How to get Perfect Line Angles for Composite Veneers – GF007

Jaz’s Introduction: I’m going to ask Devin’s question now. So in episode 52, I gave a Protrusive Dental Pearl about the use of a pencil on its front and on its side to reveal different things about the line angles when you’re doing direct composite restorations like veneers for example.

And on that YouTube video of the Protrusive Dental Pearl Dr Devin Mandalia, Devin thanks so much sending your question buddy. He says once you have drawn the desired line angles, how would you suggest to really define them? When using a bur or a disc, I tend to find I get a result which is rather flat and lacks the line angle definition so I got someone who’s absolutely phenomenal at line angles I look at Matt Parsons cases on instagram and every single case he’s absolutely nailed the line angles.

And I think that is really the most fundamental thing about what defines the anatomy of your in sciences is about getting those line angles crisp and perfect so they don’t look like flat tic tacs. So Devin, I hope you enjoy and everyone hope you enjoy this group function with Matt Parsons all about how to redefine those line angles. Thanks so much.

Main Episode:
For those listening we need to congratulate Matty Parsons I want to say your name now so you can introduce yourself in a moment but congratulations will be becoming a father to little George who’s seven weeks old. Describe the last seven weeks for us.

[Matty]
A roller coaster of nappies, no sleep, screaming kind of the moment where you get home from work and Meg just looks like she’s had hit constantly all day and just kind of like throws him at me like get him off me for half an hour at least. But and he was so annoying at the same time. So he can be just crying for no reason for two hours and you’re kind of saying what is wrong with you and then he just gives you one little smile and it’s like oh you’re so annoying because now I can’t be angry with you.

[Jaz]
So it sounds like George might have what my son had like the whole colic term right I mean my son was pretty colic for the first three four months crying for no reason and stuff. I’ll never forget that. But don’t worry the end is in sight eventually they will grow out of it don’t worry. Well George’s awesome.

[Matty]
Hopefully sooner rather than later.

[Jaz]
We’ll have to do a fatherhood podcast another day because today is about it’s a group function about nailing those line angles. Matty your work that I’ve seen on social media is just stunning like even the full protocol cases that you post on mini smart mocova and the before and afters that we see on instagram those line angles and the anatomy is just absolutely brilliant and that’s what we need your help with today. Just tell us a little bit about yourself how you started to get involved with being the go-to guy in your area for these kind of composite restorations? How did that journey evolve?

[Matty]
Great question so I qualified the same year as you I think we were both presidents together you were Sheffield and I was Liverpool. And then I think maybe we went a little bit similar, I did VT and then moved abroad for a little while, so lived in Australia for a year and traveled for a little bit and by the time I then came home I’d kind of seen a different world of dentistry so rather than the six months worked as an associate before I went was UDAs and oh my god I’ve done four UDAs today that’s an awesome day and ah god that crown didn’t fit, I’ve lost myself UD and it’s just that constant treadmill of clocking these UDAs and I went to Australia where I was seeing like a dozen patients a day and taking my time and getting to know patients better and it was just like wow this is what it can be like so I got home and started basically thinking what I need to if I’m going to do this I need to up skill.

And the first thing I did was go and do the Dipesh’s course, so mini smile makeover which I know you’ve done as well and like it sounds dramatic but it really isn’t that. It just changed my career I just started doing a few cases and then it snowballed and friends of those patients would come in and you know people saying oh put some stuff on instagram and I was like okay I’ll set up an instagram and then it just went from there and before it’s you’ve got to be careful that doesn’t become all you do because you’ll burn out if it is all you do. So try and still maintain a bit of a mixed bag but yeah it kind of just snowballed really and it’s nice because it’s the kind of stuff where every case you do you feel yourself learning something so it’s that exponential the more you do the better you get the more you do and it’s good. It’s nice.

[Jaz]
It’s been absolutely brilliant to see your evolution in the last few years. It’s good to hear your origin story and how you did one course but you know what, Matty? You know that there are so many courses out there and we go on them and the number one thing that we’ve all you and I are both guilty of and every dentist listening to this right now has been guilty of at some point in the past is they don’t apply or they don’t apply what they learn quick enough soon enough because I do think all courses and all knowledge comes with a kind of like an expiry date and if you don’t apply it soon enough then you lose your confidence, you lose your mojo, you lose that sort of enthusiasm for it and so I think part of what you said really resonates with me is not only going on the right course but then applying it and then that sort of snowballs into referrals right? Because I think it’s pretty much it started off as word of mouth before it blew up on instagram right is that fair to say?

