and polishing started when amalgam reached its final set approximately 48 hours after it has been placed and carved

Effects of finishing and polishing on restoration

1-prevention of recurrent caries\\it result in smooth lustrous

finish on surfaces and margins plaque and debris collection are reduced and restoration is easier to clean 2-prevention of amalgam deterioration\\tarnish is film on surface of amalgam produces discoloration as tarnish layer becomes thicker and darkens with aging of amalgam it becomes visible corrsion\\is destructive attack on both surface and subsurface of restoration that results from chemical or electrochemical reaction with oral environment this chemical reaction called corrsion products lead to detrioration of amalgam smooth polishing surface reduce accumulate acids plaque debris which encourage galvanic action on surface

3-maintenance of periodontal health \\any restoration

must not only maintain healthy environment for soft tissues but must also ensure the patients ability to cleanse the area facial lingual and proximal surface are critical areas that may affect patients oral hygiene and periodontium

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restoration are overcontoured or have faulty placement of facial and lingual contour lead toperiodontal breakdown than undercontoured restoration
overcontoured axial surface present area that quickly collects and harbours plaque

result in irritation bulky contour may interfere with pations ability to clean the area sightly undercontoured restoration is less of potential problem because it is less to interfere with patients ability to clean area interproximal or gingival embrasure houses the interdental papilla restoration restoration overcontoured in this area leaves less space for papilla lead to strangulation or physical displacement of papilla NB\\ either situation increases tissue breakdown udercontoured proximal area may have poor contact which increases potontial for food impaction which is not only frustrated for patient but irritation to soft tissue NB\\ aproperly contoured proximal surface is easly cleansed with dental floss the frustration of patient may contribute to inadequate flossing gingival floor of proximal box is frequently subgingival NB\\ presence of restoration margins in gingival sulcus increases incidence of gingival disease overhangs not only accumulate more plaque than smooth flush margin but also interfere with removal of the plaque the floss may get caught or tear creating source of frustration for patient who is then discouraged from cleaning the area NB\\ recontouring finishing and polishing provide to correct discrepancies in anatomical contours of restoration next

4-prevention of occlusal problems

potential occlusal problems may be prevented by finishing of amalgam restorations restoration may be left in premature occlusion lead toseveral problems tooth may exihbit pain or sensitivity especialy during mastication in more severe cases restoration or opposing tooth may fracture tooth may undergo slight orthodontic movement because of pressures of premature occlusion this problem can be corrected during recontouring process

when abrasive agents and instruments are used two coniderations can affect result of final restoration Heat is created which is potontial detrimental to amalgam[both increase pressure and speed contribute to heat production heat brings mercury to surface result in dull surface and restoration more susceptible to corrosion NB\\ once mercury is brought to surface it can be corrected only by removing surface layer of amalgam which produce under contoured restoration heat production can be minimized by using only moderate speed on rotary instruments intermittent light pressure to cause less heat than heavier or prolonged pressure using abrasive agents that wet instead of dry will reduce heat production abrasive agents remove fine layers of amalgam and leave scratches in surface as finer and finer abrasive agents are used these scratches become finer until they are no longer visible giving smooth lustrous surface NB\\ it is very important to use abrasive agents in order of decreasing coarseness finishing with least abrasive material NB\\ instruments for recon touring finishing and polishing are both hand and rotary instruments
limiting number of instruments will help keep technique simple and contribute to speed and efficiency

Rotary instruments
Burs abrasive stones and finishing discs
Burs used for recontouring and finishing amalgam are made of plain steel in contrast to carbide steel burs that are used to prepare cavities

flame-shaped plug-shaped pear-shaped barrel-shaped finishing burs white and green tapered stones and impregnated rubber cups and points

steel burs have varing number of flutes or blades for very gross amalgam
removal six fluted cutting bur may be used to cuts amalgam more rapidly its use is minimal because of deep scratches it leave on surface

burs used for finishing have more blades which are finer and leave smooth surface NB\\selection shapes and sizes of finishing burs is needed to gain access to all areas of restoration

 flam-shaped

bur for narrow areas as embrasure

areas and deep grooves on occlusal and smooth surface restoration round and plug-shaped burs small or larger size for fossa apear-shaped or barrel-shaped bur that allows contact with adjacent tooth structure for finishing cusp inclines
long and tapered used on occlusal or smooth surface of restoration rounded for use in fossa

stones

NB\\abrsiveness depends on type of particles incorporated in

matrix of stone particles in green stones are more abrasive than particles in white stones

green stones is used to remove relative large bulk of amalgam white stones for reducing small areas of enamel around marginal discrepancies
as well as small amounts of amalgam

Fig-5.24 From left: Five steel burs, two stone burs, three abrasive rubber point burs, and one abrasive rubber cup burs

finishing discs used for recontouring and finishing amalgam the thin flate shape of discs can be adapted along broad smooth
surfaces with good access NB\\discs are ideal for smoothing class V restoration or facial and lingual extensions of large restoration

finishing discs are available in variety of sizes and grits

size used depend on size of restoration andits proximity to vulnerable adjacent soft tissues girt selected depend on amount of excess amalgamator be removed

fine girt sufficient for most situations

A coarser grit followed by progressively finer-girt abrasives to minimized size of scratches left in amalgam

