Clinical Cases, Chairside

Replacement of two direct restorations in the anterior region

Case by Dr. Aleksandra Łyżwińska, DMD

The case presented is regarding a patient with two discoloured composite restorations located in the distal aspect of the maxillary right central incisor and the mesial aspect of the adjacent lateral incisor. A replacement of these restorations was planned due to marginal leakage and for aesthetic reasons. During cavity preparation, a vestibular bevel was created in the enamel of the lateral incisor to provide for a smooth blend-in of the restoration and to improve adhesion. After selective etching of the enamel with phosphoric acid gel, CLEARFIL™ SE BOND 2 was applied. The adhesive contains the original 10-MDP monomer, which establishes a strong bond by adhering to dentin chemically. The restorations were created with CLEARFIL MAJESTY™ ES Flow - Low A2 and CLEARFIL MAJESTY™ ES-2 Classic in the shade A2. Final polishing was accomplished in a four-step procedure with abrasive discs, an aluminum oxide rubber polisher, and the two-disc CLEARFIL™ Twist DIA polishing system.

Fig. 1. Initial clinical situation after rubber dam placement.

Fig. 2. Detailed view of the teeth with a discoloured resin composite restoration visible in the mesial aspect of the lateral incisor.

Fig. 3. Palatal view of the teeth revealing marginal staining of the restoration in the distal aspect of the central incisor.

Fig. 4. Palatal view of the teeth after removal of the restorations and cavity preparation.

Fig. 5. Frontal view of the teeth after removal of the restorations and tooth preparation including beveling of the enamel.

Fig. 6. Upright placement of two sectional contoured matrices designed for the posterior region – palatal view.

Fig. 7. Frontal view of the sectional matrices fixed with a wedge.

Fig. 8. Palatal view of the teeth after selective enamel etching, bonding, and the application and light-curing of CLEARFIL MAJESTY™ ES Flow - Low A2 and CLEARFIL MAJESTY™ ES-2 Classic – A2.

Fig. 9. Frontal view of the situation - a concave “emergence profile” caused by matrix bending.

Fig. 10. Final layer of CLEARFIL MAJESTY™ ES Flow - Low A2 applied to the mesio-labial aspect of the lateral incisor.

Fig. 11. Occlusal view of the final composite layer prior to finishing.

Fig. 12. Polishing with the pre-polisher of the CLEARFIL™ Twist DIA system.

Fig. 13. Polishing with the high-shine polisher of the CLEARFIL™ Twist DIA system.

FINAL SITUATION

Fig. 14. Outcome of the polishing procedure.

Dentist:

DR. ALEKSANDRA ŁYŻWIŃSKA
Warsaw, Poland

Dr. Aleksandra Łyżwińska, DMD, is a passionate aesthetic and adhesive dentist. Driven by Evidence Based Dentistry, her goal includes using modern composite materials and bonding agents in her clinical practise. In addition to her primary job, she worked as a lecturer and an assistant professor at the Department of Conservative Dentistry and Endodontics of Medical University of Warsaw, her alma mater.