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    Acid Etching

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    14 views64 pages

    Acid Etch Technique

    Uploaded by

    Alina Agv
    Acid Etching

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
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    DENTAL TECHNIQUES yaveleB tem aa lal Cele | J.J. MURRAY *T. G. BENNETT Contents ‘Acknowledgements Development of fissure sealants [New approach to restoring children’s teeth Rest ion of fractured incisors ‘Treatment of diastema Construction of temporary crowns ‘Laminate vencerson maxillary anterior teeth Splintng subluxated and tuxated teeth Acid etch ined bridges Management of malformed teeth 31 4 Direct bonding of orthodontic stachments Rotation and alignment of anterior teeth {@) Sectional fxed appliance (8) Whipsprine “Treatment of ectopic incisors Treatment of palatal canines Removal ofomthodontk rackets Retention of orthodontic result Conclusion Bibliography Index 8 8 56 3” ot o a Copyright © John J. Murray and Gordon Bennett, 1984 Published by Wolfe Medical Publications Ltd, 1984 Printed by Royal Smeets Offset b ‘Ween, Netherlands ISBN 723410143 Wokis one ofthe sites in the series of Wolte “Techniques series which will eventually ‘cover a wide range of subjects, you wish to be kept informe of new additions othe eves and receve details of out ‘ther tls, please write to Wolte Medical Publications Ltd, Wolfe House, 3 Conway Street, London WIP 6HE Alles eserved. The contents his ook, th fatima mart eeprom. ‘oa ry aber mes no cyt bed inany Dena Tecmgacses Techni of Compete Der Cnsreton ‘gery the Temporomandlr ont eau Ocho Dedicat "To Valerie, Mark, Christopher, and Sheila, Catherine, Jenny Acknowledgements Almost al ofthe photographs in this Atlas were taken at the Dental School and Hospital ‘Newcastle upon Tyne; we would like to pay tribute to Me B, Hill, Senior Photographer. and his staff for their skilful assistance and willing co-operation. We are grateful to Dr P-H. ‘Gordon for his constructive comments on the manuscript, to Mr A. W.G. Walls fr his help in providing some of the photographs, particularly the Duraingul aid etch retained bridge and the electron photomicrographs. and to Mr D. Penketh for Figures 242 and 243. The fist four Figures are reproduced by kind permission of Dr B-F. Willams, lsttute of Dental Surgery. London. We would like to thank Mrs G. Rowley and Mrs V. Dyer for their seeretatial Development of fissure sealants ‘The desc 0 finds material that would adhere directly onto enamel has bee lke the alchemist’ search for 4 method of tring base meta nto old. During the 2th century ser nitrate Black copper cement, Zine ferocyanise and methyl-2-cyanoachiate were all ces unsuccems {uly in an attempt to find @ material that would stick permanently to the dclusal surfaces of posterior teeth and prevent Gclsal cares. Ieealy, wham requited fs material wbich i runny onough so that when applied, i rans int all the nooks and crannies and blocks the fissures ofthe oeclsal suece it them must ack quickly. adhere tothe eramel surface and be strong enough ta withstand masiatoy forces. These major tequiremens were felled withthe ntraducon of the aid eich echngue, in which the enamel surface i roughened with ad andthe development of various mats based om the Bis GMA tein ‘Originally reported by Bowen. A number of methods have been ‘developed to polymere or care the resins fist ltavolet light, then themical activation. More recealy visible light hasbeen used enabling fissure sealing to he caried out more icky an easily, However, the basic procdive for sucesfl sure sealing has remained esenialy changed since 190 Caution All etching solutions contain acid, usually phosphoric aci ‘Avoid contact with eyes. skin, oral mucosa and dentine. In ‘case of contact, wash immediately with water and seek ‘medical attention if eyes are involved. Do not take internal. Composite materials contain polymerisable monomer which may cause sensitisation or lrritation if allowed to ‘contact soft tissues. Wash thoroughly with soap and water ‘contact occurs. Do not use If there is a known allergy to ‘methacrylate resin = as aig Ta ence ae 1 Clean the occlusal surface with pumise or an ol free, uoride free paste 2 Wash and dey the roth, 5 Apply acid etchant (30 to 60 per cent phosphoric acid) to the occlusal surface with a cottonwool pledget or brush for 60 seconds 4 Wash thoroughly with water 5 Dry tor Msccont, 6 Apply sealant, 7 Polymerise material 8 Check occlusion, The first ultraviolet light used to polymerise a fissure sealant was extremely bulky. This was soon replaced by a much neater piece of ‘equipment which was easier to se and could rest on the ewspof tooth While the agent was polymerised for 60 soconds, This method gained popularity inthe early 1970sand came tobe know as theray gun, but the inital cost ofthe UV light wis a drawback. 