04AS1593

Introduction: clinician would use in preparing, cementing, and

finishing most aesthetic nonmetal restorations.
An often overlooked part of our daily dental
armamentarium is our burs which, if chosen and It should be remembered that “making do” with a
used correctly, can make our work excavating decay bur of a particular shape could make a procedure
and sculpting tooth structure more efficient with an harder than it needs to be, and often simply selecting
improved end result. Many of us use just a few select a bur of the proper shape will make your procedure
burs that we may have learned to use in dental much easier. Attention needs to be paid to the
school, or have become accustomed to over years of sharpness of the bur, as using a dull bur could result
practice. In this day of hard tissue lasers, burs— in spending more time than necessary to complete a
carbide and diamond—still remain the instruments case. In a busy dental practice, time means money,
of choice in most situations. These include the and using a dull bur could lead to an uncomfortable
removal of decay and old restorations, the patient, as well.
preparation of the teeth for new dental restorations,
and the adjusting and polishing of restorations and/or
tooth structure. There are literally hundreds of burs
of differing shapes, materials, and sizes from which to
choose. This presents a daunting task and is probably
why we stick to the few we are familiar with. The
purpose of this article is to highlight a few burs
included in the Las Vegas Institute for Advanced
Dental Studies Esthetic Preparation bur kit (Figures 1
and 2 LS-7541) and the indications for their use.
This kit was designed by selecting burs which the Figure 1

Distributed by:

Sullivan-Schein Dental is an ADA

CERP recognized provider.
 Figure 2

The Bur Kit: Figure 3

As seen in Figure 2, this kit has the burs that will take you
through the preparation and initial finishing of both
anterior and posterior aesthetic nonmetal restorations.
A nice feature of the kit is the illustrated and labeled
positions of the burs on the autoclavable aluminum bur
block, so important for sterilization. The fact that the burs
are clearly indicated makes it easy to keep track of them.
As the doctor works and feels a bur needs replacement, it is
not replaced into the block. At the end of the procedure
when the assistant sees that there is an open position, that
bur is replaced with a new one. The entire block is bagged
and autoclaved, only to be opened when the next patient is
Figure 4
seen, thereby insuring a sterile and organized set of burs.

The proper selection of burs helps us efficiently create the
conservative preparations, and, ultimately, natural aesthetic
restorations our patients are seeking. Here we have a
patient desiring nonmetal porcelain restorations to fix her
discolored and unevenly shaped teeth (Figure 3).
One of the most common procedures is the removal of an
amalgam restoration. A bur that is shaped to remove the
alloy quickly and efficiently is the C813 016 bur. This is
shaped like an inverted cone, but with its diamond coating
makes removal of the alloy fast and efficient
(Figurge 4). The shape of this bur allows the water spray
to efficiently carry away the removed alloy.
When preparing a tooth for a pressed ceramic restoration,
the tooth preparation should allow for 0.6–0.8 mm of
aesthetic porcelain material. The use of the M828 030
depth cutting bur (Figure 5) will place depth cuts of
0.7 mm to help assure you have removed an adequate
amount of tooth structure and will have an even thickness
of porcelain. These depth cuts should be placed after the
arch has been recontoured to its ideal position. If an
adequate amount of reduction is not given to the
laboratory, the lab may either make the restoration too thin
which could allow the underlying color of the tooth to
show through, resulting in what is termed a “headlight”
effect, or the lab might over-contour the restoration so that
it appears bulky and unnatural.
Once the depth cuts are placed, it’s time to use the large
SC855 025 bur (Figure 6) to remove the remaining tooth
structure quickly and efficiently. The SC855 025 bur is
the largest in the kit and is a coarse large chamfer diamond
bur which proves to be very versatile. It be can used to
enamelplasty or recontour a tooth to bring it into the
proper arch form during an aesthetic case preparation. It
can be used to quickly cut through the porcelain to remove
a porcelain crown. And, it can be used when preparing a

