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  White line on class V restorations

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. -
From: cbarrington
Sent: Thursday, December 22, 2005 12:23 AM
Subject: [roots] "white lineITIS"!!!!....AHHHH!!!!!!!!!!!1

I just cant seem to consistently NOT get a white line on these class V restorations

WHAT IS THE DEAL???????????????

Photo 1: preop after radiosurgery
Photo 2: the isolation big picture.dual clamp : primary clamp = no floss because 
         clamp over dam technique used. Secondary clamp= Brinker #6
Photo 3: close up
Photo 4: final prep ..left= before ultrasonic use on finish lines.right= after 
         ultrasonic use on finish lines. Used a Buc 1 diamond impregnated tip, 
		 dry, on 4-5 setting on Satelec unit..
Photo 5: final restoration WHITE LINE AND ALL!!!!................. it is always 
         at the gingival portion this restoration was all in enamel. Re-etched and 
		 rebounded was all I did to combat the defect

FYI, the white line is not necessarily visible to the naked eye IE: the scope allows 
one to see it as clear as it appears in the picture

The enamel looks cracked on this one, but I removed undermined enamel and watched my 
resin increments and layering

These are the hardest restorations to do IMHO!!!!!!!!!!!!!!!!!!!!!!!!!!!! - Craig

class V restorations

class V restorations

class V restorations

class V restorations

class V restorations Craig, Looks like you may be a bit short of attached tissue there. In cases where that is true the USAF taught me to do a mini-flap for access and retract the flap with the #9 or 212. A mini-flap is two vertical incisions on either side of the lesion. If you can leave them in attached tissue you don't even need to suture - DanS Good eye. I was taught the procedure in dental school and I use it sometimes. I should have done it here but I didnít tunnel vision I had the radiosurg tip in my hand by the time I noticed and I couldnít stop myself IE: I had a hammer and had to swing it.:-) - Craig Craig, what is it that you specifically do with the US tip? to me it looks as if after the US prep the gingival finish line is whiter than b4 Was the left hand side dam bridge torn on purpose or accidentally? if the former, why? why the hardest? - Marcos Arenal Plane off undermined enamel...... "to me it looks as if after the US prep the gingival finish line is whiter than b4" it's "dust"..... "Was the left hand side dam bridge torn on purpose or accidentally? if the former, why? " I cut it on purpose because sometimes it pulls so tight that it lifts the clamp up....... ..even these Brinkers cant get low enough sometimes.........and when they do, they want to pop up............ "why the hardest?" Start doing them on a regular basis and you will see. They are harder than anything else to do "correctly" and I still have not become consistent yet. The isolation, the access, the gums, they wrap around the tooth 99% of the time, they are usually at the enamel/root junction and root cuts different and feels different and has different properties than enamel plus the materials stick and handle different with the root than the enamel..........almost requires two different things to get it "right".................the finishing and polishing is difficult!!!! is hard to maintain the proper contour of the tooth .........and keep in mind it is not just a straight "convexity" from point a to point b. If things are right at the DEJ, remember that part ends and essentially heads into a straighter region of the root. As well, you can easily polish off the cementum and cause post op sensitivity. As well, if you polish too much on the root, cracks in the filling start because the filling bond is not that good to the root............... I could go on but hopefully you get the point...............with numbing it is is a pain as get the rubber dam on and the Brinkers you have to make sure the lingual gum is numb as well so the clamp doesn't hurt.........if you want proper field isolation you have to numb more than just the tooth you are working on as well............granted, the lower arch is easiery but the upper sucks....... If you get a chance, try do to one some time................they will kick your @#% BRO!!!!!! me........ Let me know - Craig If you'd throw that damn dam away you wouldn't get them. :-) - Guy C , Very nice restoration, The " white line " does't bother me . As I see it ... It appears to be the enamel margin . I was wondering if you use a crochet hook to position your clamp? - Mhenley White lines in the enamel is cracking of the enamel due to good bonding and high polymerisation stress of the composites Try to reduce your light curing time in the last layer to only 3-4 seconds and keep the curing light at some distance. Twice the distance you are using today. After finishing you can post cure with your normal curing time. Another possibility is to use a flowable comp. and use it as a liner as you first increment and place it just over the margin in a very thin layer. and then continue with your normal layering technique. Continue your use of dam - Harald Prestegaard, Norway Look at the gingival margins in the final prep. Craig had the white line before he did the restoration! Otherwise and even with it that is a nice just a bit light, but nice restoration - Alan Cady GREAT ADVICE THANKS!!!!!!!!! - Craig Craig, Did you leave the caries in the adjacent Incisor???? if you had incorporated good bevels in your cavity prep you could have easity merged your composite and a better esthetic result could have been achieved IMHO and always try to use 0.5 darker shade than what you selected for the particular tooth again IMHO - Vipin Look at Unterbrinkís discussion of white lines and how to avoid them at this link. Excellent presentation of the issue. Hope this helps. - - gary The only thing I would add is that I prefer a little more bevel than what I can see in your photos. Don't know if it actually helps or just makes me feel better, but I get a decent result - Catherine Mincy That sounds like my problem from the compilation of all the stuff I have read - Craig

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