Venus Pearl is a new addition to the successful Venus range from Heraeus. Like Venus Diamond, the Venus Pearl universal composite is based on a TCD-urethane matrix.
The advantage of this new matrix is that it offers both extremely low shrinkage stress and high resistance with regard to occlusal load. However, both materials differ in terms of the filler system they use and thus in their consistency. The particle size and distribution is a little finer in the case of Venus Pearl with the large fillers of Venus Diamond being replaced by pre-polymers, which gives Venus Pearl a creamier and smoother consistency than Venus Diamond. As a result, the material is extremely easy to process using a spatula and brush, while still remaining firm.
The sophisticated shade system provided by Venus Pearl ranges from opaque, chromatic dentine shades to universal shades in a variety of VITA colours that provide medium translucency and can also be used for the single-layer technique, through to incisal shades that provide maximum translucency and are also available in opalescent hues. Depending on the required aesthetics, restorations can be fabricated with just one colour or using a combination of several colours with varying translucencies. In addition, custom shades are also available for bleached dentition, core build-up and gingival imitations.
The superior colour matching possible with Venus Pearl also assists practitioners in masking restorative margins. The material can also be easily and quickly polished to achieve a lustre similar to that of enamel.
A considerable challenge... with a simple solution
Dr Ulf Krueger-Janson is Vice President of the DGR2Z (German Society for Restorative and Regenerative Conservative Dentistry) and a member of the "Neue Gruppe" (a scientific association for dental surgeons) as well as of other professional associations such as the DGAZ, DGFDT, DGZ and the "Bensheimer Arbeitskreis" (a working group for dentistry and dental technology). He is also a certified member of the European Society of Cosmetic Dentistry, and runs his own dental practice in Frankfurt am Main.
For over 20 years, he has been successfully involved in concept-oriented dentistry, focusing on interdisciplinary therapies and the specialist areas of implant prosthetics and all-ceramic restorations, as well as the creative applications of composite fillers.
The use of digital technology in recognising basic morphological patterns in natural anterior dentition, and their reconstruction using composites, is currently the focus of his dental methodology. He is the author of numerous national and international publications, as well as a speaker and course leader both at home and abroad.
His book "3D Composites" was published in September 2010.
Mr Krueger-Janson, you have many years of experience in highly aesthetic composite restorations and so were one of the first practitioners in the world to test the new nano-hybrid composite Venus Pearl.
In your opinion, what are the challenges associated with anterior restorations?
We are all aware of the discussion as to whether the correct shade or the correct shape is the decisive factor in the success of a restoration. I believe that both requirements are prerequisite. However, when reconstructing a fractured incisal edge, the shade transition from the natural tooth substance to the composite presents a particular challenge. This is why we need a material that offers good coverage and intensive shade effects so that this type of restoration is not obvious. Nevertheless, all sharp, refractive fracture edges should be rounded and smoothed down beforehand.
In which cases would you favour direct restorations using composite? Where do you see the boundary with indirect restorations?
The demand for direct restorations has increased as a result of the attitude of today's patients with regard to maintaining their original tooth substance, the time required and the greater expense associated with indirect restorations. Thanks to improvements in the material properties of abrasion stability and flexural strength, I personally find that composites support a wide range of processing techniques that can be further extended if colour matching is optimised. Increasing the amount of filler particles while retaining translucency and still facilitating convenient processing are the modern achievements of this material that enable highly aesthetic results.
Indirect restorations remain the preferred approach for complex aesthetic corrections, or where complicated functional rehabilitation is required, or simply where we as dentists feel that we have our limitations and would like to call on the assistance of technicians.
How do you convince patients of the merits of these highly aesthetic direct reconstructions?
The easiest means is the mock-up. This allows aesthetic changes such as the closure of a gap, or changes in terms of position or shade to be shown to the patient during consultation directly in the patient's mouth, by applying composite. The mock-up - on the untreated tooth surface - can even be given to patients to take home to show to their families. As there is no bond with the tooth, the layering can be removed at any time.
