CLINICAL RESEARCH

Superficial roughness on composite

surface, composite enamel and
composite dentin junctions after
different finishing and polishing
procedures. Part I: roughness after
treatments with tungsten carbide vs
diamond burs
Federico Ferraris, DDS
Private practice, Alessandria, Italy

Alessandro Conti, DDS

Private practice, Casale Monferrato, Italy

Correspondence to: Federico Ferraris

Spalto Borgoglio 81, 15121 Alessandria, Italy; E-mail: info@studioff.it

70
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Abstract

A second analysis was then performed

The aim of this study is to investigate

were taken on C surfaces, CE and CD

different instruments for finishing com-

interfaces. Statistical analyses were car-

posite restorations, as well as examining

ried out with c2 test (a = 0.05).

different surfaces and interfaces of the

Conclusions: The finishing procedures

same restoration. The null hypothesis is

with fine grit or toothing burs gave a

represented by the fact that there are

better smoothness with tungsten car-

no significant differences on roughness

bide burs compared to diamond burs.

of composite restorations finishing be-

While with the ultrafine grit no significant

tween tungsten carbide and diamond

differences were noted between tung-

burs, furthermore the null hypothesis

sten carbide and diamond burs on the

is that there are no significant differ-

CE and CD interfaces, the diamond bur

ences on roughness between finishing

left less superficial roughness on the C

on composite surfaces (C), composite-

surfaces. With regards to the superficial

enamel (CE) and composite-dentin (CD)

roughness of the different areas of res-

interfaces. The study was performed on

toration, it can be concluded that: mi-

28 teeth, and class V cavities were pre-

nor roughness was detected on C sur-

pared on the extracted teeth. Restor-

faces, while the CD interface had the

ations were done in Filtek XTE nanofilled

most superficial roughness, regardless

composite (3M Espe) in a standardized

of whether the diamond burs or tung-

method, to then be finished. A compari-

sten carbide burs were used. This study

son was made in the phase 1 between

shows some statistical differences that

tungsten carbide burs (16 blades), dia-

could not be clinically perceivable. The

mond burs (46 m), with a similar shape

clinical relevance could be resumed as

by the same manufacturer (Komet).

follows: the fine tungsten carbide burs

Each surface received 5 bur applica-

provided less roughness compared to

tions. Consequently, an analysis with a

a fine diamond bur. There were no dif-

profilometer was performed. Phase 2

ferences between the ultrafine tungsten

involved further confrontation of ulterior

carbide and diamond burs. The less fa-

finishing with ultrafine tungsten carbide

vourable interface to be finished is CD,

burs (30 blades) and with extra and ul-

compared to the CE interface and C sur-

trafine diamond burs (25 and 8 m) (the

faces.

same shape as previously mentioned).

(Int J Esthet Dent 2014;9:7089)

with a profilometer. All measurements

71
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Introduction

The accumulation of this biofilm on

dental structures can cause secondary

The prevention of secondary decay and

cavities and the mechanical action of

the esthetic optimization of composite

brushing produces a disorganization on

resin material on surfaces are two as-

this biofilm that can prevent or stop the

pects of practical interest in restorative

formation of cavities.14

dentistry. Both can have a close correla-

According to some studies, it can be

tion with the clinical phases of finishing

concluded that microleakage and sur-

and polishing.

face roughness do not influence the

These are procedures that can be

formation of white spot lesions around

considered secondary to the final prog-

composite resin restorations, while oth-

nosis of composite restorations, but can

ers found that the presence of microle-

actually have a crucial clinical value.

akage at the adhesive interface did not

From studies, it has been shown that

significantly affect enamel demineraliza-

dentists spend 60 to 75% of their time

tion, reinforcing the lack of evidence that

replacing restorations.1

there is an association between micro-

The replacement of old restorations

leakage and caries lesions adjacent to

is closely tied to the formation of sec-

the restoration.1-3,8 However, microleak-

decay.2,3

decay

age could still be considered an etio-

can be considered the primary lesions

logic factor for secondary caries,7 fur-

ondary
around

Secondary

restorations;2

the main areas of

thermore the bacterial adhesion on the

localization are the areas where there

surface of composite resins has been

is a greater stagnation of bacterial bio-

considered an important parameter in

film, for example the cervical margins

the etiology of caries formation around

of the

restorations.4

The secondary de-

restorations.16

cay can manifest as deep or superficial

Another important aspect is repre-

lesions in proximity to the restoration.5

sented by the esthetic appearance of

The shrinkage of the polymerization im-

composite restorations, because this is

plicit in the composite can produce the

of great interest to both the dentist and

formation of interface gaps between

patient. Surface roughness influences

tooth and

restoration6

and in vitro stud-

ies have associated the presence of

secondary caries lesions with microfissures.7

resistance to staining17,18 and the natural gloss of the restoration.19,20

An elevated quality in finishing and
polishing of restorations appears to be

Restorative materials with different

highly important not only for the longev-

surface characteristics than teeth can

ity of the treatment, but also for esthetic

cause the formation of a biofilm that in-

reasons. This can be obtained with ap-

creases the capacity of bacteria to colo-

propriate procedures.

cavity.8,9

Roughness and

Many finishing instruments are de-

hard to clean surfaces contribute to the

signed to create smooth surfaces on

formation of pigmentation, accumulation

dental fillings. A great variety is com-

of plaque, inflammation of the gums, and

monly used for finishing and polishing,

nize in the oral

secondary

cavities.10-13

72
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

such as the tungsten carbide burs of

FERRARIS & CONTI

different toothing size, diamond burs of

can stem from it. Therefore, the under-

different grit size, rubber tips, abrasive

standing of the level of roughness of the

discs, polishing strips and pastes.

