Case by Dr. Aleksandra Łyżwińska, Warsaw, Poland

ABSTRACT

Indirect overlays are the contemporary restoration standard for posterior teeth with extensive hard tissue loss. They provide for cuspal coverage, which decreases the likeliness of coronal and/or root fracture. At the same time and in contrast to crowns, overlay preparations minimize the removal of sound tooth structure especially in the cervical region, which is a critical factor.¹ Modern dental resin composites allow for direct cuspal coverage in a single-visit appointment. The results of in-vitro studies suggest that these direct overlays are a suitable alternative to their indirect counterparts in specific situations.^2-6 The following case report is used to describe the direct restoration procedure by means of a maxillary right molar with an extensive, deep MOD lesion.

INTRODUCTION

In the context of treating a tooth with an extensive carious lesion, a biomechanical risk assessment should be performed. The primary method of reducing the likeliness of tooth fracture is treatment with a restoration that provides cuspal coverage. The contemporary gold standard for biomechanically compromised teeth are adhesively cemented overlays as an alternative to crowns.¹ Another option that does not involve labwork is a direct overlay restoration.^2-6 The direct approach is especially suitable for long-term temporization, which may be required during orthodontic treatment, for example.

CLINICAL CASE

The 40-year-old male patient was referred to my office before an orthodontic and prosthetic treatment. Intraoral examination (Figs. 1 and 2) revealed:

• Tetracycline discolouration,
• Multiple extensive composite restorations with marginal leakage,
• Primary and secondary carious lesions, and
• Significant mechanical weakness^7,8 (mesio-occluso-distal (MOD) cavities, cusp loss, cracks).

Fig. 1. Initial situation – extensive MOD composite resin restoration.

Fig. 2. Initial situation – unacceptable contact points, palatal wall crack line.

Based on a clinical and radiological examination (Fig. 3), it was decided to restore the maxillary right first molar with a direct overlay, which should serve as a long-term temporary for the duration of orthodontic treatment. Once the local anaesthetic had been administered, rubber dam was placed in the first quadrant and the cusps of the affected first molar were reduced. For subgingival tooth preparation, a rubber dam sheet was temporarily moved behind the second upper molar (Fig. 4). In order to obtain a good emergence profile of the restoration and a tight fit of the sectional matrix, the gingivectomy was performed with an electric surgical knife (Surtron 50D, LED SPA) (Fig. 5). The main advantages of a diathermal cut are instant tissue coagulation and hemostasis⁹.

Fig. 3. Bite-wing radiograph: Maxillary fist molar with an overhang and negative profile of the distal wall.

Fig. 4. Initial preparation with reduction of the cusps and exposure of gingiva.

Fig. 5. Gingivectomy performed using a surgical electric knife.

In accordance with the European Society of Endodontology’s guidelines on the management of deep caries¹⁰, the deepest part of the cavity was cleaned in full rubber dam isolation (Nic Tone Dental Dam, MDC Dental) (Fig. 6). Carious-tissue excavation was carried out using round burs, then the enamel and dentin were air-abraded with 50-μm aluminum oxide (Microetcher IIa, Danville). Multiple cracks, penetrating through the enamel and partially the dentin, occurred within the mesial and palatal walls. The presence of cracks crossing the dentin-enamel junction is an absolute indication to cuspal coverage^8,11.

An appropriate rubber dam isolation is essential in adhesive dentistry. Beyond the obvious advantage of a clean operation field uncontaminated by saliva and moisture, the rubber dam contributes to keeping periodontal tissues at a distance form a tooth. In order to ensure both, maximum retraction and sufficient space to work, the rubber dam was inverted (introduced to the gingival sulcus) and stabilized using PTFE tape (Fig. 7). The mesial wall was restored using a blue 3D Composite-Tight 3D Fusion matrix ring (Garrison) and a medium standard Sectional Contoured Metal Matrix (TOR VM, Fig. 8). Due to its extensiveness and shape, restoration of the distal wall was more difficult to perform.

Fig. 6. Rubber dam newly placed in the interproximal area. Full isolation is essential for the excavation of the infected dentin in the deepest part of the cavity.