[Matty]
Yeah absolutely you know treating nurses, their nurses friends and then friends of nurses friends and that kind of thing yeah but yeah. And I totally agree it’s hitting the ground running that’s the most important thing and when you go on these courses I think it’s worth maybe having a case lined up for when you get back that you think it might help you with. Make sure you get the equipment that they use in the composite you might have to spend a few quid but you do have to hit the ground running otherwise it was pointless going and then you go the other lovely thing is that then you build on it so after Dipesh’s course I went and did Andy’s course, Andy McLean and which is kind of specifically composite veneers and he works. He’s a blooming genius of what he does but he works totally differently to Dipesh so then what you start doing, it’s going well. I do like that about the way that I have been doing it from what Dipesh has taught me but that’s pretty cool Andy does so I’m going to bring that in as well and you end up finding your own kind of niche in amongst all the others.

[Jaz]
That’s a real gem right there because a lot of people say to me “Jaz, why did you go on so many different occlusion schools of thoughts?” But there’s no unified theory right? If you expose yourself to different theories different way of doing things you’ll be able to build your own version of the way you see the world and it’s that saying again that I said a few episodes of the Allen Matthews in Scotland, listen to everyone but do what feels right to you and that’s exactly what you do, you listen to Dipesh, you listen to it Andy and then you do you’re doing Matty and we could see that. We see your signature in every case, your photography like I could see some photos now without even seeing your name on instagram okay that’s Matty’s photography right there. So by the way if you haven’t seen Matty’s photography you have to check him out on instagram and just look at his photos look at his cases. So what we’re going to ask you today is a question sent by Devin Mandalia.

Devin thanks so much sending this buddy. It’s on YouTube episode 52. It was a little video I made about line angles and basically he asked the following Matty he says, “Once you have drawn on the desired line angle,” So I think what he means is using the front end of the pencil and just drawing where you want in your mind’s eye the line angles to be. “How do you suggest to define it?” So make that pencil become the reality of the line angle and what he’s found is that when he’s using burs or discs he tends to get a result which is rather flat which is happens to all of us, happened to me loads before. What is your best advice to really get those lovely well-defined line angles?

[Matty]
First of all you just you touch on photography and I just need to shout out Minesh Patel, I wonder his course and he taught me everything but moving. He’s very excellent. In terms of drawing on the line angles, it is an awesome question because you see it on social media where people have drawn on where they want the line angles to be and then the next slide is that’s where the line angle is and there’s no real explanation of how they got from one to the other.

Do you know this is a really kind of rubbish answer but don’t do that. Because your pencil line isn’t going to define where your composite is it should be it’s the other way around when you’re carving your composite in the first place, when you’ve got full ability to manipulate it you can nudge it this way, nudge it that way and if you go too far one way you can bring it back.

As soon as you start going at it with discs and burs if you take a little bit too much out of it when you’re stuffed because then what you’re going to do you’re going to re-sandblast it, re-bond it and it’s just a nightmare so you want to really get 99% of the way there while the composite is uncured because you’ve got the flexibility and if it takes you 10 minutes to get the line angle that you want or if it takes you an hour that’s okay. We’ve booked a long appointment we know it’s going to take a while and we’ll get there while the composite is uncured then use your pencil to almost shade where the line angle is and show you exactly where it is. So use it I think you–

[Jaz]
So using on its side?

[Matty]
Exactly and you’ve picked up on that because you’ve specified about drawing with the tip of the pencil and that’s the key thing is that maybe if you look at trying to get your line angles right before you cure it then cure it then shade with the pencil kind of on its side along roughly where the line angle is and what it will do is give you a pencil line of where your line angle is right now rather than where you want it to be and then you look at that and then you modify that. So if you want to–

[Jaz]
So let’s go in two directions Matty, so we can talk about once you have focused a bit more time on getting the light angle while the composite is uncured and then you can shade it in and then how do you define it at that point? And then we can go back a few steps and any tips on actually how you’re managing the interproximal areas to nudge the line angle in the direction that you want and how you want it to look?