CE interface and CD interface can have

The first decision for an operator,

clinical importance. Finally it is already

who must finish resin composite light-

known that with different polishing pro-

curable restorations, is which rotating

cedures the result obtained an enam-

instruments to use: tungsten carbide

el surface is similar to the unpolished

or diamond bur. These two types of in-

enamel26 and this factor once again

struments are different mainly because

underlined the role of the finishing and

tungsten carbide is a cutting instrument

polishing phases.

and has geometrically defined blades,

whereas the diamond bur is an abra-

The null hypothesis are represented

by:

sive instrument, and has geometrically

No significant differences on rough-

undefined grains (diamond grains). In

ness of composite restorations finish-

literature, some authors consider tung-

ing between tungsten carbide and

sten carbide burs to be better,21 while

diamond burs.

others may consider the diamond bur

No significant differences on rough-

to be better in obtaining minor super-

ness between finishing on C surfaces,

ficial

roughness,22

while some authors

CE and CD interfaces.

consider the two methods to be interchangeable.23-25

The objective of this in vitro study is the

Another question that the clinician

analysis of the different roughness ob-

should ask himself, is: with what cutting

tained on resin composite restorations

capacity should the restoration be fin-

in class V cavities with different rotating

ished? In fact, it should not be taken for

instrument materials, with different grit

granted that there are still significant dif-

and on different interfaces. The analysis

ferences in different cutting capacity (for

that is done can be summarized in three

example fine, extrafine or ultrafine) be-

fundamental aspects:

tween the two materials, even for those

Comparing fine grit or toothing tung-

studies that have considered one instru-

sten carbide and diamond burs

ment to be more valid.

Comparing ultrafine grit or toothing

Another important consideration when

carbide and diamond burs.

we speak of finishing is which is the most

Superficial roughness with all earlier

important surface on a clinical level? In

burs and grit/toothing on C surface,

fact, frequently superficial roughness is

CE interface, and CD interface.

scientifically investigated with different

finishing and polishing of the composite

The measurements taken with the pro-

surfaces, which from an esthetic point

filometer are the central surfaces of the

of view, as well as the adhesion of bac-

restoration in composite and the com-

terial biofilm, has validity. However, the

posite-enamel interface (crown middle

restoration-tooth interface is the most

third) and composite-dentin (cervical

important aspect to evaluate microleak-

third under the cementoenamel Junc-

age and eventual secondary decay that

tion [CEJ]).

73
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Fig 1

An overview of all specimens prepared for

Fig 2

Specimen ready for the test.

the in vitro study.

Finishing and polishing protocol

with thymol and then in water for the

duration of the study. The teeth were

The protocols considered in this study

mounted on a special positioning device

include a sequence of burs (diamond vs

with transparent acrylic resin (Ortho-jet,

tungsten carbide) from fine to ultrafine

Lang Dental) embedding the root up to

(analysed in this manuscript: part I) for

4.0 mm below the CEJ. All teeth are mo-

the finishing phases, then for the pol-

lars (Figs 1 and 2). Two operators made

ishing phases, a sequence of polishers

the cavities, and carried out the restor-

(from the coarsest to the finest) and a

ations and finishing procedures. The

pre-impregnated polishing brush (ana-

specimens were assigned in a random

lysed in part II of this manuscript, to be

fashion, and each operator then created

published in a subsequent issue). All

different cavities. For this study, the 14

details of manufacturing and codes of

buccal cavities will be considered, with

burs, number of passages applications

respective phases of adhesion, stratifi-

on surfaces, number of restorations fin-

cation, finishing, and polishing. For each

ished and polished with each single bur

single selected cavity to reduce variabil-

are discussed in the materials and meth-

ity, specimen preparation, as well as fin-

ods section.

ishing and polishing procedures, were

carried out by the same operator. All restorations and finishing procedures were

Materials and methods

carried out with prismatic magnifying

Preparation of cavities and

and 300 mm focal distance (Zeiss).

composite resin restorations

For this study 28 freshly extracted non-

loupes systems with 4 x magnification

Tooth preparation and restoration

carious human teeth were selected,

A standardized tooth preparation was

stored for 15 days in solution saturated

applied to all specimens. Class V cavi-

74
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Fig 3

A molar from buccal view before the cavity

Fig 4

The first phase of cavity preparation with

preparation.

rounded medium grit diamond bur (107 m).

