As Dr. Courtney Lavigne said in "Dental Composite Comparison: Venus Diamond vs. Sonicfill," she and I will looking at a few key factors in evaluating different composites. In the first of this series, Dr Lavigne took the lead and looked at Venus Diamond by Heraeus Kulzer and Sonicfill 2 by Kerr. In Part II of this series, we will now compare Venus Diamond to Estelite Omega, which is made by Tokuyama. Just like in the first comparison we will look at the compressive strength, adaptation and handling, translucency, flowability, shrinkage, polishability, and overall ease of use.
As discussed in Part I, Venus Diamond is a nanohybrid composite available in 23 shades. Venus Diamond is filled 80-82 percent by weight and 63.5-65.1 percent by volume. Estelite Omega is available in 11 shades and is a spherically filled supra-nano composite. Estelite Omega is filled 82 percent by weight and 78 percent by volume.
I have used Venus Diamond in my practice for many years and, before adding Sonic Fill 2 to my practice, I used it in both the anterior and posterior. However, since adding Sonic Fill to my practice, I primarily use it in the anterior. I do on occasion use both Estelite Omega and Venus Diamond in the posterior in my practice, but both of these get used primarily in the anterior.
Compressive strength: As we know, compressive strength is an important factor with composites. As Dr. Lavigne discussed in Part I of this series, the compressive strength of Venus Diamond is listed on their website as 332 MPa. The compressive strength for Estelite Omega was listed at approximately 400MPAa by Tokuyama.
Adaptation and handling: Just like when Dr. Lavigne evaluated the composites in Part I, this is based solely on my opinions from use in my practice. As we previously discussed, Venus Diamond is a thick composite that can be hard to adapt, and it does tend to stick a bit to instruments. To me it feels very putty-like. Estelite Omega on the other hand feels much easier to place and adapt; to me it feels almost creamy and feels like it sort of melts into the tooth. Additionally, Estelite tends to stick less to my instruments.
Translucency: Both Estelite Omega and Venus Diamond are available in enamel and dentin shades, which allows you to vary the opacity to suit the needs of your case. However, in my hands I find Estelite Omega easier to blend into the tooth. One big difference is that Venus Diamond is available in a larger number of shades and has darker shades available. On the other hand, Estelite has a few nice, very translucent shades which can be very handy. Overall, the more limited number of shades is more than sufficient for most cases and, in fact, I would say to me it had more flexibility when dealing with brighter teeth.
Flowability: While neither Venus Diamond nor Estelite Omega are super flowable to work with in my hands, Estelle Omega is much easier to place as a single material (i.e. not flowable) and be confident that you adapted it well.
Shrinkage: Venus Diamond has 1.5 percent shrinkage versus Estelite Omega with 1.3 percent. Both are very low shrinkage percentages.
Polishability: Both materials were highly polishable. In my hands, both looked very good, but I would give a slight edge to Estelle Omega in both immediate post-op and on recall.
Overall ease of use: Both of these materials are made for layering, and whenever you try layering a new system, you can expect a bit of a learning curve. That being said, for me Estelite Omega is an easier system to use overall. I attribute this to its easier handling and condensed number of shades that just seem to work well for most cases. Where Venus Diamond beats Estelite Omega is when it comes to darker shades such as A-4 and darker.
Conclusion: In summary, both of these are great materials and both will serve you well. You can see an example in the two cases below in which I treated additively in combination with orthodontics.
In this first case we added to the incisal of 6-11 to restore the patient's wear.
As you can see Venus Diamond did really well in this case, which is several years old in the above follow-up photo.
The next case I will share was again an additive case involving ortho that we treated with Estelite Omega. Like the first case, we added to the inciscal of 8 and 9, but we had much more to do on the lateral incisors as you can see.
They both have good physical properties, but when it comes to adaptation and esthetic blend, personally I prefer Estelite Omega.
Taking all of this into account, of these two, if I had to limit myself to having just one in my office, it would be Estelite Omega. In my hands I find it easier to not only blend, but the handling is also superior. For me, where Estelite Omega falls short is that it is limited to shade A-3 and lighter, but I can almost always make it work. One quirk worth mentioning is that with the Estelite Omega system, you have to make your own shade guide using actual composite and the plastic handles they supply. It is not hard or a huge deal, but it is worth mentioning as it does mean you have to spend a bit of time making the guide once you get the kit.
The Second Opinion by Dr. Courtney Lavigne
Dr. Carson did a great job summarizing the two materials, and I agree with the comparisons he has made. I also have both materials in my practice, and use them separately on a daily basis.
In my practice Venus Diamond is a material I've worked with for years, and I use it primarily for Class III and IV restorations when I'm not layering. It is thicker than and not as easy to handle as Estelite Omega, but there are so many shades that it's easy to pick a good match in a tooth that lacks translucency or high characterization. It's also great when you need a shade like C4 that you won't find in the Estelite kit.
One shade was used in the above image because these teeth were bonded as a temporary solution to assist the orthodontist prior to bracketing the teeth. The patient is having porcelain veneers completed at the end of ortho.
Estelite Omega is my hands-down favorite product to work with in the office. I use it when I'm layering composite to do direct chairside veneers, Class III or IV repairs with higher translucency, or when changing the length or position of a tooth with composite in the anterior. It's creamy and easy to manipulate, and really fun to work with. If you're doing matrix-guided composites, this is a great material. I find that even though there are very few shades, because when I'm using them I'm layering dentin and enamel the majority of the time, you can get a really great match. Unless there's an existing post/core or crown on a single central, I think it's much easier to repair a fractured tooth with Estelite and get a really nice result than porcelain. To combat the issue of very few shades when you're working with darker teeth, I use tints from Cosmedent. The light brown and violet can make an otherwise bright enamel shade mimic the adjacent teeth really nicely.
Multiple shades and opaquers were used above with Estelite because a greater amount of tooth structure was being restored and the natural teeth are highly characterized.
Estelite Omega was used in the two above images because we were repairing a larger break in the anterior and the patient had very high esthetic demands.
If I like both materials, how do I decide? It's a case-by-case decision. If I've done a wax-up and am using a matrix to restore the teeth, I'm using Estelite Omega. If it's a smaller filling or repair, a lot of times it comes down to the patient's decision. I can get a really nice result with a single shade of Venus in small anterior composites. I can get an exceptional result with a few shades of Estelite Omega in those same teeth. If I'm going to take additional time and materials to use Estelite, the patient is going to be onboard with additional chair-time and additional costs for that level of care.
Both are great, and each has its place in my office!
John R. Carson, D.D.S., P.C., Spear Visiting Faculty and Contributing Author - www.johncarsondds.com
Courtney Lavigne, D.M.D., Spear Visiting Faculty and Contributing Author - www.courtneylavigne.com