[Matty]
Yeah cool okay so once you’ve got the line angle on you want to change it. You need to be polishing on the side of that pencil line away from the direction that you want the pencil line to move, does that make sense? So this is tricky because this is obviously a very visual thing trying to describe with words but if you can imagine your line angle running down the tooth and let’s say this lovely arc or an exactly where you want it but in the mid third of that that pencil line.

[Jaz]
Let’s talk teeth. Let’s talk about an upper left central incisor and we’re talking about the mesial line angle. And then maybe use mesial and distal as or cervical and incisor as your reference points in terms of how you’re going to how we can do that would that help?

[Matty]
Yeah cool. So upper left one we’ve got our mesial line angle and it’s running from fairly close to the mesial incisal edge and it’s starting fairly parallel with the long axis of the tooth before then starting to curve towards the center of the tooth as it comes towards the gingival margin. That’s where we want it. Now let’s say we’ve put our line angle in and we’ve shaded with the side of the pencil and that line looks pretty good but halfway up it kind of deviates towards the midpoint of the tooth before coming back out to where you want it as an example okay?

And you want to polish so with one of a few things an enhancement is really good by Dentsply and the blue flexi points are really good by Cosmedent or Enlightened you can soft like this if you rather and you know whatever you’ve got really whatever works in your hands. But you want to polish on the side of that line angle opposite to where you want it to go. So you want to be polishing kind of closer to the center of the tooth and as you polish you’ll see that line angle starts being transported kind of towards the midline if that makes sense?

[Jaz]
So if you’ve got a line angle that’s too far into the middle of the tooth and it’s curving too soon then you would use it more on the distal side or towards the middle of the tooth and you’re sort of using your disc or orber in that situation you tell me which is best for that situation to move the line angle closer towards the midline right?

[Matty]
Exactly and vice versa if you’ve got very narrow line angles that are very kind of straight and you want them curving in a little bit more and that’s where I definitely use discs. Because as soon as you, that kind of that area on the, if we’re talking about that mesial line angle of left one that area of composite mesial to that line angle is really precious like once you if you pardon my french cock that off you’ve really cocked it off and it’s difficult to come back from that so you want to when you’re just in that bit you want to take it slow and fine discs, nothing too coarse and just take your time and be patient if you’re moving it the other direction but yeah that’s it. So don’t be scared to practice will be my top tip get some models or whatever and put some composite on draw your line angles and have a play polish it this way polish it that way you’ll see draw on with your pencil polish it let it move draw on again you’ll see what you’ve done. You’ll see that it’s changed and yeah in terms of what to use I would say that the best two in my hands are enhanced burs, the disc ones.

So it’s like a little five pence piece and you don’t use so it’s like a five pence piece but you don’t use the queen’s face. You use the edge of the coin if that makes sense? Are you with me? So you run it down you run it down kind of with the edge and pull down the tooth with that. All the flexi points are really good buy by Cosmedent as well for a similar kind of thing and what you get out of those which is quite nice is a little bit more random vertical texture which just adds a little bit of life likeness the enhancement you can get something that’s really perfect and homogeneous but it can sometimes look a bit too flat whereas the blue flexi points are a bit fiddlier and are going to do less but if there’s less to do then you get the advantage of a little more vertical texture and kind of randomness if you like without going over the top.

[Jaz]
Sometimes with line angles I’ve done it before where I’ve got it a little bit too pointy like you can almost feel with your glove finger it’s sharp almost because you’ve done all that sort of negotiation and where you want to be and then you’ve looked at his sharp point so at that point, what’s your top tip to just soften it and get that sharp point to a rounded point would it be the enhanced just running across it?

[Matty]
The enhance might be a little aggressive that I’ve maybe used like a fine soflex disc and almost roll it from mesial to distal over the line angle so you’re almost kind of shaving off that sharpness but saying about making a sharp angle and then softening it that is absolutely the way to do it and the way that I do it, you want when you kind of well I come back to this in a sec but it’s much easier to soften a sharp line angle than it is to define a kind of lacking line angle if that makes sense? So what you’re doing is the right thing though in my opinion that’s the way that I do and the way I find quite simple to do.

[Jaz]
Perfect that will help. So let’s talk about last thing then so almost going back a few steps and when you’re actually adapting your composite and you’re getting that line angle, you’re doing that 99% of the work to make your polishing easier and get that well-defined line angle. What top tips can you share with the Protruserati on that point?