Fig 5

Fig 6

The second phase of cavity preparation

The finishing phase of cavity preparation

with rounded fine grit diamond bur (46 m).

with rubber polisher.

ties were made on each specimen. The

final finishing was done with a polisher

cavity dimensions followed the same

(9608 314 030, Komet) (Fig 6). The cav-

parameters and diamond burs mounted

ity dimensions are approximately the

on a red ring speed-increasing hand-

following: depth 1.6 to 2.0 mm, width

piece, transmission 1:5 with water spray

5.0 to 6.0 mm, and 3.0 mm height in the

(INTRAcompact 25 LCS, Kavo). The bur

central part and 1.6 mm on the sides.

used was rounded with a 1.6 mm diam-

The cervical extension under the CEJ is

eter and drilled down to 107 m (801

approximately 1.5 mm to have a com-

314 016, Komet) (Fig 4) than for the fin-

posite-dentin margin on which to carry

ishing phase of the cavity, a bur with the

out the procedure (Figs 7 and 8).

same shape was used to drill down to

Once the cavity preparation was com-

46 m (8801 314 016, Komet) (Fig 5) the

plete, adhesive procedures were carried

75
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Fig 7

A view of final class V cavity prepared for

the composite resin restoration.

Fig 8

A particular of the cavity before restoration

with a probe: all the cavity were codified to standardize the study.

Fig 9

First step of adhesion phases: etching with

phosphoric acid at 35%.

Fig 10

After rinsing and drying the etching agent,

the area of demineralized enamel is clearly visible.

From this image, it is evident that the lower part of
the cavity preparation is in dentin.

Fig 11

Before the application of the resin adhe-

sive system, a water solution of chlorhexidine at

0.2% is applied.

76
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

Fig 12
dentin.

The primer (ethanol based) is applied in

FERRARIS & CONTI

Fig 13

The resin bonding is applied in dentin and

enamel.

Fig 14

The bonding agent is gently dried and

cured for 30 s.

out in order to complete the composite

restoration by etching with phosphoric
acid 35% (Ultratech, Ultradent) for 30 s
in enamel and 20 s in dentin (Figs 9 and
10). The cavity was rinsed for 60 seconds with a constant spray of water and
air, and a chlorexidine galenic digluconate solution at 0.2% was applied on the
dentin for 20 s27 (Fig 11), the liquid was
then aspirated slightly without drying the
dentinal substratum, in order to avoid the
collapse of the collagen fibers. The ad-

Fig 15

hesive system that was used is an etch

plied on the floor cavity.

A thin layer of flowable composite is ap-

and rinse in 3 steps (Optibond FL, Kerr),

the alcohol-based primer was applied
for 60 s (Fig 12) and after drying, a res-

10 s at 800 mW/cm2), and a second cy-

inous bond was applied on the enamel

cle for 30 s at 800 mW/cm2.

and dentin (Fig 13), for 30 s and polymer-

Finally, two layers of microhybrid na-

ized for 30 s with a halogen light (Optilux

nofilled composite resin were applied,

501, Kerr) with a power of 800 mW/cm2

the first to simulate dentin with a thick-

(Fig 14).

ness of approximately 1 mm A3 Body

A thin layer of flowable composite (less

Filtek Supreme XTE (3M Espe) (Fig 16)

than 0.5 mm) shade A3 (Tetric Flow, Ivo-

and then polymerized as indicated. The

clar Vivadent) (Fig 15) was then applied

second and more superficial layer of

at the bottom of the cavity and cured.

composite was applied, with a thickness

All cycles of polymerization of com-

of approximately 0.5 to 1 mm A3 Enamel

posite were carried out in the same fash-

Filtek Supreme XTE (3M Espe) (Fig 17).

ion: a first ramping cycle for 20 s (10 s

The composites were selected from the

from 100 to 400

mW/cm2

and the last

same batch number.

77
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Fig 16

The dentin composite resin is layered,

Fig 17

The enamel composite resin is applied to

leaving a superficial space for enamel composite.

complete the layering phases.

Fig 18

Fig 19

Rebonding phase: the margins of the res-

toration are sealed with a specific low viscosity resin.

The last polymerization is done with a

translucent air-block agent.

