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Scanning Electron Microscopy of Cavity Margins Finished with Ultra-Speed Instruments

Torger Ingar Leidal and Leif Tronstad J DENT RES 1975 54: 152 DOI: 10.1177/00220345750540011001 The online version of this article can be found at: http://jdr.sagepub.com/content/54/1/152

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Scanning Electron Microscopy of Cavity Margins Finished With Ultra-Speed Instruments

TORGER INGAR LEIDAL and LEIF TRONSTAD Dental Institute of Experimental Research, University of Oslo, Blindern, Oslo 3, Norway

The quality of the margins of the box portions of Class II cavities finished with rotating instruments at ultraspeed was assessed. In a closed row of teeth, an adequate finish was obtained at the embrasure margin where the burs rotated toward the tooth surface and into the cavity. The finish of the opposite embrasure margin and of the gingival margin was imperfect, regardless of the instrument used.
The success of a restoration depends to a great extent on precise cutting methods and adequate finishing of cavity margins. A faultless adaptation of the fillings is especially important in proximal regions, where secondary attacks of caries occur frequently.1 In a previous report, the quality of the margins of the box portions of Class II cavities finished with chisels or rotating instruments at low speed was studied.2 Of the instruments tested, enamel hatchets and slow rotating burs caused chips at the enamel edge. The neatest marginal finish was obtained with the combined use of abrasive paper disks and gingival margin trimmers. The purpose of the present study was to assess, by means of scanning electron microscopy, the quality of cavity margins finished with high-speed or ultraspeed instruments under reproducible, simulated clinical conditions.

Materials and Methods The experimental material consisted of 136 clinically intact premolars extracted from children for orthodontic reasons. The teeth had been fixed in 10% neutral buffered
Received for publication October 26, 1973. Accepted for publication June 5, 1974.

Formalin and stored in 70% ethyl alcohol. The premolars were mounted in plaster to imitate anatomic contacts, as described previously.2 Mesio-occlusal Class II cavities were prepared in the teeth under simulated clinical conditions, always facing an intact surface of a neighboring tooth. The gingival margins were placed about 1 mm coronally to the cementoenamel junction. All cavities were prepared by the same operator (T.I.L.) with a no. 1557 tungsten carbide bura in an air turbine with water spray.b The margins of the box portion of the cavities then were finished by various techniques with the use of rotating instruments. The types of instruments used are described in Table 1. ROTATING INSTRUMENTS AT ULTRA-SPEED (:400,000 rpm).-The instruments used and the number of margins included in this experimental series are shown in Tables 2 and 3. All instruments were driven with an air turbinec that rotated in a clockwise direction. Thus, at one embrasure margin of the Class II boxes, the bur rotated in toward the tooth surface and into the cavity. According to Linke,3 this is the "entry side" of the cavity. At the opposite embrasure margin, the bur rotated out of the cavity toward the tooth surface, and this is the "exit side" of the cavity.3 All embrasure margins were finished while they faced an intact surface of a neighboring tooth. The gingival margins, however, either were finished while they faced an intact surface of a contacting tooth, or after the contacting tooth had been removed (Fig 1, Table 3). In the latter instances, the gingival margins were finished with the burs held at an angle of about 200
aS. S. White, Philadelphia, Pa.
b

Midwest American, Melrose Park, Ill. e Midwest American, Melrose Park, Ill.

152
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Vol 54 No. I
TABLE 1

CAVITY MARGINS FINISHED AT ULTRA SPEED

153

INSTRUMENTS USED IN FINISHING CAVITY MARGINS

Instrument

to the long axis of the teeth to accomplish a similar beveling of the margins as obtained by the use of gingival margin trimmers.