What are the properties that you feel the ideal composite for anterior restorations should offer?
It must offer a range of shades that has been put together in a logical fashion so that practitioners can produce aesthetic results quickly, and it must also meet the requirements of easy processing and good polishability.
What physical material properties do you consider important in anterior restorations?
If the shade effect is considered one of these properties, then the material should provide comprehensive coverage of discoloration and still offer a natural appearance. Abrasion stability also has a crucial role to play in incisal areas that bear a functional load, and in this regard so too does flexural strength.
Your restorations are always completely natural and impossible to detect. How do you do it?
My approach is based on recognising the shade characteristics of the natural tooth and knowing the shade characteristics of a composite in order to use it in the most appropriate fashion. That sounds easy, and it is. Ideally you should take samples. You will need two glass plates for this purpose. Place four 1-cent coins on the edges to hold in position. Then apply different shade samples and press together with the second glass plate until it touches the 1-cent coins. You can now evaluate the completed samples in terms of translucency, opacity or the shade effect in each case. This is why I also like to try out small shade samples in the patient's mouth, e.g. on an adjacent tooth. This is very effective, because it allows the shade to be compared on the spot, enabling better shade determination.
Can you tell us the tricks that you use during shade determination?
Prof. Barghi, who is based in the US, once said during a lecture that over 80% of people have shade A. That is why I prefer shade systems that provide universal basic shades. The individual nuances such as brightness or grey hues can be created using white shades that are therefore cloudy - and similar to enamel - or translucent shades that are therefore grey in appearance. A thin layer of A1, for example, can increase brightness. We therefore have a wide range of different shade effects at our disposal. Shade determination thus takes place during application, as every shade nuance can be adapted individually as described above once a basic shade is available.
How do you always manage to achieve the correct individual translucency for each restoration?
That's a very appropriate question. You need the right foundation. For example, an opaque basic shade that provides good coverage, onto which I would apply one or more layers where required. This is where creativity begins. Enamel shades offer greater saturation than translucent shades. Translucent shades are grey in appearance. When we look at natural dentition, it is precisely this combination of shades that we notice at the incisal edge.
Venus Pearl is a new addition to the successful Venus range from Heraeus. Like Venus Diamond, the Venus Pearl universal composite is based on a TCD-urethane matrix. The advantage of this new matrix is that it offers both extremely low shrinkage stress and high resistance with regard to occlusal load. However, both materials differ in terms of the filler system they use, and thus in their consistency. The particle size and distribution is a little finer in the case of Venus Pearl with the large fillers of Venus Diamond being replaced by pre-polymers, which gives Venus Pearl a creamier and smoother consistency than Venus Diamond. As a result, the material is extremely easy to process using a spatula and brush, while still remaining firm.
The sophisticated shade system provided by Venus Pearl ranges from opaque, chromatic dentine shades to universal shades in a variety of VITA colours that provide medium translucency and can also be used for the single-layer technique, through to incisal shades that provide maximum translucency and are also available in opalescent hues. Depending on the required aesthetics, restorations can be fabricated with just one colour or using a combination of several colours with varying translucencies. In addition, custom shades are also available for bleached dentition, core build-up and gingival imitations.
The superior colour matching possible with Venus Pearl also assists practitioners in masking restorative margins. The material can also be easily and quickly polished to achieve a lustre similar to that of enamel.
You were one of the first dentists worldwide to test the new Venus Pearl nano-hybrid composite - what was your impression?
Your developers have achieved something very special.
How would you evaluate the processing characteristics?
The material does not stick or stretch, can be easily adapted, and is very easy to process as a result.
The most important thing is that layers do not contain bubbles, and this can be easily achieved thanks to suitably adapted thixotropic properties. By that I mean that the layers do not run once they have been applied, yet still bond well with one another.
How does Venus Pearl assist you in achieving perfect aesthetics?