To complete the restoration, a seal-

treated with the tungsten carbide and

er was applied to the margins of the

diamond burs were treated by the same

composite, to seal any small gaps (Op-

operator who carried out the different

tiguard, Kerr) (Fig 18) that was polym-

phases of the restoration.

erized for 30 s at 800

mW/cm2,

and to

completely convert the superficial composite, a gel air-block was used on the

Finishing procedures

restoration, which was cured for an ad-

The finishing procedures relative to this

ditional 30 s at 800 mW/cm2 (Deox, Ul-

article are divided in 2 different phases:

tradent) (Fig 19).

phase 1, fine grit or toothing (Table 1),

Once the procedures for the repair

phase 2,

ultrafine

grit

or

toothing

were complete, the specimens were

(Table 1), both phases 1 and 2 will be

ready for finishing. The specimens to be

distinguished between specimens treat-

78
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Table 1

Details and codes of the rotary intruments used in the finishing phases

Manufacturer

Order#

Particle size/
number of blades

Phase 1 carbide fine

Komet, Lemgo

H390Q 314 018

16 blades

Phase 1 diamond fine

Komet, Lemgo

8390 314 016

46 micron

Phase 2 carbide ultrafine

Komet, Lemgo

H390 UF 314 018

30 blades

Phase 2 diamond extra/

ultrafine

Komet, Lemgo

390EF 314
016/390UF 314 016

25/8 micron

Type of Burs

ed with diamond burs and tungsten car-

blades) with a comparable form to that

bide burs. Both type of burs were used

of the diamond conical rounded tip

applying light pressure in a single direc-

with special cross cut (H390Q 314 018,

tion that had been previously traced on

Komet) on the other seven specimens

the specimen surface. After three speci-

(Figs 23 to 25).

men applications, the bur was replaced

with a new one.

The specimens were then analyzed

in an anonymous fashion (the operator

Phases 1 and 2 of finishing were car-

at the profilometer did not know which

ried out on 14 specimens (7 for each

burs were used on which specimens)

operator) that were assigned randomly

in the center at Komet in Lemgo, using

at the time of the cavity preparation. The

the roughness profilometer (Perthome-

specimens to be treated with tungsten

ter S8P 4.51, Mahr Perthen). The rough-

carbide or diamond burs were also ran-

ness of the surface was analyzed by

domly assigned. Both were treated using

choosing between three different sub-

only burs with a friction grip attachment

strates: composite at the center of the

mounted on a red ring hand piece (IN-

restoration (C), composite-enamel (CE)

TRAcompact 25 LCS, KaVo). The speed

interface and composite-dentin (CD)

is between 80,000 and 100,000 rpm.

interface (Fig 26). The results that are

The burs were applied five times to each

obtained are supplied according to dif-

surface, with the carbide burs following

ferent parameters highest peak (Rmax),

the rotation of the blades and the hand-

mean roughness depth (Rz), average

piece.

roughness (Ra), and the difference be-

Phase 1 was carried out (according to

tween the highest peak and the lowest

the parameters described above) using

valley (Rt), all measured in yoctometers

a conical rounded tip diamond bur fine

(ym). It is decided to use the Rz data

grit (46 m) (8390 314 016, Komet) on

that represents the average height dif-

seven specimens (Figs 20 to 22) and a

ference between the five highest peaks

tungsten carbide fine toothing bur (16

and the five deepest valleys. This is a

79
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Fig 20

The appearance of the roughness surface

Fig 21

First phase of carbide finishing: a tungsten

of a class V composite restoration before the first

carbide fine toothing bur (16 blades), with conical

phase of finishing with tungsten carbide burs.

rounded cross cut tip, was applied using light pressure in a single direction for five times.

Fig 22

The appearance of the roughness sur-

Fig 23

The appearance of the roughness surface

face of a class V composite restoration after the

of a class V composite restoration before the first

first phase of finishing with a fine toothing tungsten

phase of finishing with diamond burs.

carbide bur.

Fig 24

First phase of diamond finishing: a fine grit

Fig 25

The appearance of the roughness sur-

diamond bur (46 m) was applied using light pres-

face of a class V composite restoration after the first

sure in a single direction for 5 times.

phase of finishing with a fine grit diamond bur, the

lines leaved from the bur are easily detectable.

80
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Fig 26

The profilometer in action after the first

finishing phase.

Fig 27

Second phase of carbide finishing: a tung-

sten carbide ultrafine toothing bur (30 blades) was

applied using light pressure in a single direction for
5 times.

Fig 28

The appearance of the roughness surface

Fig 29

Second phase, step 1, diamond finishing:

of a class V composite restoration after the second

an extrafine grit diamond bur (25 m) was applied

phase of finishing with an ultrafine toothing tungsten

five times using light pressure in a single direction.

carbide bur.

method suggested for short surfaces.

The seven specimens already treated

After the survey of surface roughness,

with tungsten carbide burs were finished

the other phase of finishing began.

with ultrafine toothing carbide burs (30

The second phase was carried out

blades) (H390 UF 314 018, Komet) and

following the same principles with burs

also applied five times using light pres-

with a form comparable to those used

sure in a single direction (Figs 27 and

in phase 1, using seven specimens al-

28). The speed was still between 80,000

ready treated with the diamond bur, and

and 100,000 rpm.

finished with extrafine grit (25 m)(390EF

The specimens were then analyzed

314 016, Komet) and ultrafine grit (8 m)

again with the roughness profilometer

(390UF 314 016, Komet) diamond burs

using the same criteria as phase 1

with applied five times using light pres-

(Fig 33).

sure in a single direction (Figs 29 to 32).