Two hand instruments used for recontouring are amalgam knife and file

amalgam file used to smooth amalgam after use amalgam knife

sharp amalgam knife used to shave away excess amalgam
NB large areas of excess amalgam can be crushed or broken apart by large amalgam file this is dependent on age and strength of amalgam

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these instruments used to remove excess amalgam extending apical to gingival cavosurface margin of preparation where access is a problem

Polishing agents are two common agents pumice and tin oxide

pumice is avaliable in variety of grits or particle sizes

fine grades as flour of pumice are used in first stage of polishing amalgam

NB\\it is usually mixed with water to form a slurry

Tin oxide is final polishing agent applied and it is also mixed with water or alcohol

NB\\because of its very fine particle size it produces a high luster or sheen
both pumice and tin oxide are applied with flexible rubber cups or occlusal brushes

other types of polishing agents are avaliable in the form of mounted rubber points cups

NB\\these may be impregnated with particles of varying degrees of abrasiveness

these cups and points are easier to use and adapted into all areas of restoration

finishing composite resin restoration

F inshing C R are to remove excess material and to contour and smooth surface of restoration which are accomplished with use of coarse abrasive instruments as coarse and medium grit discs and mounted white polystones NB\\carbide finishing burs are specifically designed for C R and produce smooth surface can be used [ it is important not to confuse carbide finishing burs with steel used to finish amalgam it will be abraded by filler particles in C R producing discolored restoration ] Diamond stones are used but not leave as smooth finish as carbide finishing burs instruments such as gold knife or file may be useful along gingival cavosurface margin NB\\ smoothing surface of restoration can be done with fine and extrafine discs composed of silicone carbide or zirconium silicate

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Finishing Instruments for composite; From left: : A mounted fine

white stone bur Two medium grit diamond burs Two fine grit diamond burs A rubber disc A mandrel Two flexible discs Four plastic stubs discs with a mandrel Matiaining and Sterilizing handpieces burs and stones; all hndpieces burs must be sterilized after used.

procedure
1-remove excess material from incisal margin adapt edge[outer 1mm] of coarse disc to the excess material using light sweeping strokes to slowly reduce material and contoure restoration to keep disc adapted to contours of tooth rotate it slightly as it is moved from distal to mesial end [caution to avoid unnecessarily contacting enamel gingival margin of preparation requires special consideration during finishing because of its proximity to root surface the use of rotary instruments shouled be minimized NB\\Cementum is very susceptible to abrasion even fine finishing discs can rapidly remove cementum

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2-use coarse disc to remove excess material from gingival margin if it is located on enamel adapt it in manner similar to that for incisal margin directing sweeping strokes toward center of restoration

3-use gold knife to remove excess material from gingival margins that extend onto root surface shave thin layers of excess material with tip of the blade because it can nick or abrade cementum exercise care in placing and using gold knife

4-remove excess material from distal margin rotate disc so that only outer edge is contacting excess material use light sweeping strokes to move disc along entire margin

5-contour the center of restoration examine gingivoincisal contour by observing tooth from mesial or distal view and mesiodistal contour by observing tooth from gingival by mirror or incisal aspect NB\\compare contoures with those of adjacent tooth or contra lateral tooth to determine need for further contouring move outer edge of disc over excess bulk in middle of restoration to blend middle with surrounding contours

6-check margin with explorer to determine amount of excess remaining continue using coarse disc until bulk of excess material is removed

NB\\ if close proximity of rubber dam gingival tissue or gingival retractor limits access to specific areas of gingival margin [use aflame-shaped or tapered carbide finishing bur ] position side of bur against excess material [ use light sweeping motion to run bur against bulk areas move bur parallel to gingival margin using light to moderate pressure] NB\\ USE CAUTION to avoid scarring enamel and damage adjacent soft tissue 7-continue contouring and removing excess composite resin using medium grit disc adapt disc to all four margins and to center of restoration NB\\medium disc removes slight excess while leaving smoother surface follow same steps and adaptation described for coarse disc

8-check restoration with an explorer use very light pressure to avoid abrading metal and producing streaks of discoloration on surface NB\\at this stage margins should be flush with cavosurface and original contours should be replaced [ restoration has a grainy appearance NEXT

NB\\ if detect submarginal discrepancy of 0.2 mm or less reduce adjacent enamel with white stone if discrepancy greater than 0.2 mm or is long gingival margin reduction of enamel is not indicated [enamel in this area is very thin and margin is difficult to adjacet without causing damage to cementum or surrounding structures

oid on surface can be repaired unless surface contaminated by saliva hemorrhage or non water

soluble lubricating agents

mechanical retention can be placed around void with carbide bur

mix small amount of composite resin and place it into the void after material set

finish area with discs

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polish micro filled composite resin restoration specific rotary instruments are avaliable in variety of types and shapes [follow manufactures specific instructions for using different types use intermittent pressure moving instruments over entire surface untile aluster is achiev

evaluation of esthetics is accomplished visually

it is important to do this after rubber dam removed

and tooth and restoration have moistened dry composite has slightly different shade just as dry isolated tooth changes color slightly

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