ROTATNG INSTRUMENTS AT HIGH SPEED

Tungsten carbide instruments: Fissure bur, cross-cut, dome-ended Fissure bur, cross-cut, dome-ended Fissure bur, plain, safe-ended Fissure bur, inverted taper, plain, dome-ended Twelve-blade bur, inverted taper,

1558*
1556t 56LNt

332Lt
7303t
7204t
34X+

plain, dome-ended Finishing bur, tapered, plain, safe-ended Diamond instruments Diamond, normal grit, square-ended, end-cutting only Finishing diamond, extra-fine grit, cylindrical

(,z120,000 rpm).-In some teeth (Table 4) the embrasure margins were finished with burs driven by a conventional engine equipped with a high-speed handpiece.d With this equipment, friction grip burs may be rotated at a speed of about 120,000 rpm in a clockwise, as well as in a counterclockwise direction. Thus, in this series, all embrasure margins were finished as entry

margins.,
ZlO When the finishing procedures were completed, the cavities were subjected to a heavy water spray for ten seconds and then to a blast of air for five seconds. The teeth were removed from the plaster, dehydrated, and air-dried, and the regions of interest were
d

* S.S. White, Dental Products Division, Philadelphia, Pa. t Jet, Beavers Dental Products, Morrisburg, Can. $ Horico, Hopf, Ringleb & Co, Berlin, Ger. Fis, Finzler, Schrock & Kimmel, Bad Ems, Ger.

MicroMega E, Prodonta SA, Geneva, Switz.

TABLE 2 QUALITY OF EMBRASURE MARGINS OF CLASS II BoxEs FINISHED WITH ULTRA-SPEED INSTRUMENTS

(ans400,000 rpm) AccORDING TO THE CMI

Entry Margin

Exit Margin
Score

Score
Instrument

No. of Margins

No. of Margins

0
... ...

1558 1556

10 10

2 5

1
...

10 10

1
...

5 5

5 4

56LN 332L 7303 7204 Z1o

10
10 10 10 10

6
8 9 6 9

4
1 1 4 1

...

...
...

10
10 10 10 10
1 2
1 4 5

5
8 8

5
1 1

1
...

...

5
3

1 ...

TABLE 3 QUALITY OF GINGIVAL MARGINS OF CLASS II BoxEs FINISHED WITH ULTRA-SPEED INSTRUMENTS (=.s400,000 rpm) AccORDING TO THE CMI
Intact, Neighboring Tooth Present
Score Instruments

Neighboring Tooth Missing, Bur Tilted 20 Score No. of Margins

No. of Margins

1558 56LN

332L 7303
Z1O 34X

8. ... ... ... ... 10 10 1 2 1 10 ... 2 10 1 ... 3. ...

10

7 7
9 3

10 10 10
...

7 7
6
... ...

2 3

...

2
...

2
...

...

... ...

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154

LEIDAL AND TRONSTAD

j Dent Res January-February 1973

FIG 1.-Position of bur in finishing of gingival margins. Lef t, intact neighboring tooth is present, restricting movement of bur to working position approximately parallel to long axis of teeth. Beveling of margin cannot be achieved. Right, neighboring tooth is not present, and margin is finished with bur in tilted position 200 to obtain beveling of margin.

given an electrically conducting coat of carbon and gold in a vacuum evaporator. The margins then were examined under a scanning electron microscope, usually operated at 25 kv.e The quality of the margins was scored according to the criteria of the Cavity Margin Index (CMI) system2: 0, perfect margin; 1, acceptable margin (few, isolated small chips at the enamel edge); 2, imperfect margin (continuous row of small chips or some larger chips at the enamel edge or both); and 3, unacceptable margin (many large chips or a continuous fracture of the enamel edge). The scorings were performed at a magnification of 150 times.
Results
EMBRASURE
MARGINS AT ULTRA
Jap.

SPEED.-The

e JSM-50A, Jeol, Tokyo,

quality of the embrasure margins finished with clockwise rotating burs at ultra-speed is shown in Table 4. A considerable difference in quality between the entry side and the exit side of the cavities was evident (Figs 2, 3). At the entry side, only three of 70 margins were rated as imperfect (CMI score 2) or unacceptable (CMI score 3), and all instruments tested except the cross-cut fissure burs gave median CMI scores 0. Of the cross-cut fissure burs, the one with the smallest diameter (1556) gave five perfect margins (CMI score 0) and five margins that were rated acceptable (CMI score 1) (Fig 4). Similar results were obtained with some of the plain burs (56LN and 7204). The greatest number of perfect margins was found in the groups finished with the plain, domeended burs (332L and 7303) or the extrafine-grit diamond (ZIO). However, the mar-

TABLE 4 QUALITY OF EMBRASURE MARGINS OF CLASS II BOXES FINISHED WITH HIGH-SPEED INSTRUMENTS (,,- 120,000 rpm) ACCORDING TO THE CMI
Score
Instruments

No. of Margins

1556

Clockwise rotation Counterclockwise rotation 332L Clockwise rotation Counterclockwise rotation

9 10

5 ...
...