81
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Fig 30

The appearance of the roughness surface

Fig 31

Second phase, step 2, diamond finishing:

of a class V composite restoration after the second

an ultrafine grit diamond bur (8 m) was applied

phase, step 1, of finishing with an extrafine grit dia-

five times using light pressure in a single direction.

mond bur.

Fig 32

The appearance of the roughness surface

of a class V composite restoration after the second

Fig 33

The profilometer in action after the second

finishing phase.

phase, step 2, of finishing with an ultrafine grit diamond bur.

Statistical analysis

Results

Descriptive statistics were used to pre-

Rotary instruments: fine tungsten

sent the sample (mean SD); data were

carbide vs fine diamond burs

expressed in yoctometers. Evaluation

of the finishing phases was performed

Considering the surface of the nanofilled

using the c2 test. Data analysis was per-

composite (C) it was discovered that

formed using the software STATA (Stata-

the fine toothing tungsten carbide bur

Corp 2007, Stata Statistical Software:

(H390Q 314 018, Komet) left an inferior

Release 10. College Station). An a error

roughness that can be considered stat-

of 0.05 was accepted as a statistically

istically significant (P < 0.05) compared

significant difference.

to the fine grit diamond bur (8390 314

016, Komet).

82
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Table 2

Mean roughness depth (rz) using fine and ultrafine tungsten carbide and diamond burs on dif-

ferent substrates

CE

CD

CE

CD

Fine/SD

Fine/SD

Fine/SD

Ultrafine/SD

Ultrafine/SD

Ultrafine/SD

5.3/1.2

5.8/1.5

5.8/2.2

3.1/0.7

3.2/1

4.9/2.7

8.6/1

8.4/1.9

8.4/2.3

2.5/0.5

3.3/1.4

3.8/2.6

Considering the same rotary instruments, the results on the CE and CD in-

016 / 390UF 314 016, Komet) used in the

extrafine and ultrafine grit sequences.

terfaces, the fine tungsten carbide bur

Considering the same rotary instru-

confirmed an inferior roughness, which

ments, the results on the CE and CD

was statistically significant compared to

interface, the ultrafine tungsten carbide

the fine grit diamond bur (Table 2).

bur did not show any differences on

roughness that were statistically signifi-

Rotary instruments: ultrafine

tungsten carbide vs ultrafine
diamond burs
Considering the surface of the nanofilled
composite, it was discovered that the
ultrafine toothing tungsten carbide bur

cant, compared to the extrafine and ultrafine grit diamond burs (Table 2).

Surfaces: composite vs composite-enamel junction vs compositedentin junction

(H390 UF 314 018, Komet) left a super-

Considering the surface to be finished

ior roughness that can be considered

as the principle variable, it was discov-

statistically significant (P < 0.05) com-

ered that with fine tungsten carbide burs

pared to the diamond burs (390EF 314

there were not statistically significant dif-

83
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

Table 3

Mean roughness depth (Rz) on different interfaces using fine tungsten carbide and diamond

burs
Fine c/SD

Fine d/SD

4.5/1.5

8.4/1.6

CE

5.6/2.1

7.9/1.9

CD

5.6/2.2

8.5/2.4

ferences between CE and CD interfaces, while the C surface showed inferior

roughness.

Discussion
The material used for this study is Filtek

With fine diamond burs, there were

Supreme XTE (3M Espe), which is a na-

not statistically significant differences

nofilled material that makes use of nano-

on roughness between C, CE and CD

technology (capable of grouping clus-

(Table 3).

tering nanometric particles) also known

Considering the different surfaces,

as nanoclusters, and are also defined

with ultrafine tungsten carbide and dia-

as nanoparticles. These types of mater-

mond burs, it was discovered that the

ials give excellent results with regards to

CD interface had the highest roughness,

surface roughness.28

CE had the intermediate and C had the

inferior roughness (Table 4).

In vitro scientific studies have shown

that various nanofilled materials give
an excellent surface quality,29,30 have
low wear31 and increased wear resistance.32,33
The nanofilled materials also possess
excellent mechanical properties,34 a rela-

84
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Table 4

Mean roughness depth (RZ) on different interfaces using ultrafine tungsten carbide and dia-

mond burs
Ultrafine c/SD

Ultrafine d/SD

2.7/0.7

2.5/0.8

CE

3.6/1.5

3.2/1.2

CD

4.7/2.6

4.6/2.9

tively low shrinkage and high strength.35

margins of the restoration.22 It can be

Some observations found that even

assumed that the cause is a non-homo-

the finest grade diamond finishing bur

geneous performance of the blades of

caused extensive damage to surface

this type of bur.

