BOOKLET OF DR JOSÉ ARBEX FILHO’S ONLINE COURSE

AESTHETICS AND FUNCTION

1. ANAMNESIS / HISTORY

Patient Adielen, 17, had an enamel hipoplasy on her right central upper incisor tooth 10 years ago.
She fractured the right and left upper incisor tooth where Dr Arbex( father) with 87 years old made an
aesthetic intervention with direct composite resin.

2. PLANNING

Inicially , we asked X rays , photos, videos and models from superior and inferior archs.

The clinic protocol is based on the necessity to make the periodontal aethetic surgery. If it is
necessary to make the surgery, we have to wait 45 days to heal the gums before continuing the
process. After that we start the whitening : home and in office bleaching. We need 3 weeks to
complete the beaching. After that we make a gap of 15 days to stabilize the color and the enamel
structure. Afterwords we iniciate the Aesthetic Restorative Work with Composite Resin.

3. CLINICAL PROCEDURES

1. Periodontal Aesthetic Surgery from canine to canine , executed by Dra Andrea Murta on
06/12/2017.

2. Dental Bleaching (home and inoffice) made by Dra Ana Paula Gontijo on 08/25/2017.

3 . Aesthetic Restaurative Work in Composite Resin in 8 superior elements executed by Dr Jose Arbex
Filho on 09/16/2017.

4. STEP BY STEP

4.1 PERIODONTAL AESTHETIC SURGERY

4.2 DENTAL BLEACHING

It was done by two forms: home and inoffice bleaching.

Inicially we did a mold of the patient and a posterior confection of the whitening plates. After that we
made a complete isolation of the superior and inferior arch with lips and cheek retractor, top dan,
gauze, cotton in all the gingival mucosa to protect the papilla and surrounding soft tissue.
We use the bleaching based on hidrogenic peroxide in 35% concentration inoffice during 45 minutes
on laser. After this procedure, we give the patient the bleaching plates and give directions for its use
during the process.

4.3 AESTHETIC RESTAURATIVE WORK

Restauration of the left central upper incisor in Composite Resin.

The diagnostic waxing is an important step to as aesthetic rehabilitation. The silicone guide will make
it easier to biuld the anterior guide and check the length of the tooth.

 Anesthesia
 Insertion of the retraction cord 000 in the gingival sulcus before the tooth preparation
using the IPC spatula from Cosmedent for composite resin.
 Removal of the superficial layer of the old restauration to give space for the future filling.

If you are quite sure about the quality of the bonding of the old restauration, you don’t need to remove
it all, just the superficial layer.

. Remove the palatal filling with diamond burr by Comet giving space to the future restauration.

. Vestibular Preparation is performed by using the diamond burr with electric multiplier with
abundant rinsing.

 Relative Moisture Control

 Steil Abrasive strip on interproximal to make it easier to adapt the adhesive tape used here
as a polyester matrix.
 Setting the color with quick light polymerization. In this case we chose the BL2 by Estelite
Omega, supra nano resin.
 Acid Etching with Uni Etch Acid for 30 seconds on palatal and buccal faces.
 Rinse it all over and dry hard the tooth and the surrounding area.
 Apply the Single Bond Adhesive from 3M in three layers in palatal and bucal faces. Remove
the excess with air and cure the palatal and bucal faces for 20 seconds.
 Insert the direct composite in the palatal área with high resistente resina such as Empress
Direct Resin Trans 30 from Ivoclair Vivadent. For this procedure use de IPC spatula and the
Resin Modelin Bisco. All the palatal surface including the incisal edge will be performed in
one layer.

We use the instrument Compo Roller from Kerr to make the palatal concavity avoiding gaps and stains.
Cure it all in high power.

 First vestibular layer is biuld with opaque composite resin to cover the brownish stain (Resin
A1 dentin from Estelite Omega).
 Quick Cure of 5 seconds
 Isert the body resin in vestibular face from the vertical area to the medium third (color B1
Estelite Omega). This resin is not indicated in chewing areas.
 From the medium to incisal third we use the BL2 Estelite Omega in one layer , defining the
anatomy and shape of the teeth.

Manipulate and spread the resina lightly with the use of a brush , spatula and the modelin resina to
avoid bules ans stains. Therefore will be defined the anatomic shape with some excess to be removed in
the polishing procedures.