Fig. 7. PTFE tape placement for improving isolation in the gingival area. Al₂O₃ sandblasting.

Fig. 8. Mesial matrix fit.

The first attempt to adapt an elongated Sectional Contoured Metal Matrix and the green 3D Composite-Tight 3D Fusion (Garrison) ended with failure (Fig. 9). The matrix was changed for a longer and more curved one (Fig. 10). The ring was replaced by a smaller Palodent V3 Ring (Dentsply Sirona, Fig. 11). Due to the depth of the carious lesion, an antibacterial adhesive system was used (CLEARFIL™ SE Protect, Kuraray Noritake Dental Inc.). It contains the MDPB monomer, which offers an antibacterial effect that lasts even after hybrid layer formation^12-14. Furthermore, the fluoride included in the bond liquid intensifies the cariostatic mechanism of CLEARFIL™ SE Protect and supports the so-called “Super Dentin” formation¹⁵.

Fig. 9. Insufficient fit of the distal matrix.

Fig. 10. New, longer and more curved matrix in place.

Fig. 11. Different matrix ring placed in the distal area.

After polymerization of the bonding agent, the nanohybrid flowable composite resin (CLEARFIL MAJESTY™ ES Flow High, Kuraray Noritake Dental Inc.) was applied in a thin layer. The proximal wall was restored using both packable (CLEARFIL MAJESTY™ ES-2 Universal, Kuraray Noritake Dental Inc.) and flowable composite resin (CLEARFIL MAJESTY™ ES Flow Super Low, Kuraray Noritake Dental Inc.) (Figs. 12 and 13). Core build-up was performed with bulk-fill type composite. The cusps were reconstructed free-hand with the previously used CLEARFIL MAJESTY™ ES-2 Universal (Figs. 14 and 15). The universality of this product provides for a good optical integration and blending with the adjusted tissue, regardless of the colour of the underlying tooth structure. The fissures were gently highlighted using brown tints.

Fig. 12. Thin layer of flowable composite resin CLEARFIL MAJESTY™ ES Flow High (A2) applied on the cavity floor. The proximal walls are built up with build-up by CLEARFIL MAJESTY™ ES-2 Universal and CLEARFIL MAJESTY™ ES Flow Super Low (A2).

Fig. 13. Proximal walls build-up – palatal view.

Fig. 14. Core build-up. Free-hand cusp coverage with CLEARFIL MAJESTY™ ES-2 Universal, palatal view.

Fig. 15. Cusp coverage – occlusal view.

The initial polishing was performed with the rubber dam still in place. The excesses of composite resin were removed with the aid of abrasive discs, diamond burs and a “Brownie” polisher (BAL, Nevadent). Pre-polishing and high-shine polishing were executed with TWIST™ DIA for Composite (Kuraray Europe GmbH.) supported by a goat hair brush (Micerium) (Figs. 16 to 17).

Fig. 16. Occlusal surface after surface modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing.

Fig. 17. Occlusal surface after modeling with CLEARFIL MAJESTY™ ES-2 Universal and initial polishing – palatal view.

After removal of the rubber dam, the occlusal contact points of the direct overlay were adjusted (Figs. 18 and 19). Every spot touched by the burr was subsequently repolished according to the previously described protocol (Figs. 20 and 21).

Fig. 18. Occlusal adjustment. Contact points recorded with articulation paper (100 μm).

Fig. 19. Occlusal adjustment. Contact points recorded with articulation paper (100 μm= and articulation foil (16 μm).

Fig. 20. Final effect after polishing with TWIST™ DIA for Composite.

FINAL SITUATION

Fig. 21. Final effect – palatal view.

CONCLUSION

As a result of decades of improvements mainly with regard to the filler density and polishability, modern dental composites offer a great gloss retention and favourable wear properties. In addition, polymerization shrinkage has been decreased due to the integration of nanohybrid filler technology. Those features allow us to restore biomechanically compromised teeth using a direct restoration technique.