2
 Figure 5 Figure 7

Figure 6 Figure 8

tooth. Using a bur with a large surface area is often cusp of conservative veneer preparations. This buccal
advantageous for a number of reasons—the larger surface shoulder helps create a thicker restoration on the buccal
area will cut faster, dull slower and leave the tooth surface cusp and provides a shoulder, making cementation of the
smoother. If the tooth were prepared with a small-diameter veneer easier.
bur it would be much slower and often could leave the
For the preparation of veneers the M846KR 016 bur
tooth surface with a wavy finish. Using the large
(Figure 9) gives you a nice gingival chamfer and tapered
SC877 025 is like snowshoeing on snow, removing the
reduction of the axial walls of the preparation. Care should
tooth structure without sinking into the tooth, leaving an
be taken to round where the axial and incisal/occlusal plane
even surface.
meet to improve the fit of the restorations and again
For preparation of nonmetal inlays and onlays, the decrease stress on nonmetal restorations.
M845SKR 018 and M84SKR 025 burs, respectively, are
The KS4 bur (Figure 10) with its football shape is ideal to
ideally shaped. The broad end creates a well defined
reduce the lingual surfaces of the anterior teeth ensuring
shoulder butt margin on the external tooth surface, making
proper reduction in an area often under reduced. Under-
the restorations stronger while leaving rounded internal line
reducing the lingual surface of the anterior teeth could
angles which reduces the stress placed on the internal of
cause the final restorations to be thin and possibly weak.
nonmetal restorations and, thereby, decreases the incidence
Using a football-shaped bur also helps create a concave
of tooth fractures (Figure 7). Another use for the
form on the lingual surface of the teeth so that in function
M845SDKR 018 is for placing a shoulder on the buccal
the porcelain is placed under compressive forces. A convex
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 Figure 9
Figure 10
lingual tooth form would place the porcelain under more
tension which could contribute to the restoration possibly
failing. Another problem caused by under-reducing the
lingual surface of these teeth is that the dental technician
may create over-contoured restorations, causing
problematic occlusal interferences.
Adjustment of Temporaries:
A finishing carbide bur, such as the H50A 010 (Figure 11),
is ideal to remove flash from the margins of composite
temporaries or excess composite luting cement from the
margins of the final restorations. It is important that the
margins of the temporaries are smooth and well adapted to
the tooth; otherwise, gingival inflammation may result,
causing difficulty when the final restorations are adhesively
bonded in place. When smoothing the margins of the
final restorations it is important to leave the tooth surface
smooth to avoid plaque accumulation and not remove the
4
Figure 11
Figure 12
glaze or external stain from the porcelain. The size of the
H50A 010 allows you accomplish both of these tasks with
its small size and fine fluting.
The H375R 012 and H375R 014 are ideally shaped to use
on the large surfaces of temporaries, leaving a smooth
surface ready to be polished to a high shine.
Figure 12 shows the H375R 012.
Occlusal Adjustments:
When adjusting the occlusion on porcelain, different burs
should be used. For major adjustments, a medium fine or
fine diamond, such as the M849 009 and the #F274 016
burs, respectively, should be used with a water spray to
avoid heating the porcelain and in a manner to maintain
the occlusal anatomy of the tooth. Once any major
adjustments have been made, a finishing carbide bur like
the H379 014 bur should be used to remove any fine
scratches left by the diamond burs. Again, water spray
should be used to prevent
COURSE SPONSOR
overheating of the Sullivan-Schein is course sponsor. Sullivan-
porcelain, and a final Schein’s ADA CERP recognition runs from
November 2001 to December 2004.
polish attained using
another AXIS product, the COURSE CREDITS
All participants scoring at least 80% on the
Ceraglaze Ultimate examination will receive a certificate verifying
3 CEUs. The formal continuing education
Porcelain Polishing Kit,
program of this sponsor is accepted by the
which brings out a glaze- AGD for Fellowship/Mastership credit. The
current term of acceptance extends from
like shine to the porcelain. December 2001 to December 2004.
Participants are urged to contact their state
Figure 13 shows the H274 dental boards for continuing education
requirements.
016 adjusting the occlusion
of an acrylic temporary Figure 13 PARTICIPANT FEEDBACK
If any participant wishes to communicate with
while maintaining the the author of this course, please direct
occlusal anatomy. Using questions to Sullivan-Schein by fax at
1-800-781-6337. Be sure to provide us with
this bur removes the acrylic the following information: name, address,
e-mail address, telephone number, and course
while leaving the surface
completed.
smooth.
COURSE EVALUATION
We encourage participant feedback
A Finished Case: pertaining to all courses. Please be sure to
complete the attached survey included with
Figures 14 and 15: the answer sheet.