areas of enamel, and on composite. It

The unfavorable roughness achieved

was concluded that composites finished

with the diamond bur has been under-

with diamond burs appeared rough and

lined in the past, but it was considered

uneven, which was particularly evident

that the carbide burs left ridges that

with the hybrids because of the mixture

were more difficult to eliminate later on

of large and small

particles.36

with the final polishing. Some authors

The choice of different rotary instru-

concluded that although the diamond

ments to obtain smoother surfaces, has

burs gave rougher surfaces, and were

been investigated in the past, with ex-

not optimal, overall the gouges were not

cellent polishing results in favor of the

as deep as with the carbide burs and

tungsten carbide burs.21 On the contra-

could therefore be more easily polished

ry, other authors have noticed that the

to a smooth surface.37

carbide tips did not perform at the same

In past studies driven with scanning

level, causing damage to the peripheral

electron microscopy, it was observed

85
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

that diamond burs had a tendency to

carbide bur (yellow-blue ring), it was de-

tear filler particles and leave irregulari-

cided to avoid the step with the extrafine

surface.38

On the

bur in the second phase of finishing (al-

contrary, another showed that the hard-

so indicated by the manufacturer) and

ness of microfill complexes and their

to proceed with the ultrafine multiblade

weak bond to the organic matrix do not

white ring (30 blades).

ties on the composite

permit the flutes of a carbide bur to cut

cleanly.39

A very important variable, other than

which type of bur to use (carbide or di-

In this study, the comparison was not

amond), is with which cutting capacity

made between tungsten carbide and

of the rotating instrument the finishing is

diamond burs with the same colorimet-

done, also because usually the clinician,

ric code (red ring). The reason for this

according to which grade of surface fin-

stems from the fact that the carbide burs

ishing and modification he would like to

that were used have a yellow code (with

make, begins with more aggressive in-

fine grit according to the manufacturer)

struments to then move on to finer blades

there is an addition of horizontal notches

or grit. The results of this study show how

(blue ring), whose function is to subdi-

fine toothing carbide burs finish the res-

vide shavings in many microshavings.

toration surfaces better in composite

According to the manufacturer, removal

than fine grit diamond burs. The study al-

should be greater on material of hard

so shows that with ultrafine grit, smoother

consistency with respect to the same

surfaces are achieved, but that there are

bur without notches. When magnified,

not significant differences between car-

small scrapes can be noticed due to the

bide and diamond burs.

action of the notches, which can be a

Another question is with regards to

drawback with respect to the advantage

the speed of rotation of the burs during

of greater removal and lesser bur knead-

finishing procedures. In the past, it has

ing with respect to the version without

been observed that carbide burs used

notches. However, as it has been noticed

at high speed on hybrid composites cre-

from data from this study, the grade of

ated a smooth surface,40 but it is also

finishing is advantageous if compared

true that for better control of the rotating

to the fine grit diamond bur (red ring, 46

instrument, it is advisable to reduce ro-

m). Afterwards, the tungsten carbide

tation speed. In fact, on natural enamel

fine toothing bur with 16 blades with yel-

it has been observed that the diamond

low-blue ring was used (like the normal

bur used at a high speed produced a

yellow ring that has 16/20 blades) and

very rough enamel surface.26

not the bur with a red ring that gener-

The importance of a good finishing

ally has 8 to 12 blades. The compari-

on interface restorations is considered

son was done with a fine grit diamond

by some to be fundamental to prevent

bur (red ring, 46 m) and for the second

secondary decay.7,16

phase of the finishing it was decided to

Not all studies agree on the correla-

use two steps for the diamond (extrafine

tion between roughness on the interface

yellow ring, and ultrafine white ring). For

restoration tooth and the presence of

the cutting characteristic of the tungsten

secondary decay.

86
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

FERRARIS & CONTI

Regardless, it is common sense to re-

significant differences were not noted

establish a smooth surface after a restor-

on the CE and CD interfaces.

ation in composite, first and foremost to

Comparing the three surfaces: C, CE,

impede the adhesion of bacteria on the

and CD, it was noted that with fine grit

composite and to avoid microinfiltration

diamond burs there were no signifi-

at the margins of the repair and to obtain

cant variations, while with fine toothing

a suitable appearance. Some analysis

carbide burs, differences were noted

found, at both the enamel and the den-

between C compared to CE and CD,

tin margins, no statistically significant

which gave equal results. With both

differences in microleakage across bur

the carbide and diamond ultrafine grit

types. Further results show that dentin

burs, there were analogous differenc-

margins leaked significantly more than

es that were statistically significant: C

enamel margins for all bur

types.41

was the smoother surface, followed by

Based on these observations, even

the CE interface and finally higher su-

this study indicates that the surface

perficial roughness was noted on the

roughness is worse on the CD interface

CD interface.

than on the CE interface and therefore

The clinical perception, which does

the composite surface. This fact is of

not have scientific validity, notes that

great importance because it emphasiz-

with prismatic magnifying 4X, there

es how factors that can be considered

was a greater roughness on the sur-

relevant by the clinician with regards to

faces finished with the fine grit dia-

surface roughness are secondary with

mond bur.

regards to the type of tissue on which

the restoration terminates.