Direct overlays are a suitable alternative for a conventional indirect restoration in many situations.^18,19 According to researchers, the advantages of direct restorations with cuspal coverage include minimal tooth preparation, vital pulp-oriented treatment, the possibility to treat patients in a single appointment and a potentially lower cost of the treatment.^18-20 However, it should be emphasized that the presented technique requires advanced restorative skills that need to be acquired first before starting to implement it.

REFERENCES

1. Dietschi D, Duc O, Krejci I, Sadan A. Biomechanical considerations for the restoration of endodontically treated teeth: a systematic review of the literature--Part 1. Composition and micro- and macrostructure alterations. Quintessence Int. 2007 Oct;38(9):733-43.
2. van Dijken JW. Direct resin composite inlays/onlays: an 11 year follow-up. J Dent. 2000 Jul;28(5):299-306. doi: 10.1016/s0300-5712(00)00010-5. PMID: 10785294.
3. Mondelli RF, Ishikiriama SK, de Oliveira Filho O, Mondelli J. Fracture resistance of weakened teeth restored with condensable resin with and without cusp coverage. J Appl Oral Sci. 2009 May-Jun;17(3):161-5.
4. Deliperi S, Bardwell DN. Multiple cuspal-coverage direct composite restorations: functional and esthetic guidelines. J Esthet Restor Dent. 2008;20(5):300-8; discussion 309-12.
5. Deliperi S, Bardwell DN. Clinical evaluation of direct cuspal coverage with posterior composite resin restorations. J Esthet Restor Dent. 2006;18(5):256-65; discussion 266-7.
6. Mincik J, Urban D, Timkova S, Urban R. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study. Int J Biomater. 2016;2016:9138945.
7. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989 Nov;15(11):512-6.
8. Banerji S, Mehta SB, Millar BJ. The management of cracked tooth syndrome in dental practice. Br Dent J. 2017 May 12;222(9):659-666.
9. Bashetty K, Nadig G, Kapoor S. Electrosurgery in aesthetic and restorative dentistry: A literature review and case reports. J Conserv Dent. 2009 Oct;12(4):139-44.
10. European Society of Endodontology (ESE) developed by:, Duncan HF, Galler KM, Tomson PL, Simon S, El-Karim I, Kundzina R, Krastl G, Dammaschke T, Fransson H, Markvart M, Zehnder M, Bjørndal L. European Society of Endodontology position statement: Management of deep caries and the exposed pulp. Int Endod J. 2019 Jul;52(7):923-934.
11. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc. 2002 Sep;68(8):470-5.
12. Hashimoto M, Hirose N, Kitagawa H, Yamaguchi S, Imazato S. Improving the durability of resindentin bonds with an antibacterial monomer MDPB. Dent Mater J. 2018 Jul 29;37(4):620-627.
13. Imazato S, Kinomoto Y, Tarumi H, Torii M, Russell RR, McCabe JF. Incorporation of antibacterial monomer MDPB into dentin primer. J Dent Res. 1997 Mar;76(3):768-72.
14. Imazato S, Kinomoto Y, Tarumi H, Ebisu S, Tay FR. Antibacterial activity and bonding characteristics of an adhesive resin containing antibacterial monomer MDPB. Dent Mater. 2003 Jun;19(4):313-9.
15. Nakajima M, Okuda M, Ogata M, Pereira PN, Tagami J, Pashley DH. The durability of a fluoride-releasing resin adhesive system to dentin. Oper Dent. 2003 Mar-Apr;28(2):186-92.
16. Bore Gowda V, Sreenivasa Murthy BV, Hegde S, Venkataramanaswamy SD, Pai VS, Krishna R. Evaluation of Gingival Microleakage in Class II Composite Restorations with Different Lining Techniques: An In Vitro Study. Scientifica (Cairo). 2015;2015:896507.
17. Oficjalne informacje producenta Kuraray Noritake Dental https://www.kuraraynoritake.eu/pl/clearfil-majesty-es-flow (dostęp 08.02.2022).
18. Angeletaki F, Gkogkos A, Papazoglou E, Kloukos D. Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent. 2016 Oct;53:12-21.
19. Dhadwal AS, Hurst D. No difference in the long-term clinical performance of direct and indirect inlay/onlay composite restorations in posterior teeth. Evid Based Dent. 2017 Dec 22;18(4):121-122.
20. Banerji S, Mehta SB, Millar BJ. Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome. Br Dent J. 2010 Jun;208(11):503-14.
21. Opdam NJ, Roeters JJ, Loomans BA, Bronkhorst EM. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite restoration. J Endod. 2008 Jul;34(7):808-11.
22. van Dijken JW. Direct resin composite inlays/onlays: an 11 year follow-up. J Dent. 2000 Jul;28(5):299-306.