1 Anexample of the first ultraviolet Tight used to cure ‘ssure sealants, www.allisiam.net Problem ogee 1 3 The specially developed Nuvait. 4 Thetipofthe light resting on the cusp of tooth. A umber of maths lovohing chemi ymerisstion were developed, for example Gone White Seslan™ ant Delton™ Poy ‘merstion was achieved by mixing one drop ‘ol univenal guid and one drop of exalt together and wating fr chemicsl polymer Sstion to occ. The application fechnigue tr broadly sina for bath materia el 5. Clan the occlusal srfice with pumice or 6- Apply ad thing lig (tooth condone other il re, fluoride free prophylanls pate. to the cua surface with a cotonwoo! pledaet forbs for seconds. 7. Then wash thoroughly with water. 8 Dry with compressed air for 30 seconds, 9 Mix sealant ~ one drop of “universal” and Taspect the surface Ir Joss not appear tos” one drop of catalyst~ins mixing Well re-etch, The tooth must be de 10 Apply sealant with applicator sind watt for chemical pelymet ation to take place ~ the time cle approximately wo (This applicator is patent pro: tected design of Johnson & Johnson.) u Sealant being applied. 3 13 Check cclsalsurface for coverage and retention, 12. Check to ensure the sealant has polymerisd in ‘he mixing well The chemical method of polymerisation climinated the need for an ultraviolet Tight source, but the polymerisation period took at lesst-one minute ring which time the tooth had to temtin dry Sometimes this was not possible to achieve, par calarly for newly erupted first permanent’ molar teeth, right at the back of the mouth, i You shildien. The third method of polymerisation, by blue visible ght, bas reduced the curing time to 20 seconds, vice i incorporated into the Prisma light system ‘hich emits a short buzzing sound every 10 seconds ‘The cleaning, washing, and etching procedures are identical tothore previously described ‘There is no doubt that the advent of fissure sealants has hanged attiudes tothe ‘early carious lesion’. At onetime it used to be regarded as inevitable that cares would occur Sooner of later on the oecusal surface of molat and premolar teeth. The concept of ‘prophylactic edontatomy’ promulgated by Thaddeus P. Hyatt in the 1920s was that it was better to restore the tooth sith amalgam efore caries actully fcurred, thus preventing larger lesions ftom developing fer, However, many young children find the process of ling and fling unplessantand the ideal’ restoration which never fais from marginal leakage Is lificult if not impossible {0 achieve. The concept of “prophylactic adontotomy” or “preventive fling’ was certainly responsible for unnecessary festorative procedures being. applied to milions of teeth ‘When fissure sealants are applied corretl tothe surfaces of tecth witha high potential for decay, particularly the occlusal Surface of permanent molars the chances of maintaining the entition completely free from caries or fillings are greatly increased, 20 _ child who hasan extensive restoration onthe occlusal surface of the lower left rst permanent mola. The margin ofthe restoration i Acfective around the dstobuecal cusp. The cavity will have t0 be enlarged and the restoration renewed. "The lower night fst permanent molar has been Assure sealed successfully. This not only means that a restoration has been pre ‘ented, but also that the "repatof repair hasalso been prevented. New approach to restoring children’s teeth ‘When caries has penetrated the enamel and reached the amelodentnal junction, ireversble destruction has occurred and the potential for the farious lesion to spread along the amelodentinal junction and into ‘entine increuss, The only treatment i to dill out the decay and place 4 restoration. ‘Traditionally, the utine of the cavity preparation following Black's directives on clasial cavity preparation inthe 1880s has involved the concept of “extension for prevention’ in that the ‘occlusal fasures are included in the eat preparation and the cavity ‘undercut, inthe hope thatthe ensuing saga restoration vill prevent the recurrence of caries. This method resus inevitably in a certain amount of sound tooth tissue being removed, However, it is now possible in early carious lesions which have just penetrate into dentine {o remove the caries with minimal cavity preparation, to protect the ‘exposed dentine wit a calcium hydroxide preparation and then to acd exch the cavity and the occlusal suace i exactly the sime Way a8 for Fissure sealing, Then the cavity fled with 3 composite material, which has the same chemical composition as 2 fssre sealant, but with silica particles added to give greater strength. The occlusal surface is then Fissure sealed with an unfilled resin and the whole surface, inluding the small pit detec, is polymensed, The ensuing restoration ts simpler for the patient and embodies the principle of extension for prevention twthout the unnecessary removal of sud ts 21 An upper