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

KLINIKINIS ATVEJUS SU
DR. NICOLA SCOTTI

Restauruojant krūminius dantis su derviniu kompozitu, tokie funkcionalūs aspektai, kaip glaudūs ir anatomiškai teisingi proksimaliniai sąlyčiai ir natūralios formos okliuzinis paviršius, atsparus nusidėvėjimui ir tinkantis dantims antagonistams, yra netgi svarbesni už puikią optinę integraciją. Štai kodėl tokiais atvejais kiekvienas dantistas turėtų vengti švaistyti laiką atspalvių parinkimui ir skirti dėmesį faktoriams, turintiems poveikį restauracijos patikimumui ir ilgaamžiškumui. Puikią pagalbą šiai užduočiai įgyvendinti siūlo „CLEARFIL MAJESTY™ ES-2 Universal“, dervinis kompozitas su vienu universaliu atspalviu (U) krūminių dantų sričiai, pašalinantis atspalvio nustatymo ir parinkimo poreikį. Tuo pat metu jis suteikia gerą pritaikymą kraštuose, mažą susitraukimo įtempį ir didelį atsparumą nusidėvėjimui, kuris reikalingas siekiant puikių ilgalaikių rezultatų.

1 pav. Pradinė situacija su plačiu pirminiu karieso pažeidimu antrojo kaplio distalinėje padėtyje

2 pav. Kaplys po darbo lauko izoliavimo koferdamu, karieso ekskavacijos ir plombos paruošimo

3 pav. Sekcijinės matricos ir pleišto naudojimas siekiant optimaliai pritaikyti. Abu laikomi vietoje su atskyrimo žiedu, kuris padidina tarpproksimalinę erdvę ir taip užtikrina glaudų, anatomiškai teisingą proksimalinį sąlytį

4 pav. Proksimalinės sienos antstatas su „CLEARFIL MAJESTY™ ES-2 Universal“ (U atspalviu), po kurio atliekamas selektyvus emalio ėsdinimas su fosforo rūgštimi („K-ETCHANT Syringe“) ir surišimas su „CLEARFIL™ SE Bond“

5 pav. Plonas takaus kompozito sluoksnis („CLEARFIL MAJESTY™ ES FLOW High“) tepamas ant plombos apačios kaip dervos sluoksnis

6 pav. Su „CLEARFIL MAJESTY™ ES-2 Universal“ (U atspalviu) atliekama restauracija. Nors universalaus atspalvio kompozitas labai gerai dera prie jį supančios dantų struktūros, natūrali išvaizda pasiekiama į plyšį pridedant vos vos rusvo atspalvio

7 pav. Gydymo rezultatas iškart nuėmus koferdamą. Proksimalinis sąlytis yra glaudus, o okliuzinė anatomija geros formos paciento individualiai kramtymo dinamikai. Restauracijos kraštas praktiškai nematomas, o danties burė atrodo lengvesnė dėl natūralios danties struktūros dehidratacijos

GALUTINĖ SITUACIJA

8 pav. Gydymo rezultatas po dviejų mėnesių.

Išvada

Šis atvejis parodo, kad pasirinktas kompozitas puikiai tinka paprastesnėms restauracijos procedūroms krūminių dantų srityje. Medžiaga tvarkoma gerai, suteikia tokių pačių mechaninių savybių kaip ir kitos „CLEARFIL MAJESTY™ ES-2“ serijos medžiagos ir harmoningai dera su ją supančiomis struktūromis, nors ir nėra per daug permatoma. Taip galima pašalinti atspalvio nustatymo procesą, nepažeidžiant gydymo rezultato. Šiame kontekste sutaupytą laiką galima panaudoti funkcionaliems aspektams ar net kitam pacientui.

DR. NICOLA SCOTTI

By Paul de Kok, Amsterdam (KVPA) Periodontic Clinic & ACTA

Picture 1

The Patient
Joris reported to the clinic with two discoloured composite two discoloured class IV composite restorations in tooth 11 and 21 11 and 21 (picture 1). These vital teeth were traumatized in his childhood. He was not satisfied with the aesthetics of the restorations neither with the overall shape and colour of the two teeth. It was therefore decided to make porcelain facings for tooth 11 and 21.

Picture 2

The preparation
In order to limit the sacrifice of healthy tooth tissue while still creating sufficient space for the porcelain, a preparation was chosen with an incisal reduction of 1.5mm and a buccal reduction of 0.5mm. A so-called depth cutter – a diamond drill with 0.5mm deep recesses – was used to achieve this (picture 2).

Picture 3

To be able to adjust the shape of the mid-line to the new facings, cutting was carried out centrally through the contact. From the distal aspect the contactpoint was remained. The thin shoulder was positioned equi-gingivally, so that a dry operative field could be achieved without damage to the gingiva.

The preparations were then finished using fine drills and polishing discs. The existing, well bonded diamonds composite restorations were left in situ (picture 3).

Picture 4

Since the transparent facings are very thin, the colour of the cut teeth is significant. The colour of the cores was therefore matched using the Natural Die colour guide (picture 4). Finally, impressions were made. Temporary restorations were placed by means of 4 spot etching points and bonding.

Picture 5

Cementation
To combine superior aesthetics with adequate strength, pressed lithium disilicate restorations were chosen for Joris. Prior to cementing the facings, they were tried for size and checked for marginal integrity, contact points, occlusion/articulation and aesthetics. Then the correct cement colour was established by testing the facings with various try-in colours PANAVIATM V5 Universal (A2); Universal (A2) appeared to be the most appropriate colour in Joris’s case. The teeth were then polished with pumice and the facings were cleaned with alcohol, after which the teeth from 14 up to and including 24 were isolate by a rubber dam.
An incisor clamp was placed on the first teeth to be cemented. The facing was tried for fitting once more to ensure that it was free of contact with the rubber dam or the clamp and that the operative field of the preparation was totally dry (picture 5).

Picture 6

The facing was etched with 9% fluoricacid (picture 6) for 20 seconds to achieve micro-mechanical retention.

Picture 7

It was then rinsed with water for 20 seconds before being neutralised in a solution containing ceramic neutralising powder. CLEARFILTM CERAMIC PRIMER PLUS was then applied to the facing. This ensures chemical bonding between the facing and the composite cement thanks to the incorporated silane and MDP. The adjacent teeth were separated by means of a transparent strip, after which the preparation was etched with 35% phosphoric acid (picture 7). TOOTH PRIMERTM was applied after thorough rinsing with water and drying after it had taken effect for 20 seconds.

Picture 8

A thin layer of PANAVIA V5 cement was then applied to the facing. The facing was placed on the preparation with the application of light finger pressure. A microbrush was used to remove the major excess along the margins. The cement of the buccal and palatal aspect was light cured for 5 seconds. A sharp scaler and floss were used to remove the final excess. Glycerine gel was then applied to the outline to avoid oxygen inhibition during curing. The cement was finally light cured from both sides for 20 seconds, the glycerine gel was rinsed away and the margins were finished by means of a composite polishing stone. After placement of the first facing, the rubber dam clamp was moved to the neighbouring tooth so the cementation of the second facing could proceed. This facing was once more tried for fit, pre-treated and cemented in an identical manner (picture 8).

Picture 9

The result
The facings were checked a few weeks later (picture 9). Joris was very satisfied with the aesthetics of his two central incisors. The transitions from tooth to restoration were invisible and the gingiva was healthy.

Picture 10

The transparency, surface structure and gloss are better adjusted to the neighbouring elements and to Joris’s smile (picture 10).