The vacation period is over and we all are slowly returning back to our everyday routines and work. With all the travel and holidays in the last months you might have missed this great article in the LabLine Summer edition: Graftless solutions and implant-supported monolithic zirconia fixed prostheses.

It is an extensive, beautiful and detailed case report created and documented by team of well known and respected KOLs: Fortunato Alfonsi, Antonio Barone, Marco Stoppaccioli, Romeggio Stefano and Vincenzo Marchio.

Check it out by clicking here.

LAMINATE VENEER RESTORATION
USING LITHIUM DISILICATE

WITH PANAVIA™ Veneer LC (Clear)
Case by Yohei Sato (DMD, PhD) and Keisuke Ihara (CDT)

Fig. 1 The patient visited would like to have the a aesthetics
of the maxillary right and left lateral incisors improved.

Fig. 2 A silicon guide fabricated from a diagnostic wax model
was applied and the necessary clearances were determined.

Fig. 3 Since the lateral teeth are microdonts, the
preparation of each abutment was completed by simply
exposing a fresh enamel surface to be covered with
laminate veneers.

Fig. 4 A layer of porcelain was applied on the lithium
disilicate substrate, to complete the laminate veneers.

Fig. 5 The veneer was conditioned according to the
prosthesis‘ IFU. After trial fitting, the intaglio surface of the
laminate veneer was cleaned with KATANA™ Cleaner.

Fig. 6 CLEARFIL™ CERAMIC PRIMER PLUS was applied and
dried to prime the restoration.

Fig. 7 The preparation was cleaned with KATANA™ Cleaner.
Applied and rubbed for more than 10 seconds. Then, it
was washed off sufficiently (until the cleaner color had
completely disappeared), and dried with compressed air.

Fig. 8 K-ETCHANT Syringe was applied and left for 10
seconds before water-rinsing and compressed air-drying.

Fig. 9 PANAVIA™ V5 Tooth Primer was applied and left for 20
seconds before mild compressed-air drying.

Fig. 10 PANAVIA™ Veneer LC Paste was applied to the
intaglio surface of the laminate veneer.

Fig. 11 The laminate veneer was seated and the fit
checked. Then, the excess cement was tack-cured (not
more than 1 second at each point) and removed. Finally,
the restoration was light-cured and finished.

FINAL SITUATION

Fig. 12 The laminate veneer restorations one month after
placement. The morphology and color of the right and
left lateral incisors have been improved, providing a good
balance to the entire anterior dentition.

LAMINATE VENEER RESTORATION
USING KATANA™ Zirconia STML

WITH PANAVIA™ Veneer LC (Clear)
Case by Yohei Sato (DMD, PhD) and Keisuke Ihara (CDT)

Fig. 1 The patient was referred by an orthodontist. The main
complaints were improper aesthetics of the teeth due to dark
triangles betwen the teeth and incisal wear.

Fig. 2 On the basis of the pre-treatment diagnosis using
a mockup, the teeth were prepared, with keeping in mind
that the enamel should be preserved to the maximal extent
possible.

Fig. 3 A fixation retainer was present at the palatal side,
making it difficult to take coventional silicon impressions.
Therefore, an intraoral scanner was used.

Fig. 4 A layer of porcelain was applied to each KATANA™
Zirconia STML laminate veneer to complete the restorations.
The inner surface of each restoration was sandblasted, being
careful to prevent chipping.

Fig. 5 After trial fitting, bonding inhibiting substances as
blood and saliva were removed using KATANA™ Cleaner.

Fig. 6 CLEARFIL™ CERAMIC PRIMER PLUS was applied and
dried using compressed air.

