Quadrant restoration with a single-shade composite with CLEARFIL MAJESTY™ ES-2 Universal

Case by Dr. Vincenzo Picciariello

Innovative single-shade composites are an attractive option at least for posterior restorations, as they allow clinicians to skip laborious steps and save time. Nevertheless, the aesthetic and functional demands are high. The following case example demonstrates how CLEARFIL MAJESTY™ ES-2 Universal performs in the clinical environment and reveals how well the material blends in with surrounding tooth structure.

A 33-year-old female patient came to the clinic with a request to replace amalgam restorations in the upper right quadrant (Fig. 1). The second molar had an occlusal carious lesion, while the amalgam restoration on the first molar showed marginal leakage most likely leading to secondary caries. After the placement of rubber dam (Fig. 2), the existing restorations were removed, revealing secondary caries in the first molar and the second premolar (Fig. 3). The cavities were finished using fine-grained diamond burrs and sonic instruments and subsequently sandblasted with 50-micron aluminium oxide in order to facilitate the adhesive procedures (Fig. 4). In this way, the surface energy, bonding surface area, and surface roughness are increased and the wetting ability of the adhesive is improved for a high-quality bond with the enamel and dentin.

Fig. 1. Pre-operative image.

Fig. 2. Isolation of the working field with rubber dam.

Fig. 3. Secondary caries visible after removal of the amalgam restorations.

Fig. 4. Completed cavity preparation with air-abraded bonding surfaces.

Wooden wedges, sectional matrices and relative separator rings were placed to transform the Class II MOD cavity of the first molar into a Class I cavity by means of the centripetal build-up technique (Fig. 5). On each tooth, selective etching of the enamel was performed with 35% phosphoric acid etching gel (K-ETCHANT Syringe, Kuraray Noritake Dental Inc.), which was removed by thorough rinsing and drying, before applying the two components of CLEARFIL™ SE BOND – the self-etching primer and the light-curing bonding agent. The bond was treated with a gentle stream of air to make a uniform surface and finally, the adhesive layer was light cured for 40 seconds. The procedure was completed with immediate dentin sealing using a flowable composite (CLEARFIL MAJESTY™ ES-FLOW Low in the shade A3) in controlled thicknesses.

The restoration of the cavities was completed using CLEARFIL MAJESTY™ ES-2 Universal (Kuraray Noritake Dental Inc.) in the only available posterior shade Universal. In order to characterize the fissures and enhance the appearance of the occlusal morphology, staining agent in the shade dark-brown was applied. CLEARFIL™ Twist DIA (Kuraray Noritake Dental Inc.) was the polishing system of choice. After polishing, the difference in colour between the restorations and the visibly dehydrated enamel surfaces could be observed (Fig. 6). Upon inspection after 30 days, the restorations showed adequate and satisfactory chromatic integration (Fig. 7).

Fig. 5. Wedges, sectional matrices and rings placed for build-up of the first molar’s proximal walls.

Fig. 6. Image taken immediately after polishing with dehydrated enamel and the rubber dam still in place.

FINAL SITUATION

Fig. 7. Picture of the treatment outcome taken after 30 days.

The treatment of this quadrant demonstrates how CLEARFIL MAJESTY™ ES-2 Universal composite is an integrative innovation to the Kuraray Noritake Dental Inc. line of composites that allows the clinician to simplify the modeling procedures for direct restorations in the posterior regions, obtaining excellent aesthetic and functional results.

Dentist:

DR. VINCENZO PICCIARIELLO

Graduated from the faculty of dentistry and dental prostheses of Bari in 2009; specialized in direct and indirect conservative dentistry. Completed his training in aesthetic adhesive restorative dentistry in Geneva by attending the Anterior Bio-Esthetic Restorations Master Program of Dr. Didier Dietschi. He perfected himself under the guidance of Dr. Salvatore Scolavino and Dr. Gaetano Paolone at WeRestore in Rome. Member of the Italian Academy of Conservative Dentistry. Author of national and international publications.

Speaker at national and international conferences on adhesive dentistry topics. Since 2009, he has been working as a freelancer in Bitonto, dedicating himself mainly to implant and periodontal surgery and to adhesive aesthetic restorative-prosthetic dentistry.

• Apr 29, 2021

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