Clinical relevance
Considering the measurement units to

Conclusions

analyze the roughness with the pro-

Within the limitations of this study, the

shows some statistical differences that

following conclusions can be drawn for

could not be clinically perceivable.

filometer and the yoctometer, this study

clinical purposes, relative to direct res-

The null hypothesis that considered

torations in composite:

that there were no significant differ-

Comparing the fine grit and toothing

ences on the roughness of composite

burs, the tungsten carbide had a bet-

resin restorations finishing between

ter capacity of finishing compared to

tungsten carbide and diamonds burs

the diamond bur, thereby obtaining

can be rejected with regards to the

surfaces with less surface roughness,

fine burs, because the tungsten car-

both on C surfaces and on the CE and

bide burs (Fig 22) showed better fin-

CD interfaces.

ishing compared to the diamond burs

Comparing the ultrafine grit and tooth-

(Fig 25).

ing burs, the diamond bur had a better

Considering the ultrafine burs, the

capacity of finishing than the tungsten

null hypothesis can be accepted that

carbide bur only on C surfaces, while

concluded there wouldnt be any clin-

87
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

CLINICAL RESEARCH

ical differences between the tungsten

this study. Komet, who in addition to sup-

carbide (Fig 28) and diamond burs

plying the rotating instruments for the

(Figs 32).

finishing and polishing stages, carried

The null hypothesis that considered

out all the analyses with the profilome-

that there would be no significant dif-

ter. Thanks to Dr Dario Consonni for the

ferences on roughness between fin-

statistical analysis. Thanks to 3M-Espe,

ishing on C surface, CE and CD in-

Kerr, Ultradent and Ivoclar Vivident for

terfaces can be rejected, because

supplying the material to carry out the

from a clinical point of view the CD

restorations. Thanks to Drs Raffaele

interface is the most difficult to finish

Acunzo,

compared to C and CE. Furthermore,

Chiapparoli, Francesca Manfrini, Rob-

the CD interface is usually a critical

erto Rossi, Giovanni Sammarco, and

point for hygiene procedures and for

Ilaria Venuti for their help in locating ex-

potential secondary caries, and the

tracted teeth. Thanks to Mrs Francesca

clinician should pay close attention

Vasile, Ms Daniela Enriquez and Mr Re-

during the finishing of this area.

nato Alcidi, for contributing in various

Andrea

Camurati,

Samuele

ways to the realization of the samples.

Acknowledgements

Thanks to Dr Domenico Massironi for

Many thanks to all those who participat-

Marina Conti and Mr Mauro Ferraris for

ed and contributed to the realization of

their support.

his advice and teachings. Thanks to Ms

References
1.

2.

3.

4.

5.

Kidd EAM, J-BS, Beighton

D. Diagnosis of secondary
caries: a laboratory study. Br
Dent J 1994;176:135139.
Mjor IA. Clinical diagnosis of
recurrent caries. J Am Dent
Assoc 2005; 136:14261433.
zer L, TA. What is known
about caries in relation to
restorations as a reason for
replacement? A review. Adv
Dent Res 1995;9:394402.
Mjor IA, Toffenetti F. Secondary caries: a literature review
with case reports. Quintessence Int 2000;31:16579.
Hals E, Nernaes A. Histopathology of in vitro caries
developing around silver
amalgam fillings. Caries Res
1971;5:5877.

6.

7.

8.

Boeckh C, Schumacher
E, Podielski A, Haller B.
Antibacterial activity of
restorative dental biomaterials in vitro. Caries Res
2002;36:101107.
Fontana M GonzalezCabezas C. Secondary
caries and restoration
replacement: an unresolved
problem. Compend Contin
Educ Dent 2000;21:1518,
2124, 26 passim; quiz 30.
Cenci MS, Tenuta LM,
Pereira-Cenci T, Del Bel Cury
AA, ten Cate JM, Cury JA.
Effect of microleakage and
fluoride on enamel-dentine
demineralization around
restorations. Caries Res
2008;42:369379.

88
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014

9.

Marsh P, Nyvad B. The oral

microflora and biofilm on
teeth; in: Fejerskov O, Kidd
EAM (Eds). Dental Caries:
The Disease and Its Clinical
Management. London: WileyBlackwell, 2003:2948.
10. Larato D. Influence of a composite resin restoration on
the gingiva. J Prosthet Dent
1972;28:402404.
11. Weitman R, Eames W.
Plaque accumulation on
composite surfaces after
various finishing procedures.
Oral Health 1975:65:2933.
12. Wise M, Dykema R. The
plaque-retaining capacity of
four dental materials. J Prosthet Dent 1975;33:178190.