Fig. 7 The surface of each tooth was cleaned and treated
with K-ETCHANT Syringe for 10 seconds before washing it
away with water and drying with compressed air.

Fig. 8 PANAVIA™ V5 Tooth Primer was applied and left f

Fig. 9 PANAVIA™ Veneer LC Paste was applied and the
laminate veneers were seated. For this case, we placed six
veneers during one session.

Fig. 10 The unpolymerized excess paste was removed with
a brush according to the wet clean-up technique.

Fig. 11 The result after final light curing. Since the excess
cement was easily removed, there were almost no cement
residues.

FINAL SITUATION

Fig. 12 Result one month after placement of the laminate
veneer restorations. The marginal gingiva has been improved
thanks to the good fit of the laminate veneer restorations.

Case by CDT Daniele Rondoni

When planning to replace Class II restorations, many things need to be considered. In order to select the most appropriate restorative technique and preparation design, it is essential to evaluate the amount and state of the remaining tooth structure, first. After repeated restoration replacement or in teeth originally restored with amalgam, for example, the remaining walls and cusps are often weakened and prone to fractures and cracks. When the cavity walls appear to be too thin or the structure is weak at the time of restoration replacement, it may be better to remove walls and cusps and opt for indirect adhesive restorations (overlays) instead of direct composite restorations. Due to favourable material properties – in particular a high flexural and compressive strength while being gentle to the opposing dentition and not too rigid for the surrounding tooth structures – we often opt adhesive restorations made of KATANA™ AVENCIA™ Block in those situations.

The following clinical case is used to describe the replacement of two composite restorations with overlays made of the innovative hybrid ceramic material.

Fig. 1. Initial clinical situation with composite restorations on the second premolar and first molar in need of replacement. The tooth structure particularly of the first molar was weak, with the distobuccal cusp already fractured.

Fig. 2. Prepared tooth structure ...

Fig. 3. Restorations milled from a KATANA™ AVENCIA™ Block after high-gloss polishing and characterization.

Fig. 4. Finalized restorations on a resin model.

Fig. 5. Adhesively cemented restorations in the patient’s mouth.

FINAL SITUATION

Fig. 6. Treatment outcome with a nice transition from the tooth structure to the restoration.

Case by Dr. Jusuf Lukarcanin

Restoring posterior cavities is a standard task we perform virtually every day. Yet, it is a challenging procedure as access to the affected teeth is often limited. This fact complicates many steps from working field isolation to material application and sculpting. By streamlining procedures and establishing protocols that are followed every time, it is possible to achieve predictable outcomes even in difficult situations, as shown below.

Fig. 1. Class II cavity in a second molar after caries removal and cavity preparation.

Fig. 2. Working field isolation.

Fig. 3. Application of adhesive (e.g. CLEARFIL S³ BOND PLUS) into the cavity.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Classic (Kuraray Noritake Dental Inc.) in the shade A2.

Fig. 5. Build-up of the dentin core using the incremental technique with CLEARFIL MAJESTY™ ES-2 Premium in the shade A2D.

Fig. 6. Contouring of the occlusal enamel layer made of CLEARFIL MAJESTY™ ES-2 Premium in the shade A2E.

Fig. 7. Polishing of the restoration with Twist DIA for Composite.

FINAL SITUATION

Fig. 8. Treatment outcome.

Compact, time-saving and aesthetic

How many different shades of composite do you need to create appealing restorations in virtually every clinical situation? If you opt for “CLEARFIL MAJESTY™ ES-2” Universal shade concept, a few shades will do the trick.

With wonderful support of our internationally recognized key opinion leaders, we have prepared a Clinical Case brochure of “CLEARFIL MAJESTY™ ES-2” Universal for you. The brochure highlights a variety of clinical cases in the anterior and posterior region to show the all about excellent properties of our latest composite. Let the pictures speak for themselves!

Click here to view. Enjoy!

