Cosmetic dentistry beauty & science

10 I I CE article _ adhesive dentistry and remove any debris. Then the enamel and composite core were etched for 15–30 seconds. A single component, fifth-generation adhesive (OptiBond Solo Plus Unidose, Kerr Dental) was applied in two coats and air-thinned until there was no more movement. The enamel should be glossy (Fig. 9). Flowable composite (Premise Flowable, Kerr Dental) was dispensed into the prepped tooth and then the inlay was inserted into the tooth. The FenderWedges were removed and the onlay was further seated using the Titanium- coated #21 Acorn with gentle pressure. Com- plete seating was facilitated using the contra- angle packer/condenser while an explorer was helpful in removing excess flowable before curing. When dealing with onlays involving interproximal surfaces, it is a good idea to floss after seating the onlay and before curing. The restoration was cured from all angles, starting at the interproximal gingival floors where leakage is most likely to occur. Occlusal flash and excess flowable composite were then “buffed” with a short flame carbide while the interproximal margins were adjusted with bullet or needle carbides. Sometimes a Bard Parker #12 scalpel and Qwik Strip (Axis) are used to allow for easier removal of interproximal cement. Once the proper occlusion was established, a diamond-impregnated point and/or cup was usedtopolishtherestoration.Polishingwasfur- ther enhanced through the addition of polishing paste. In just one appointment, an esthetic and conservative interproximal onlay replacing a mesiobuccal cusp was prepped, placed and polished (Figs. 10 & 11). _Case 2 This patient also came in with a dental emer- gency. The filling had fallen out of his broken, lower right molar the day before he was going overseas for three weeks on business. He wanted a “quick and permanent solution” (Fig. 12). First the tooth was anesthetized. Next, a FenderWedge was used to isolate the in- volved tooth, protect the adjacent interproximal surface and pre-wedge the teeth for optimal contacts (Fig. 13). The Isolite was placed to ob- tain a dry and illuminated field. We used caries detector to ensure complete decay removal (Fig. 14). The tooth was then microetched, etched and desensitized with HemaSeal and Cide (Advan- tageDentalProducts).Twolayersofself-etching bonding agent (OptiBond All-In-One Unidose, Kerr Dental) were applied to provide reduced postoperative sensitivity and high dentin bond strength. This was then air-thinned and light- cured. Flowable composite (Premise Flowable, Kerr Dental)wasaddedtotheinternalwallsandfloor, creating an even floor and filling in undercuts that were originally prepared for caries removal and amalgam retention (Fig. 15). After the tooth was insulated, the prep was refined with a flat- end cylinder, fine-grit, short shank diamond. Two Identic hydrocolloid impressions (Dux Dental) were then taken as before. These impres- sions were handed to the assistant to be poured in the lab (Fig. 16). During the time between the onlay prep and seat, a small filling was done on another tooth to make the most of this ap- pointment time slot while the onlay was being fabricated in the lab. Fig. 20_Expasyl prior to seat. Fig. 21_Expasyl and FenderMate prior to seating. Fig. 22_Adapting FenderMate. cosmeticdentistry 3_2013 Fig. 20 Fig. 21 Fig. 22