Stained and irregular teeth

RECORD-KEEPING
(Figure 14) are now bright, Sullivan-Schein maintains records
uniform, and aesthetic with of your successful completion of any
CE Seminars. Please contact our offices at
pressed ceramic veneers Sullivan-Schein, Attn.: CEHP, 26600 Haggerty
Figure 14 Rd., Farmington Hills, MI 48331,
(Figure 15). by mailing a note requesting a copy of your
continuing education credits report. This
report, which will list all credits earned to
date, will be generated and mailed to you
within five business days of receipt.

IMPORTANT INFORMATION
The opinions of efficacy or perceived value
of any products or companies mentioned in
this course and expressed herein are those
of the author and do not necessarily reflect
those of Sullivan-Schein. Completing a single
continuing education course does not
provide enough information to make the
participant an expert in the field related to the
course topic. It is a combination of many
educational courses and clinical experiences
that allows the participant to develop the
skills, broad-based knowledge, and expertise
related to the subject matter.
Figure 15
Conclusion: COURSE FEE/REFUND POLICY
The cost for this course is $55.00. Any
If you have been using the same burs since dental school, consider trying the Las Vegas participant who is not 100% satisfied with
this course can request a full refund by
Institute Esthetic Preparation bur kit to make your day easier and help you achieve the contacting:
Sullivan-Schein
results your patients desire. Attn: CEHP
26600 Haggerty Road
Farmington Hills, MI 48331

5
 AXIS Dental... Now rolling with the
Las Vegas Institute!

One of the most important aspects of achieving ideal aesthetics involves proper preparation of the
teeth and finishing of the final restorations.With this in mind, AXIS Dental Corporation and the Las
Vegas Institute have collaborated to create the LS-7541 Las Vegas Institute Esthetic Preparation Set.
With this set the practitioner will be able to efficiently prepare both anterior and posterior
restorations, as well as the margins.

The LS-7541 set is organized in an autoclavable aluminum block bearing the distinctive LVI purple color,
and is marked with both the number and diagram of the bur to assure easier replacement of the bur to
its proper position. The LS-7541 set also includes a diamond recontouring disk (NTI D943-080), which
attaches to a slow straight handpiece that LVI finds useful in recontouring provisionals and final restorations.

LS-7541
(228-2612-XH)..........$194.99 A X I S D E N TA L C O R P O R AT I O N

888.584.3237
Continuing Education Test Questions
Answer Sheet on Back Cover
1. The AXIS bur block:
a. Was designed for anterior and posterior restorations
b. Is autoclavable
c. Is designed for easy bur organization
d. All of the above
2. Using an old, dull bur may lead to slower tooth
preparation and more doctor frustration.
a. True
b. False
3. The shape of the C813 016 bur allows for:
a. Efficient alloy removal
b. The water spray to carry the alloy away
c. Both a and b
4. The use of a depth cutting bur, such as the M828 030:
a. Helps ensure even and adequate amounts of porcelain
thickness
b. Should be used to place depth cuts horizontally
c. Should be used to place depth cuts vertically
d. a and b
e. a and c
5. Using a large bur, such as the SC855 025:
a. Allows you to remove tooth structure quickly
b. Helps avoid a "rippled" preparation surface
c. Gives you more control
d. All of the above
6. With all porcelain restorations:
a. The internal line angles should be sharp
b. The internal line angles should be rounded to avoid stress
buildup
c. There should be a feathered gingival margin
d. There should be a distinct chamfer to butt gingival margin
e. a and c
f. b and d
7. The KS4 diamond bur:
a. Helps maintain the concave shape of the lingual surface of the
anterior teeth
b. Helps prevent the creation of occlusal interferences
c. Helps decrease the tension placed on the lingual of a porcelain
restoration
d. All of the above
8. Leaving excess temporary material at the gingival
margin of temporaries:
a. May result in gingival inflammation which will interfere with
adhesive bonding techniques
b. Should be removed carefully with a finishing carbide, such as
the H50A 010
c. Both a and b
9. When adjusting the occlusion of porcelain restorations:
a. Quick adjustments made without water are best
b. Adjustment should be done carefully with water to prevent
heat buildup
c. Care should be taken to maintain occlusal anatomy on the
restoration
d. a and c
e. b and c
10. When polishing porcelain restorations:
a. Diamond burs leave scratches in the porcelain
b. Diamond burs recontour the porcelain quickly
c. Finishing carbides should be used to remove the diamond
scratches
d. The Ceraglaze Ultimate Porcelain Polishing Kit should be used
to attain a glaze-like appearance
e. All of the above
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 Creating Beauty With Burs?
Dr. Mike Miyasaki

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