Venus Pearl uses the same shade system as Venus Diamond. So you don't need to familiarise yourself with something new yet still benefit from a logically-structured shade system. Such as the 4 opaque basic shades for example that as a result provide good coverage and are available for base layers with different degrees of brightness, for any shade combination. And as well as the standard shades A1, A2 etc. for certain effects, white, brown-yellow, translucent or opalescent shades are also available. In my opinion, they are arranged well and according to an easily understandable structure.
Arranging the shades in this way makes shade selection easier. This is because base layering using a basic shade provides the foundation. Customisation can then already begin with the next layers. In the case of monochromatic teeth, i.e. those comprising one colour only, just one coating of A2 or A3 is sufficient. If you would like to make the lateral edges a little more translucent and thus greyer in appearance, CL - CLear - should be used in this area. If the "halo" effect is to be replicated in the incisal area, CO - Clear Opal - is recommended.
Could you demonstrate for us the treatment process involved in direct restorations with Venus Pearl, using a current patient case as an example?
Of course!
Case Report: Venus Pearl nano-hybrid composite by Dr Ulf Krueger-Janson
One female patient presented to me with an inadequate composite restoration of tooth 11.
Figure 1 shows the condition of a composite filling 2 years after a bicycle accident. The patient was unhappy with the shade transition from the natural tooth substance to the filler and its greyish colouring. The shape and the profile of the incisal edge were also deemed unsatisfactory.
To determine the shade, I applied layers of sample shade to the dry and unconditioned tooth surface and carried out polymerisation (Figure 2). Polymerisation is advisable in this regard so that the correct shade appearance can be verified should any changes in shade occur. This should take place directly at the start of treatment in order to prevent the tooth from dehydrating, resulting in colour shift. In order to determine the basic shade, I applied the opaque dentine shades (OMC - Opaque Medium Chromatic und OLC - Opaque Light Chromatic) to the cervical and central parts of tooth 11. On the adjacent tooth at the same height, I layered a more transparent hue - A2 (known as the enamel shade) in order to check the impression made by the shade. Using the samples applied in the incisal area indicated in Figure 3 (Cl - CLear, CO - Clear Opal), the level of brightness of each material could be determined. During subsequent layering you must take into consideration that each layer will be considerably thinner and the effect of the shade (particularly of the samples applied in the incisal area) will appear less intensive.
I then removed the previous inadequate composite filler (Figure 4) and bevelled the enamel in a round fashion, flattened towards the end. The incisal-facing area should be shaped in a round dome so that no ridges are created that could cause light to refract intensively.
The adjacent teeth were then covered using Teflon tape, the tooth etched (Figure 5), bonded and the silicone key placed in position (Figure 6). I then layered OLC (Opaque Light Chromatic, Venus Pearl) over the entire palatal area of the silicone key (Figure 7).
Using OLC, I then continued to build up the tooth shape beyond the edge of the fracture towards the incisal and vestibular area, and applied a contouring layer of CLear (CL) on the distal edge of the monochromatic layer structure (Figure 8).
Following removal of the silicone key, the tooth contour is more clearly visible, as is the grey transparent CL layering in the distal area (Figure 9).
I then continued coating the opaque OLC base and applied the CL shade with its grey appearance to the edges. In order to replicate the bright area as seen on 21, shade A1 was layered in the centre and brushed (Figure 10) towards the cervical area. Final coating was then performed using A2 so that the tooth shade would appear healthy and bright.
Following finishing and polishing, the restoration can now be evaluated in terms of shape and appropriateness of shade (Figure 11).
The patient is a dental technician and very happy with the result (Figures 12 and 13). Together, we were able to optimise the shaping of the incisal edge.
Viewed from the front (Figure 14), the edge layering integrates perfectly in the dental environment thanks to its natural design in terms of shaping and shade.
Mr Krueger-Janson, thank you very much for this excellent example. And thank you for talking to us.
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Tuesday, 15 October, 2024