White line on class V restorations

From: cbarrington
To: ROOTS
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







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 didn’t tunnel vision I had the radiosurg tip in my hand by the time I noticed and I couldn’t 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!!!!..............it 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 well..............to 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!!!!!!...........trust 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 Unterbrink’s discussion of white lines and how to avoid them at this link.
Excellent presentation of the issue.  Hope this helps.

http://www.planetcerec.com/clinical/white_lines.shtml  - 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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