Finishing and Polishing
Using the best tools to achieve natural-looking results
When finishing a restoration, clinicians are careful to ensure that any new structures added to a patient’s mouth blend as seamlessly as possible with the existing dentition. Each distinct step in creating a strong, esthetic final restoration requires its own unique set of tools.
The last step, finishing and polishing, offers clinicians an almost overwhelming number of options for shaping a restoration into its final form. The number and variety of finishing and polishing tools available allow clinicians to perform superb finishing touches on all types of dental work and provide patients with restoration results that look like their natural teeth (Figure 1 through Figure 8).
The finishing and polishing tools available on the market are each specially designed and manufactured to work with different materials and in specific situations. In many cases, more than one implement is used to achieve optimal results.
Not only do clinicians need to be mindful of the indications for each of their finishing and polishing tools, they must also know the proper sequence in which to use them to ensure the long-term health and esthetics of each restoration. If an essential part of the process is overlooked, the tooth can be left rough and susceptible to plaque and staining. Some common types of finishing and polishing products and their indications are discussed here.
Aluminum Oxide Products
Four-Disc Grit Sequence
When finishing a restoration, aluminum oxide discs can be used for the contouring of all tooth surfaces as well as bulk reduction of excess material. These tools will help clinicians with the contouring and finishing of curved surfaces such as labial proximal line angles, lingual marginal ridges, cervical areas, and incisal edges; with the shaping and finishing of incisal corners; and with the finishing and polishing of labial surfaces. They are also excellent for contouring and finishing posterior marginal ridge areas, as well as lingual and buccal surfaces.
Designed to gradually reduce the amount of roughness caused by initial abrasion until a smooth glossy tooth surface is achieved, the four-disc grit sequence is an excellent option for clinicians when finishing a restoration. To provide maximum control for the operator, composite finishing should be done under low-speed/high-torque (speed from 0 to 30,000 rpm).
The four discs used in this technique include:
Coarse—The coarse grit is the stiffest of all the discs. This grit is used in conjunction with multi-fluted finishing burs for gross contouring and shaping. When used with pressure, the coarse disc makes it easy to blend the composite into the tooth surface, eliminating the white line and raised margins.
Medium—The medium grit should be used to continue smoothing the restoration surface. Medium grits remove any remaining imperfections and marks.
Fine—This part of the grit sequence is where polish really starts. The fine grit helps remove the smallest imperfections while adding a nice luster to the restoration.
Superfine—The superfine grit further refines the surface smoothness attainable to create a highly polished restoration.
Thin aluminum oxide strips are used to contour and polish interproximal areas. A high-quality strip will remove difficult stains and create a high polish without damaging the soft tissue, making it a useful tool in the clinician’s arsenal. It is important that aluminum oxide strips stay intact as they are drawn through the interproximal contact areas, as a broken strip could potentially cause damage to the clinician’s work.
Cups and Points
Aluminum oxide cups are used to polish gingival margins, achieve labial characterization and anatomy, and effectively reach areas such as the gingival third and the gingival margins of anterior teeth. Aluminum oxide points are designed to create labial grooves in veneers, and to finish and polish occlusal surfaces of posterior teeth, as well as the lingual surfaces of anterior teeth.
An aluminum oxide polishing paste should be used as the last step in the finishing and polishing process. Polishing paste with felt discs and points can be used to bring out the final beautiful polish of composites, metals, porcelain, or natural dentition after prophylaxis.
Diamond strips help initiate the interproximal finishing process while maintaining the integrity of the interproximal contact. Diamond strips are available in a variety of grits. A larger-grit (45-μm) strip should be used for interproximal stripping of natural teeth or for gross removal of material, and smaller grits (15 and 30 µm) are used to start interproximal polishing.
A Customized Approach
With such a diversity of finishing and polishing tools available, clinicians who take the time to research and experiment with different methods will discover what works best for their procedures and practice, facilitating their ability to provide the most esthetic, stable final result for each patient, in every case.
The author is part owner of Cosmedent.
K. William Mopper, DDS, MS
Member and Fellow
American Academy of Cosmetic Dentistry