... 2

... ...

10 9 7

10 10

...

1 1

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FIG 2.-Part of perfect entry margin finished with plain tungsten carbide fissure bur (56LN) at 400,000 rpm (CMI score 0) ES, enamel surface; CW, cavity wall (orig mag x150).

FIG 4.-Part of entry margin finished with cross-cut tungsten carbide bur (1556) at 400,000 rpm. Tracks of bur are (liscernible in cavity wall (CW). Enamel edge exhibits a few isolated small chips (CMI score 1) ES, enamel surface (orig mag x150).

plain tungsten carbide bur (56LN)

finished with at 400,000 rpm. Chipping of surface enamel has occurred at margin (CMI score 2) ES, enamel surface; CW, cavity wall (orig mag X150).

FIG 3.-Part of exit margin

FIG 5.-Part of entry margin finished with extra-fine-grit diamond (ZIO) at 400,000 rpm. Shallow grooves corresponding to cutting units of diamond are seen in cavity wall (CW). Enamel edge is not quite straight, but without chips (CMI score 0). ES, enamel surface (orig mag x150). 155

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156

LEIDAL AND TRONSTAD

j Dent Res January-February 1975

the cross-cut fissure bur (1556) rotating in a clockwise direction, five were perfect (CMI score 0). However, the same bur, when rotated counterclockwise (backwards), yielded only unacceptable margins (CMI score 3). The use of a plain bur (332L) resulted in mainly unacceptable margins, regardless of direction of rotation. GINGIVAL MARGINS AT ULTRA SPEFED.-The quiality of the gingival margins finished with clockwise-rotating instruments at ultra speed is seen in Table 3. The margins that were finishied with a neighboring tooth present were characterized by a continuous fracture of the enamel edge, and with a few exceptions, received CM\I score 3 (unacceptable margins) (Fig 8). Only two margins finished with dome-ended burs were rated acceptable (CMI score l), and no margin was perfect. However, when a tilting of the burs of about 20 was made possible by removal of the neighboring tooth, a fairly perfect finish of the gingival margins was aclhieved withi all instruments tested (median CMI score 0) (Fig 9). Equally good results were obtained with different dome-ended, end-cutting burs

gins finished with the diamond, although without chips, were not as straight as the margins finished with carbide burs; they exhibited a sliglitly undulating course (Fig 5). At the exit side, only three of 70 margins were rated as perfect (CMI score 0) . Most margins were found to be imperfect (CMI score 2) or unacceptable (CMI score 3), and the median CMI score for all exit margins was 2. Characteristic for these margins was a cihipping out of the surface enamel from the cavity wall toward the tooth surface (Fig 3). Fewer chips were observed at the margins finished with the extra fine-grit diamond (median CMI score 1). These margins were not straight, but exhibited shallow grooves. EMBRASURE MARGINS AT HIGH SPEED.-The quality of the embrasure margins finished witlh clockwise or counterclockwise rotating burs at higlh speed is shown in Table 4. Witlh this teclinique, the burs had a strong tendency to "crawl" out of the cavity and tllereby damage the margins and the adjoining enamel surface (Fig 6). Large chips usually were broken out of the enamel edge from thie tooth surface toward the cavity wall (Fig 7). Of the nine margins finished with

FiG 6.-Part of embrasure

margin finished

with clockwise rotating plain tungsten carbide l)ur (332L) at 120,000 rpm. Bur las "crawvled' out of cavity and damaged margin and adjoining enamel surface (ES). CW, cavity wall (orig mag X50).

withi counterclockwise rotating plain tuingsten

carbide btir (332L) at 120,000 Ypm. Bur lIas cut into enamel suiface (ES) (arrows) and caused fractuye of enamel edge. CW, cavity wall (orig mag x50).