left rst permanent molar with Small amalgam fesoration in the mesial pit and ‘an early carious lesion nthe distal pit. 22. A fine bur ls used to remove the carious tissue and deficient amalgam from the tooth, Which is soated by meant of a rubber dam of 23._A view of the cavities. The lor of each cavity i then Hned with calcium hydroxide preparation. the occlusal surface are etched for 60 seconds, light sensitive fissure sealant is then “applied io the occlsal surface ‘washed for 10 seconds and dried for 30 seconds (oobtaina frost” appearance 28 ‘The materia is then cured for ‘vith stable ight to comple 0-30 seconds he restoration 26. The cavities ae filed wit > 8 i E 23 A view ofthe lower arch of another patient Showing a composite restoration and fisure ton on the lower ri Restoration of fractured incisors ‘When a tooth js fractured, particularly if dentine is exposed, the vitality ofthe pulp of the tooth ts at much greater sk, because it has ost part ofthe very hard protective outer covering. Even f the toth i kent lean, the loss of hard tissue following a erown fracture means thatthe Dilp is now subjected to greater thermal and chemical changes than ‘would otherwise be the cae, This inereases the risk of pulp death in Fractured tooth. The treatment of choice sto cover the exposed dentine as quickly as posible so as to ty and maintain the vitality ofthe tooth Before the introduction of the seid etch technique, the only method available was by cementing a stainless steel band or crown on the tooth in the hope that the pulp could be protected until soot formation had been completed, Then the tooth could eventually he restored with a «crown, usually of porcelain, when the patient was about 16 years of age. ‘The advent of the acid etch technique meant that a tooth coloured: ‘material could be bonded on othe fractred area, thereby replacing the Tost tooth tissue. At ft, this method wae regarded as 2 most help ‘but temporary, method and it was assumed that the final restoration ‘would sl he a porcelain jacket crown. During the lst 10 to 15 yo hnumber of modifications have been suggested to the technique an there hhave been considerable improvements in the aesthetic of composite materials, so the acid etch technique for restoring fractured incisors Should now be regarded as a medium to longterm treatment and in Some cases the definitive restoration. 30 The upper left central incisor has been fractured, exposing dentine. ‘Stainless tel crown. 31. The traumatised tooth is covered with 32. The tooth restored (in 1972) with an acid ‘etch compenite restaration. ‘The following technique has heen employed for the restoration of fractured. permanent inckors in young ehilren aged 6 4010 years, ‘who present having recently been in an acedent “The method is suitable for fractures in which dentine is involved. but the pulp should pot he ‘exposed. In these cases the prime objective is terry to preserve the vitality ofthe pulp so that oot development will continue normally 33 Thetooth is cleaned with pumice. |The toth is washed and dried. 5 The exposed dentine is protected with a ‘aleum hydroxide preparation. [36 A crown former is trimmed so that it forms ‘a matrix which jst eovers the fracture line and {extends 2 to 3mm onto the remaining crown Tabialy and palataly. Te is essential thatthe crown former fis tightly onto the tooth 37 The fractured enamel, and 2 to 3mm only ‘of normal enamel, Tabialiy and palatal, is ‘tched for il sovonds. Note that no prepara. tion of the fractured enamel has been carried 39. The tooth is dried for 30 seconds until the ost" appearance is seen, 441. The composite is mixed, placed in the ‘rown former, and held firmly oh the toth for Siminutes. 40. The fracture line i painted with bonding agent. 42 Allowing the composite to set. Although some excess can be removed from the labicl Suaface with a probe, itis essential that the finger and thumb hoidiag the crown former ‘onto the tooth do not move and that pressure is ‘maintained on the crown for S minutes to allow Chemical polymerisation to take place. Ifthe composite is disturbed during the setting feaction the stzength of the bond will be ‘diminished and a smooth polished finish tothe Surfice of the composite wll not be obtained 4s 48 The cli crown s removed with aselpe Any exces Gomposie is removed with oar intumen ata posible the aba surace not touched, athe Hine sath race bined by contact with the celui crow former ho tremely ifcltto reproduce evenifalaeappicn 44 Excess composite is removed with an excavator. This is simple to do providing the aid etching has extended ony to the margin ofthe crown former 46 The fnal restoration should approximate to the original crown shape. It will be noted that ther is similar restoration ‘on the other cental incisor. “The final restoration should epproximate othe Orginal shape. The teatment fs simple ard the principles are essentially the same'as forthe Rare wal echnigue, The main pupae that of profstng the pulp, hasbeen acoved with no tooth preparation, with consierabiy bot asthtisr than the sales see row One disadvantage of the method described Is that marginal ssning com occu pariaary fon the labial surface where the composite {eoration overlapped 2 to Simm ont norm fname If the sain occurs it can be plished Shay al areal st Some operators recom: tend beveling he factred enamel or cating a“halt enamel prepartion’ sa an attempt To achieve. greater thickness of composite and Feduce the marginal ssining, An example of thebeveled enamel tchnig,wnng ight em tive composite rein, wll mw be shown. 