FERRARIS & CONTI

13. Chan K, Fuller J, Hormati A.

The ability of food to stain
two composite resins. J Prosthet Dent 1980;43:542545.
14. Holmen L, Thylstrup A, Artun
J, Clinical and histological
features observed during
arrestment of active enamel
carious lesions in vivo. Caries Res 1987;21:546554.
15. Lima FG, Romano AR, Correa MB, Demarco FF. Influence of microleakage, surface roughness and biofilm
control on secondary caries
formation around composite
resin restorations: an in situ
evaluation. J Appl Oral Sci
2009;17:6165.
16. Montanaro L, Campoccia D,
Rizzi S, Donati ME, Breschi
L, Prati C. Evaluation of
bacterial adhesion of Streptococcus mutans on dental
restorative materials. Biomaterials 2004;25:44574463.
17. Patel SB, Gordan VV, Barrett
AA, Shen C. The effect of
surface finishing and storage solutions on the color
stability of resin-based composites. J Am Dent Assoc
2004;135:587594; quiz 654.
18. Lu H, Roeder LB, Lei L,
Powers JM. Effect of surface
roughness on stain resistance of dental resin composites. J Esthet Restor Dent
2005;17:102108; discussion
109.
19. Heintze SD, Forjanic M,
Rousson V. Surface roughness and gloss of dental materials as a function of force
and polishing time in vitro.
Dent Mater 2006;22:146165.
20. Paravina RD, Roeder L,
Lu H, Vogel K, Powers JM.
Effect of finishing and polishing procedures on surface
roughness, gloss and color
of resin-based composites.
Am J Dent 2004;17:262-266.
21. Berastegui E, Canalda C,
Brau E, Miquel C. Surface
roughness of finished composite resins. J Prosthet Dent
1992;68:742749.
22. Ashe MJ, Tripp GA, Eichmiller FC, George LA, Meiers

23.

24.

25.

26.

27.

28.

29.

30.

31.

JC. Surface roughness of

glass-ceramic insert-composite restorations: assessing several polishing techniques. J Am Dent Assoc
1996;127:14951500.
Kaplan BA, Goldstein GR,
Vijayaraghavan TV, Nelson
IK. The effect of three polishing systems on the surface
roughness of four hybrid
composites: a profilometric and scanning electron
microscopy study. J Prosthet
Dent 1996;76:3438.
Brackett WW, Gilpatrick RO,
Gunnin TD. Effect of finishing
method on the microleakage
of Class V resin composite restorations. Am J Dent
1997;10:189191.
Hondrum SO, Fernandez Jr
R. Contouring, finishing, and
polishing Class 5 restorative materials. Oper Dent
1997;22:3036.
Giampaolo ET, Machado AL,
Pavarina AC, Vergani CE.
Different methods of finishing
and polishing enamel. J Prosthet Dent 2003;89:135140.
Breschi L, Mazzoni A, Nato
F, Carrilho M, Visintini E,
Tjderhane L, et al. Chlorhexidine stabilizes the
adhesive interface: a 2-year
in vitro study. Dent Mater
2010;26:320325.
Janus J, Fauxpoint G, Arntz
Y, Pelletier H, Etienne O.
Surface roughness and
morphology of three nanocomposites after two different polishing treatments by
a multitechnique approach.
Dent Mater 2010;26:416
425.
Yap AU, Yap SH, Teo CK, Ng
JJ. Comparison of surface
finish of new aesthetic restorative materials. Oper
Dent 2004;29:100104.
Silikas N, Kavvadia K,
Eliades G, Watts D. Surface
characterization of modern
resin composites: a multitechnique approach. Am J
Dent 2005;18:95100.
Turssi CP, Ferracane JL,
Serra MC. Abrasive wear of

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

resin composites as related

to finishing and polishing
procedures. Dent Mater
2005;21:641648.
Yap AU, Tan CH, Chung
SM. Wear behavior of new
composite restoratives. Oper
Dent 2004;29:269274.
Xu HH, Quinn JB, Giuseppetti AA. Wear and mechanical properties of nano-silicafused whisker composites. J
Dent Res 2004;83:930935.
Mitra SB, Wu D, Holmes BN.
An application of nanotechnology in advanced dental
materials. J Am Dent Assoc
2003;134:13821390.
Chen MH, Chen CR, Hsu SH,
Sun SP, Su WF. Low shrinkage light curable nanocomposite for dental restorative material. Dent Mater
2006;22:138145.
Quiroz L Lentz D. The effect
of polishing procedures on
light-cured composite restorations. Compendium Contin
Dent Educ 1985;6:437439.
Goldstein GR, Waknine S.
Surface roughness evaluation of composite resin polishing techniques. Quintessence Int 1989;20:199204.
Grundy JR. Finishing posterior composites. An SEM
study of a range of instruments and their effect on a
composite and enamel. Restorative Dent, 1985;1:148,
150, 152158.
Lutz F, Jetcos JF, Phillips RW.
New finishing instruments for
composite resins. J Am Dent
Assoc 1983;107:575580.
Boghosian AA, Randolph
RG, Jekkals VJ. Rotary
instrument finishing of
microfilled and smallparticle hybrid composite
resins. J Am Dent Assoc
1987;115:299301.
Shook LW, Turner EW, Ross
J, Scarbecz M. Effect of
surface roughness of cavity
preparations on the microleakage of Class V resin
composite restorations. Oper
Dent 2003 28:779785.

89
THE INTERNATIONAL JOURNAL OF ESTHETIC DENTISTRY
VOLUME 9 NUMBER 1 SPRING 2014