[Matty]
As a proud member of the Protruserati if I can say it. The main thing for me is making sure that when you’re kind of placing that composite on the tooth. So we learned at uni that, let’s stick with an upper central it’s got three planes so it kind of tucks in towards the cervical, quite flat and then curves back in again at the incisal edge. When we’re working from mesial to distal we don’t have that so much, it should be flat so when we are kind of creating that, well flat-ish when we’re creating that labial aspect, we only really want to be working in two planes.

So when we’re applying the composite we either want it flat on the tooth facing directly at us or say 45 degrees or so sloping away from us. So that if you were to cross-section that tooth, it would be well that composition it would be a kind of a trapezium shape if that makes sense and that the top of the trapezium so the smaller length of the trapezium should be really, really, flat and it’s really kind of a top tip is that when you’re doing this kind of work that view from the incisal edge looking in your mirror is crucial because that’s where you’re looking at have I domed the kind of restoration? So is it really kind of dominant across because then you’re not going to get that point where the composite suddenly changes direction because that’s what gives you that line angle and it’s going to be a lot more gradual into the embrasure then into the contact point so you’re not going to have that definition you might get a hint of a line angle but it’s not going to be exactly as you want it.

And so as you’re applying the composite, your instrument, a little bit like when we did bridge perhaps at uni fixed bridge, your bur stays in the same angulation while you’re working you don’t deviate from that, similar kind of idea. So you’re whatever you’re using I like to use an OptraSculpt Pad to do the kind of the main labial aspect as I’m moving around the tooth that’s staying in the same plane I’m not curving it from mesial to distal, I’m smearing it left and right rather than rotating, if that makes sense? Then use something like an ipcl so a really fine carver to then almost tuck the composite then down towards the contact point and again with that what you want it in the same plane so you want it kind of then angling about 45 degrees away from that labial aspect and then once you’re there it’s very you know you have the main shape there within a minute and then you spend 20 minutes tweaking and perfecting and getting it right and but it’s much, much, easier to tweak it if it’s most of the way there already if that makes sense?

[Jaz]
That does make perfect sense. What’s your main method of interproximal management i.e. Mylar pull technique or do you like to put matrices in? or like most cases I guess it’s case dependent any advice you can shed on that? And that’s the last thing I’m going to really squeeze out of you.

[Matty]
Yeah case defendant. Mylar Pull is the kind of the go-to especially if there’s already a contact point there. that we’re kind of conforming to if you like all I’m trying to do if the teeth are already touching I’m just trying to get some composite into that contact I’m not trying to create this lovely contact because the contact’s already there and the kind of exception to the rule would be diastema closure, where we might use like a curved matrix for the gingival say third and then a mylar strip for then the rest because if you use a curved matrix for the entire thing you end up with that kind of console point where they curve down really nicely touch each other and then as you get towards the incisal edge they start curving away again and so there’s two parts to a contact point the curved aspect of the gingival margin then the flat aspect. And but yeah I’d say nine times out of ten, mylar pull and there’s loads of stuff on YouTube if you just look for mylar pull technique on YouTube there’s loads of good examples of that.

[Jaz]
What I’ll do is I’ll put it on the Protrusive Dental community Facebook group so people can be familiar with those but you’re right they’re Bud hopper all these people have got really good videos. I think– actually got one as well on the mylar pull technique so I’ll find that and I’ll link it. Matty, I’ve really got some great value from today and thank you so much for coming on to, to really help Devin and everyone basically with that really important daily sort of issue that we find with composites and guys if you haven’t already do check out Matty on instagram. What’s your instagram handle?

[Matty]
It’s ddr.matt.parsons, the classic.

[Jaz]
You guys should check it out. Honestly, it’s absolutely phenomenal. Matty, thank you so much I will let you go and be a father to George again. I hope you got nice things planned with him this weekend just lots of cuddles and love I’m sure.

[Matty]
Oh, Jaz, thanks so much. It’s an absolute honour to be on this.

Jaz’s Outro: 
Amazing thanks so much. Thank you Matt for coming on the podcast to help us with nailing our line angles. I hope you enjoyed that guys like always follow @protrusivedental and if you have a burning question, a small issue that’s a big problem in your life then do share it with me and I’ll find someone to nail it for you so you can be a better dentist Monday morning. Thanks guys for joining me and I’ll catch you in the next episode.