Start Reading: Special MAJESTY ES-2 Universal - Clinical Cases Brochure

Case by Dr. Nicola Scotti

When restoring posterior teeth with resin composite, functional aspects such as tight and anatomically correct proximal contacts and a naturally shaped occlusal surface that is wear-resistant and antagonist-friendly are even more important than a perfect optical integration. This is why every dental practitioner should avoid spending a lot of time on shade selection in these cases and focus on the factors that have an impact on the reliability and longevity of the restoration. Great support in accomplishing this task is offered by CLEARFIL MAJESTY™ ES-2 Universal, a resin composite with a single universal shade (U) for the posterior region that eliminates the need for shade taking and selection. At the same time, it offers good marginal adaptation, low shrinkage stress and high wear resistance needed for great long-term results.

Fig. 1. Initial situation with a wide primary carious lesion in the distal aspect of the second premolar.

Fig. 2. Premolar after isolation of the working field with rubber dam, caries excavation and cavity preparation.

Fig. 3. Placement of a sectional matrix and a wedge to optimize the fit. Both are held in place with a separation ring, which increases the interproximal space and hence ensures tight, anatomically correct proximal contacts.

Fig. 4. Build-up of the proximal wall with CLEARFIL MAJESTY™ ES-2 Universal (U shade) following selective enamel etching with phosphoric acid (K-ETCHANT Syringe) and bonding with CLEARFIL™ SE Bond.

Fig. 5. A thin layer of flowable composite (CLEARFIL MAJESTY™ ES FLOW High) applied to the cavity floor to act as a resin coat.

Fig. 6. Restoration completed with CLEARFIL MAJESTY™ ES-2 Universal (U shade). While the universal shade composite blends in very well with the surrounding tooth structure, the natural look is completed by adding a tiny bit of brown tint to the fissure.

Fig. 7. Treatment outcome immediately after rubber dam removal. The proximal contact is tight and the occlusal anatomy well-shaped for the patient’s individual masticatory dynamics. The margin of the restoration is virtually invisible, while the buccal cusp appears lighter due to dehydration of the natural tooth structure.

FINAL SITUATION

Fig. 8. Treatment outcome after two months.

Conclusion

The present case demonstrates that the selected composite is well-suited for simplified restoration procedures in the posterior region. The material handles well, offers the same mechanical properties as other materials from the CLEARFIL MAJESTY™ ES-2 series and blends in harmoniously with the surrounding structures without being too translucent. This way, it is possible to waive the shade-taking process without compromising the treatment outcome. The time saved in this context may be spent on functional aspects – or even on another patient.

Dentist:

DR. NICOLA SCOTTI

Daniele Rondoni, hammasteknikko (CDT)

Tavallisesti hammaskeraamin esteettisyyttä – erityisesti sen läpikuultavuutta – voidaan parantaa vain taivutuslujuuden kustannuksella. Kararay Noritake Dental -yhtiön Uusi KATANA™ Zirconia on erilainen. Rungon alaosan taivutuslujuudella 1,100 MPa:a ja korkealla läpikuultavuudella rungon yläosassa ja inkisaalisesti esteettisyydelle ei ole indikaatiorajoja, kuten alla oleva tapaus osoittaa.

Kuva 1. KATANA™ Zirconia YML -materiaalista toteutetut 4-osaiset ja 6-osaiset sillat jyrsinnän ja sintrauksen jälkeen. Vestibulaaripinnan luonnollinen rakenne on tärkeä edellytys monoliittisten restauraatioiden esteettisyydelle.

Kuva 2. Kahden sillan frontaalinäkymä mallin päällä CERABIEN™ ZR FC Paste Stain -tuotteen (Kuraray Noritake Dental Inc.) ultramikrokerroksen levittämisen jälkeen.

Kuva 3. Värjätyt ja lasitetut restauraatiot ja niiden läpikuultavuus valossa.

Kuva 4. Potilaan suuhun sementoidun 6-osaisen sillan bukkaalinäkymä.

Kuva 5. Potilaan suuhun sementoidun 6-osaisen sillan bukkaalinäkymä.

Tämän uudentyyppisen monikerroksisen zirkoniumoksidin avulla voidaan valmistaa esteettisiä monoliittisia restauraatioita myös etualueella. Eri kerrosten lujuuseroista huolimatta materiaalilla voidaan toteuttaa lujuudeltaan erinomaisia restauraatioita ja materiaalin hyvä läpikuultavuus inkisaalialueella takaa luonnollisen lopputuloksen sintrauksen jälkeen. Ultramikrokerrokset ja monoliittisen pinnan lasitus takaavat lopputuloksen, johon potilaat ovat tyytyväisiä.