FIG 7.-Part of embrasure margin finished

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(1558 and 332L) and with a cylindrical, safeended bur (56LN).

CORNERS BETWSEEN EMBRASURE AND GINGIVAL MIARGINS AT ULIRA SPEED. Favorable corner

angles were attained with dome-ended burs. This type of instrument, especially the plain dome-ended burs (332L and 7303) also gave neatly finished margins with few faults at the entry side corner (Fig 10) . At the exit side of the cavity, however, the finish of the corner margins was without exception imperfect or unacceptable (Fig 11).
Discussion The important observation by Linke3 that a consistent difference in quality exists between the embrasure margins of the entry side and the exit side of cavities finished with an air turbine was fully confirmed and further eluLcidated in the present study. At the entry side, a perfect or acceptable finisht of tlhe margins seems to be accomplished witlh tlhis teclhnique almost regardless of bur type uLsed. Thluts, the finishi achieved with the 1558 cross-cut bur was amazingly neat, and only sliglhtly inferior to that obtained with burs especially designed for finislhing purposes. Conversely, at the exit side of the cavities, an acceptable finish of the margins was not accomplished with any type of bur tested. Because many differently designed burs were

used, it seems to be generally valid that exit margins cannot be finished adequately with rotating instruments at ultra speed. Diamonds have been shown to cause less chipping at the exit margins than carbide burs, but diamonds produce rather deep grooves in the margins.4 In the present study, a diamond with extra-fine grit, originally made for finishing of resin fillings, was used to overcome this undesirable effect of the instrument. To a certain extent, this was accomplished, but the exit margins were not consistently good enough for the method to be recommended (Table 2). An obvious solution to the problem would be to run the burs counterclockwise at those margins where clockwise rotating burs have proved unsuitable. At present, this is not possible with low-torque, ultra-speed equipment. In the present study, therefore, the goal was pursued by means of high-torque, high-speed instruments rotating in both directions. Even at the relatively high speed of 120,000 rpm, the high torque of the equipment made this technique unsuitable for finishing purposes. The margins and the adjoining enamel surface usually were severely damaged, and unfortunately, this was especially so after counterclockwise rotation of the burs. It is conceivable that effective burs designed for counterclockwise rotation

FIc 8.-Part of gingival margin finished with extra-fine-grit diamond (.10) at 400,000 rpm. Buir was held parallel to long axis of tooth. Continuous fdacture of enamel edge has occurred (CMI score 3). GF, gingival floor; ES, enamel surface (orig mag X150).

FIG 9.-Part of gingival margin finished with cross-cut, dome-ended tungsten carbide bur (1558) at 400,000 rpm. No contacting tooth wvas present and bur was tilted about 200. Beveling (B) of margin was accomplished, resulting in perfect conditions (CMI score 0). GF, gingival floor; ES, enamel surface (orig mag x150).

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LEIDAL AND TRONSTAD

j Dent Res January-February 1975

ation, Rodda9 has stated that a beveling of the gingival margin would be a mistake and should not be carried out. The findings of the present study as well as those of a previous report2 contradict this view. Rather it seems that an instrument that works parallel to the direction of the cervical enamel prisms will cause a fracture of the enamel edge. However, if an instrument works at an angle to the prism direction, the surface enamel is not fractured, but cut, and a neat finish of the gingival margin is obtained. This observation seems to have general validity because equally perfect margins were obtained with gingival margin trimmers2 and with dome-ended or square-ended burs at ultra speed. It should be noted, however, that in a closed row of teeth, a correct beveling and thereby an acceptable finish of the gingival margins of Class II cavities seem to be attainable only with gingival margin trimmers.