 Define the incisal with efect resin blue in incisal third without excesses.
  Redefine the anatomy shape with thin layer of resin BL2 making the finishing easier.
 Use the transluced resin Trans 30 in the incisal third to reinforce the chewing area .
 Double Final Cure for 30 seconds each face.
 Check the proportions with the silicone guide and the dry point compass.
 Remove the retraction cord and begin the finishing and polishing procedures.
 Finishing with diamond burs from Komet in electric multiplier, removing excesses, building
the shape and giving texture.
 Use the Soft Lex Discs for incisal and proximal edges.
 Adjust the occlusion properly (anterior guide and eccentric movements).
 Finishing and polishing with rubber cup (blue , pink and white) DFine Cosmedent. with
irrigation. Acabamento. Rubber cup from Odontomega (light colors ) just for sulcus and
proximal areas.
 Using polishing and finishing strips from the coarse to thin in inter proximal areas.
 Checking the palatal oclusion with Accul Film. Palatal finishing and polishing as vestibular
showed above.
 Polishing with felt puffs and Enamelize paste.

USED INSTRUMENTS ;

*SPATULAS;

->GOLDEN IPC-T TN STICKLESS - Cosmedent

->Green Spatula -Microfil Almori Swiss - Cosmedent

->Spatula for Incisal Shape; SD2 2M colors

->Spatula Compo Roller 5300 – Kerr

*ARTICULATING PAPER

-> Accufilm II (Parkell)

Dental Cremer and Tiradentes

*BRUSHES;

-> Hot spot -handle (artist -Line Brush cabo ref;299)

Hot Spot

-> Brush;

Code;1014
Code;1021

->Tokuyama Dental-Brush n:24

*COMPOSITES;

-> Estelite Omega ,Empress Direct (Ivoclair)e Filtek Z350 XT(3M).

-> Palatal Face -> Empress Direct Trans 30

-> Cervical to Incisal Third (Stain) -> Estelite Omega A1 Dentin

-> Cervical to Medium Third -> Estelite Omega B1 Enamel

-> Cervical to Incisal Third -> Estelite Omega BL2

-> Incisal Third –> Filtek Z350 XT BT

-> Last Layer -> Estelite BL2

Dental Cremer

Dental Tiradentes

*STRIPS;

-> Diamond Strip->TDV Dental Cremer

-> Abrasive strip - Oraltech

-> Steil diamond strip for proximal finishing (extra fine red 3,75mm) Cosmedent

-> Epitexx Gc Blue (coarse),Orange (medium ),Green (fine) Dental Cremer

-> Optidiscc Super Coarse (Kerr)

-> Soflex Xt Pop on Coarse (Kerr)

*BURRS ;Komet ;

-> 859 314 010- Fine preparation

-> 6844 314 014 - Medium Preparation- Green and Red Strips

-> 8859 314 010- Fine Finishing

-> 801 314 014 - Spherical for Preparation

-> 909 314 040 - Palatal Adjustments

*BRUSHES;

->Blue Flex Robber Cup - Cosmedent

-> Pink Flex Robber Cup - Cosmedent

-> White Flex Robber Cup Alpen - Coltene

-> Eve -Odontomega (Spiral)

-> Pink Prolific Brush Estoddart - Hot Spot

-> Brush Micro small (microtuf) pink, purple, blue – Hot Spot

*COLOR OF THE TEETH;

->Color before the bleaching: A2/A1.

->Color after the bleaching : Bleach 4 / Bleach 3

*ACID;

-> Uni Etch Acid 37% for 20 seconds – BISCO (Oral Tech)

*LIP RETRACTOR;

->Anterior transparent -Odonto Magazine Dental Aragão

-> Oral Opener ;Ppink / retractor -lip prop (imported)

*KAVO ENGINES ;

->Finishing ;E 25L Expert Matic lux

->Micromotor; E20L
-> Alta;E 680 L Expert torque

*POLISHING PASTES ;

-> Enamelize Paste- Cosmedent

-> Ata Porcelize - Cosmedent

-> Felt Diamond Flex - FGM Dental Cremer

BLACK BACKGROUND

Smile Line (Style italiano)

CAMERA

Canon EOS 7D MARK II –FLASH TWIN

TELEPHONE NUMBERS

Oraltech Tel: (43) 3178 8700

Cosmedent: Renata – (41)3234 1068

Haiaty (41) 3234 1061

Kerr: Karla – (31) 9 8484 3373

Celso- (31) 3728 8700

Dental Cremer: 0800 727 7565

Dental Tirandentes (Alba)- (31) 3238 4300

Oralteck- (43) 3178 8700

Odontomega- Marcus (16) 3610 9636

Hot Spot: 3267 5514