DANIELE RONDONI, MDT

Tri Adham Elsayed

Tässä videossa esitetään konsepti I-luokan täytteiden tekemiseen alle 10 minuutissa.

Tri Elsayed käyttää Clearfil Majesty ES Flow-, Clearfil Universal Bond Quick- ja Clearfil Twist Dia -tuotteita sekä esittelee yhden juoksevien yhdistelmämuovien eduista perinteisiin yhdistelmämuoveihin verrattuna. (Valinnaisen) "leimatekniikan" avulla Clearfil Universal Bond Quick sidosaineella (ei odotusaikaa) ja viskositeetiltaan erilaisilla juoksevilla yhdistelmämuoveilla saadaan aikaan nopeita ja helppoja täytteitä. Tämä on hyvin käytännöllistä molaarialueen yhdistelmämuovitäytteissä.

Tämä potilas pyysi pelkästään esteettisistä syistä kartionmuotoisen yläkakkosensa (12) korjaamista. Potilaalle tarjottiin hoitoa, johon sisältyisi oikomishoidon ensimmäinen vaihe, jolla olisi pyritty luomaan yläkakkosen ihanteelliseen muotoon palauttamisen vaatima tila. Koska potilas kieltäytyi tästä oikomishoidosta, hammas päätettiin korjata yhdistelmämuovilla ja sovittaa käytettävissä olevaan tilaan.

Sidosjärjestelmänä käytettiin CLEARFIL SE BOND 2 -tuotetta, ja korjaus toteutettiin uudella CLEARFIL MAJESTY ES-2 Universal -yhdistelmämuovilla. Vaikka tämä materiaali on suunniteltu yhden sävyn tekniikkaan, jossa on vain kaksi sävyä etualueelle, päätin yhdistää pastat, jotta saavutettaisiin paras lopputulos. Yläkakkosen kervikaali- ja keskiosan rekonstruoinnissa käytettiin tummaa sävyä (UD). Inkisaaliosa korjattiin vaalealla (UL) sävyllä.

Alkutilanne, jossa yläkakkonen on kartionmuotoinen (12).

Alkutilanteen kuva, joka on otettu polarisoivalla suodattimella sävyn arviointia varten.

Valittiin uusi CLEARFIL MAJESTY ES-2 Universal -yhdistelmämuovi, jossa on vain kaksi sävyä etualueelle. Se mahdollistaa hyvän optisen integraation Kuraray Noritake Dentalin valon diffuusiota edistävän teknologian ansiosta.

Sävynmääritys hampaan pinnalle kovetettujen CLEARFIL MAJESTY ES-2 -yhdistelmämuovin Universal UL (Universal Light)- ja UD (Universal Dark) -sävynäytteiden avulla.

Eristys kofferdamilla.

CLEARFIL SE BOND 2 -tuotetta käytettiin vahvan sidoksen muodostamiseen hammasrakenteen ja yhdistelmämuovimateriaalin välille.

LOPPUTILANNE
Yhdistelmämuovin väri ja pinnan viimeistely sulautuvat hyvin viereisiin hampaisiin.

Yksinkertaistettu taka-alueen täyte sävyvalinnan eliminoinnilla

Tohtori Piotr Marchewka

Tehokkuus on tärkeää taka-alueen yhdistelmämuovitäytteissä. Se voidaan saavuttaa esimerkiksi eliminoimalla sävyvalinta ja yksinkertaisella kerrostekniikalla. Seuraavassa kliinisessä tapauksessa yläkuutonen ja –viitonen täytettiin CLEARFIL MAJESTY ES-2 Universal (U) –yhdistelmämuovilla ja yhden sävyn tekniikalla.

Alkutilanne: Yläkuutosen puru- ja palatinaalipinnoilla ja yläviitosen distaaliosassa havaittiin kariesvaurioita. Kofferdam asetettiin kosteuden hallitsemiseksi.