would to some extent improve the results of this method.5 However, if it is desirable that a perfect finish of both embrasure margins of Glass II boxes should be obtainable with rotating instruments, the manufacturing of an air turbine that rotates in a counterclockwise direction is necessary. Such an instrument would be useful for finishing purposes and could conceivably be used for cavity and crown preparation. For gingival margins, it has been claimed that the finish obtained with carbide burs at ultra speed is at least as satisfactory as that obtained with any other method of instrumentation.6 The results of the present experiments, however, indicate that this is not valid under all clinical conditions, blut only when a certain beveling of the margins has been achieved. Since reports by Black7 it has been generally accepted that the gingival margins should be finished with instruments working parallel to the direction of the enamel prisms. Black7 found that the prisms in the cervical enamel were apically inclined, and designed his gingival margin trimmer accordingly, to obtain a beveling of the margins. More recent studies have indicated, however, that the enamel prisms in this region are as a rule horizontally directed.8 After taking these findings into consider-

Conclusions The quality of the margins of the box portion of Class II cavities finished with clockwise rotating instruments at ultra speed (400,000 rpm) was assessed and scored according to the criteria of the Cavity Margin Index (CMI) system. Burs of different de-

FIC, 10.-Corner between embrasure wall (EW) and gingival floor (GF) at entiy side of cavity, finished with dome-ended tungsten carbide bur (332L) at 400,000 rpm. Corner angle is favorable and finish acceptable. ES, enamel surface (orig mag x80).

FIG 11.-Corner between embrasure wall (EW) and gingival floor (GF) at exit side of cavity, finished with a dome-ended tungsten carbide bur (332L) at 400,000 rpm. Fracturing of enamel edge has occurred, and quality of margins is unacceptable. ES, enamel surface

(orig mag x80).

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Vol 54 No. I

CAVITY MARGINS FINISHED AT ULTRA SPEED

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sign gave similar results. At the embrasure side where the burs rotated toward the tooth surface and into the cavity (entry side), the quality of the margins was perfect or acceptable (median CMI score 0). The quality of the opposite embrasure margin (exit margin) was imperfect (median CMI score 2). An attempt to improve the quality of the exit margins by use of high-torque, high-speed instruments (120,000 rpm) rotating in a counterclockwise direction was not successful. A counterclockwise rotating air turbine seems to be necessary to achieve this goal. The finish of the gingival margins was unacceptable (median CMI score 3), except when the conditions allowed a tilting of the bur of about 200, which resulted in a beveling of the margins. In these instances, a neat finish was obtained (median CMI score 0).

ished with Chisels or Rotating Instruments at Low Speed, J Dent Res 53: 1167-1174, 1974. 3. LINKE, S.: Untersuchungen von Kavititenriindern, die mit Schleifkorpern in verschiedenen Drehzahlbereichen bearbeitet wurden, in EICHNER, K. (ed): Normal-, hoch- ..und hdchsttouriges Bohren und Schleifen von Zahnhartsubstanzen, Munich: Hanser Verlag, 1966, pp 58-64. BOYDE, A., and KNIGHT, P.J.: The Use of Scanning Electron Microscopy in Clinical Dental Research, Br Dent J 127: 313-322, 1969. BOYDE, A.: Finishing Techniques for the Exit Margin of the Approximal Portion of Class II Cavities, Br Dent J 134: 319-328, 1973. BOYDE, A.; KNIGHT, P.J.; and JONES, S.J.: Further Scanning Electron Microscope Studies of the Preparation of Class II Cavities, Br Dent J 132: 447-457, 1972. BLACK, G.V.: A Work on Operative Dentistry, Vol II, Chicago: Medico-Dental Publishing Co., 1908, pp 93-117. OSBORN, J.W.: Directions and Interrelationship of Prisms in Cuspal and Cervical Enamel of Human Teeth, J Dent Res 47: 395-402, 1968. RODDA, J.C.: Modern Class II Amalgam Cavity Preparations, NZ Dent J 68: 132-138, 1972.

4.

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References
1. SELLMAN, S.: Studier over Sekundarkariesfrekvensen pa Tandlakarinstitutetes Klientel, Odont T 52: 241-273, 1944. 2. TRONSTAD, L., and LEIDAL, T.I.: Scanning Electron Microscopy of Cavity Margins Fin-

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