49 The bevel exten surface, beyond the! 2 to 3mm up the labial scot the fracture 447 A.fracure ofthe upper left central incisor, 48 A tapered diamond bur i used wo produce S-year-old patient involving enamel and a bevel at an angle of approximately 4° to the dentine Inbal surtace 0 ‘50. The dentine is protected with a calcium $1 Bonding agent is applied with a brush. hydroxide preparation and the foath i etched, washed and dried so as t0 obtain a “fosty {ppearance. 52 The crown formers filled with 153. The crown former it removed and the S4 . .. aSoflex" polishing strip tive composite resin and placed in positon. margins smoothed by means ofa Swift abra Excess mateial is removed with «plastic sivestip instrument and the material is cured with the Tight source. Both labial and palatal surfaces should hecured to.ensire polymersation www.allislam.net Problem 55... ora Softer disc [56 The final restoration. Treatment of diastema ‘The method described above for restoring fiactured incisors can be used to bond com= ‘onto ncemal enamel inorder to Feduce a diastema Diastema (3.Smm) between the upper 58 A suitable mate is cut from a crown fo ‘entrl incisors former. o ou 7 « 9 Thetoothis etched for 60seconds... 6... washed for 10 seconds 62 A bonding agent is then applied to the 63 The matrix is filed with composite ofthe 64 When the operator is satisfied with the ‘mesial surface with a Brush ‘appropriate shade and applied t the tooth positon of the matrix the composite ix cured 6s surace. ‘Sith the light source = o Construction of temporary crowns ‘The principles involved in restoring a fractured incisor oF closing « diastema can also be extended to constructing a temporary crown; for example, to convert a lateral incisor into central incisor, or 10. change. a. peg lateral {incisor into @ normal size lateral incisor. This ‘an be particulary helpful as a temporary oF Semipermanent measire in the developing ‘dentition where the size of the pulp chamber Would preclude the placing ‘of porcelain ‘rowns, which require Eutting into the tooth Either chemially-cured or lighten composite material canbe used. (68 The upper central incisors in this patient ‘were impacted because of the. presence of Supernumerary teeth, Even after the super rumerary teeth were removed the. central incisors didnot erupt and had to be removed surgically, (69 Crown formers are trimmed so that they Fi sghty athe gingival margin but increase thesize of the crown, 7 The whole of the crown, labial, palatal, ‘mesial and distal is etched and then washed and dried. All surfaces of the tooth should now havea frosty" appearance. 71_A bonding agent is applied to the toth surface. 72 The crown former is filled with the ‘composite resin in this ease a chemically cured ‘microil composite); it placed on the upper Fight central incisor, the ekcess is removed and the crown shed in place for S minutes. an 75 A similar procedure is carried out on the 74 When the composite has set, the crown 78 Any excess composite is removed with a upper leftinckor. formers are removed with a sealpel. fine tapered diamond bur. % 76 Final trimming can be carried out with a ‘77 The ial result from the Iabialaspeet «78... and fom the palatal aspect. stone. 79 A similar technique employing» tight Sensitive material, can be used, for example, 10 Convert an upper lateral lacsor to a central Incisor. A esomn former is adapted tof tightly atthe gingival margin. 82 The crown former is filed with light sensi- tive composite resin of the appropriate shade fd applied tothe toth. ‘Time is svailable 0 {rim any exces from the gingival margin, 0 The tooth ig etched, washed and dried (0 81 The bonding agent i applied witha brush achieve a rosy" appearance 53 When all excess hus Deen removed, the 84 Adjustment of the incisal edge can be ‘material is polymerised with the light twill be achieved with a fine tapered diamond bur nsessary to shine the Fight bovh labially and Palataly for t least 20 to 30 seconds becae bt the bulk ofthe materia. Laminate veneers Discoloured upper anterior teeth, particularly those stained by ttracyelines, are an extremely diffcult clinical problem. Oa the one hand the tooth struct ‘ssualy sound and free from decay and therefore from a clinical poin of view iil o