Hampaiden ulkoasu karieksen poiston, hammaskiilteen selektiivisen etsauksen ja CLEARFIL SE BOND 2
-tuotteen käytön jälkeen.

Sektionaalinen matriisi paikallaan. Sitä käytetään kunnollisen interproksimaalisen kontaktin luomista helpottamaan.

Okklusaalinäkymä CLEARFIL MAJESTY ES-2 Universal -yhdistelmämuovilla valmistetuista lopullisista täytteistä.

Mesio-okklusaalinäkymä lopullisista täytteistä. Pinnat kiillotettiin CLEARFIL Twist Dia -tuotteella.

Lopulliset tilanteet kofferdamin poiston ja okklusaalisten säätöjen jälkeen.

Irfan Abas
Hammasimplantologi & paikkaushoitoja tekevä hammaslääkäri

Irfan Abas on asiantuntija suun implantologian ja paikkaushoitojen alalla ja kansainvälinen puhuja. Hän on pitänyt aiheesta yli 20 esitystä, työpajaa ja reaaliaikaisen kirurgian kurssia ympäri maailman. Hollantilaisessa hammasalan aikakauslehdessä TP:ssä, jossa hän on myös toimittajana, on julkaistu useita hänen artikkeleitaan. Toinen kohokohta on julkaisu NTvT:ssä yhdessä professori Gert Meijerin (Radboud UMC) kanssa; professorin ohjauksessa Abas suoritti nelivuotisen väitöskirjan jälkeisen jatkokoulutuksen paikkaushoitojen alalta 2014. Hän on myös ohjaaja ja luennoitsija AAIE:ssä ja Alankomaiden MINECin puheenjohtaja. Irfan Abasilla on oma klinikka Bussumissa, Alankomaissa (tandartsabas.nl).

Terve 42-vuotias miespotilas pyysi pahoin kuluneiden alahampaidensa korjaamista.

Ennen hoitoa

Valmistelu (2–5)

Mallin valmistamisen jälkeen siihen tehtiin urat.

Jotta kaksi litiumdisilikaattilaminaattia mahtuisi paikalleen, oli valmisteltava 1 mm:n tila. Mallin poistamisen jälkeen valmistelu viimeisteltiin.

Välin mittaaminen silikonimuotilla.

Lopullinen valmistelu (edessä)

Tilapäisvaihe (6–10)

Tilapäisestä muovipohjaisesta materiaalista (Protemp) valmistetut laminaatit

Piste-etsaus ennen tilapäislaminaattien sidostamista paikalleen.

Pieni määrä juoksevaa yhdistelmämuovia levitettiin etsatuille pinnoille.

Tilapäislaminaattien koko pinta valokovetettiin.

Tilapäislaminaattien viimeistely.

Lopullinen sementointi (11–25)

Hammasteknikon valmistamat laminaatit.

Laminaattien istuvuuden varmistaminen

Kofferdam asetettiin, jotta kiinnitysaineen sementointi voitiin tehdä hallitusti.

Etsaus 35-prosenttisella fosforihapolla (K-Etchant Syringe) 10 sekunnin ajan.

Käsittely itse-etsaavalla esikäsittelyaineella (PANAVIA™ V5 Tooth Primer) (jätettiin vaikuttamaan 20 sekunniksi.)

Litiumdisilikaattilaminaattien etsaus vetyfluoridilla.

Clearfil Ceramic Primer Plus MDP -silaaniesikäsittelyainetta levitettiin laminaatteihin.

Laminaatit kiinnitettiin asetusinstrumenttiin ennen lopullista sementointia.

PANAVIA V5 Paste -tahnaa levitettiin laminaatin sisäpinnalle.

PANAVIA V5 Paste -tahnaa levitettiin koko laminaattiin.

Laminaatti asetettiin ja liiat poistettiin.

Valokovetus (vähintään 10 s).

Välittömästi PANAVIA V5 -kiinnitysainesementoinnin jälkeen.

Heti toimenpiteen jälkeen.

Heti toimenpiteen jälkeen.

Arviointi (26–28)

Kaksi kuukautta toimenpiteen jälkeen.

Yksi vuosi toimenpiteen jälkeen.