Composite Tips from Dr Tony Rotondo

Restoration and Implantology
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BACD Annual Conference 2019 – Dr Tony Rotondo

The line-up of speakers at 2019’s BACD Annual Conference included noted Australian speaker Dr Tony Rotondo. On the first day of the conference, he invited delegates to his hands-on workshop, where he demonstrated how to restore the mesio-incisal third and create natural-looking composite veneers.

The workshop began with an exploration of colour perception, with a focus on hue, chroma and value. He also discussed translucency and how it relates to dental composite materials.

Dr Rotondo explained: “I learned something from an exceptional prosthodontist in the US. Imagine being in a plane and flying over an island. If you look out the window, you might see the shoreline of the island as it meets the sea but as you look further out, the ocean appears a deeper blue and you can’t see the ocean floor.

“The deeper a swimmer goes under the surface of the sea, the deeper blue the ocean will appear. It’s the same concept with dentine and enamel.”

After presenting a case study – where he restored the mesio-incisal third of his son’s anterior tooth – Dr Rotondo detailed the steps involved in creating a silicone key for a wax-up model. He advised his audience to minimise interference with the dam, visualise the palatal finish line on the silicone key, ensure proximal adaptation, and position the incisal finish line in the mid-incisor.

For the hands-on part of the workshop, delegates followed step-by-step instructions to create a composite veneer by building up the material. The age of the patient will ultimately dictate the placement of the dentine on the tooth.

Gud, besser, scheisse

“I’m often fighting my natural instincts so that the restoration doesn’t look too regular,” he said. “I do have a tendency to seek out a bit of irregularity.” Dr Rotondo explained that after the dentine has been built up, this is the right time to use an abrasive or separating strip to create space between the teeth.

He spoke about a German dental technician that described the process of applying dentine composite material as “gud, besser, scheisse”, emphasising that it is better to build up the composite a little at a time and add more only when required or end up with a poor, overworked result. Dr Rotondo then went on to show delegates how to trim, polish and contour composite veneer with various different burs.

He said: “The hardest part of this process is the interproximal surfaces – trim all the way to the contact point but not beyond with a disc bur. The solution to avoid opening the contact point is to create separation between the teeth with wedges. I will then try to create valleys on the surface of the tooth rather than grooves with a speed-reducing handpiece – 95% of this will be polished out eventually.

“A flat incisal edge isn’t really what happens in nature, so I will also take a little bit of the material away if needed to ensure a natural-looking result.”

The workshop concluded with Dr Rotondo demonstrating how he finishes off a composite veneer by applying peri-chromata to the tooth.

Afterwards Dr Harriet Morse said: “I thoroughly enjoyed my morning learning about composite veneer techniques with Tony – so many great tips to take away and a very engaging speaker!”

Day two

On the second day of the conference, Dr Rotondo addressed the management of complex and interdisciplinary cases with direct resin. Reinforcing many of the ideas and concepts discussed during his workshop, he discussed the importance of facial analysis before planning for a composite restoration.

He also explained that the first step of treatment is to determine the incisal edge position, the incisal plane, and tooth size/proportions in order to “create a vision for the case”.

Going through the step-by-step techniques he uses to build up composite restorations, Dr Rotondo discussed the idea of FOOC (Fear of opening the contact) and how clinicians are often afraid to open the contact point when contouring. Again, he advised practitioners to create space between the teeth using wedges.

Dr Rotondo also explained how making the teeth the right shape before commencing orthodontics had become his treatment philosophy for a shared vision between restorative dentist and orthodontist. He demonstrated how, in such cases, this approach can resolve the combined issue of space appropriate and altered tooth morphology, including cases requiring tooth substitution, micro-dontia, macro-dontia, or the loss of tooth volume due to attrition, abrasion and erosion.

Sharing the stage with Dr Mario Semenza, Dr Rotondo brought the morning to a close with an engaging Q&A session, during which delegates engaged in a lively debate about the application of both direct and indirect restorations.

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