cu into sound tissue and rsk dumaging the pulp On the other hat ‘and unsightly. Inthe past the ‘usual ine of treatment was to delay treatment until the patient reached 16 0 18 Years of age, when porcelain jacket crowns could be provided. However, the ‘evelopment ofthe avid etch technique enables plastic veneers to be bonded to the Iblal enamel surface, so improving the appearance ‘A number of developments in the laminate veneer technique have taken place in the lst few years. Inially, the pre-formed veneers were trimmed atthe chai Side and a cemically cured composite resin was used fo attach the veneer tothe «etched enamel surface, It was not always possible to adapta pre-formed veneer very closely to some incisor teeth and an indirect technique was developed, whereby the veneers were trimmed on model and then heat adapted {0 the labia surface in the laboratory. The use of light-sensitive resin was introduced hich gave the flexibility of ‘command cure’. Greater time was available to place the veneers inthe optimum position and any excess composite could be removed while it was sill soft. When the clinician was satisfied withthe position of the veneer the composite was then polymerised quick with the light Source 86 A preformed laminate veneer (Mastique") is chosen which ‘most closely approrimatesto the size ofthe tooth, 157. The vencer is trimmed and smoothed with « white 88. 50 that it fits jut into the gingival crevice. stone - ‘The length of the venecr is then redveed unt it docs ot extend beyond the natural incisal edge. $9 The bial surface then ced, washed and dried inthe normal way Joid strips are placed on the adjacent teeth. rosy” appearance ofthe etched labial surface 2s 2% 93 Some excess material can be removed witha probe, tbat the veneer must be Beld firmly in place for thre ‘minutes and then not touched for a further two minutes, tallow chemical polymerisation to take place 92 The veneer, which has been cleaned and primed for ten minutes with the agent provided, i then filled ‘with composite ofthe appropriate shade and placed on the Labia surface ‘94 After five minutes any rsmalning excess composite is removed with sandpaper dies ora tapered diamond bur. The incisal edge should be trimmed so that the force of the occlusion is taken om the natural incisal edge rather than onthe veneer. Finally, the margins of the veneer are scaled with a further application of the bonding agent with a paintbrush ‘One ofthe problems with this tecnign is {Rares the laminae an exermely good fi the toth made rater bully n't no Tinga ection. Another problem is tha thee is danger of presaing wo hard on the Taminate veneer whit wating forthe com site to polymers, 80 nreducng ais Tote ntsc compost merce. “These problems can be reduced by ensuring a close-fiting vencer by preparing them on a ‘model in the laboratory and heat treating the fencer fo adapt it fo the model. Furthermore, the polymerising time can be reduced by using the visble light ‘curing composite, which tnables the veneer tbe postioned gently and thea cured in 2010 6 seconds ‘97 A latex compound is spread evenly over the imide ofthe labial surface 10 act 6 spacer for the. composite resin which attaches the veneer to the tooth surface 9S An impression of the upper arch was taken from which the plaster model shown was made. ‘A chisel is used to remove small amount of plaster at the gingival margin so that the veneer twill below the gingival margin 38 ‘98 When all the vencers have been trimmed, silicone impression material Is held firmly in place against the vencers, with an elastic band ‘The model is them placed in a machine which applies heat and pressure so thatthe veneers are softened and adapted more closely 0 the lial surface othe teeth, 96 Labial view showing the trimming of the plaster around the gingival margin of the upper Fight central incisor OL 4 99 The neat adapted veneers closely adapted 100 The indirect method of preparing lami- 101 The prepared veneer is checked on the tothe model. nate veneers, together with the'use of the labial surface ofthe upper right lateral incor. Prisma ight tocure the composite, was wed on the following patient with tetracycline staining 103 102 The tooth is then cleaned with pumice, 103 Celluloid strips are placed in the 104... washed and dried to achieve the washed and dred stitial areas on iter side ofthe tooth, which is necesary frosty” appearance then etched plied to the labial surface to 106 Curing the opaque for 10 seconds. tooth showing through the 107 The vencer, coated with composite, is placed on 108 When the operator is satisfied with the position of the veneer, the composites cured with the light for S010 the labial surface and any excess composite is removed with plastic instrument. {0 seconds, tuoi rimming can be carried ot wih» 110. «a feale abrasive die (Sox) 11. anabrave rp (Sote).

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