Cosmetic dentistry beauty & science

08 I I CE article _ adhesive dentistry ministered to achieve profound anaesthesia. Next, a nitrous oxide nasal mask was placed to decrease the patient’s exposure to mercury aerosol while the amalgam was being removed. In this case, because the patient opted not to use nitrous oxide, pure oxygen was administered through the nasal mask. We continued by isolating tooth #3 with a rubber dam. This step was essential to reduce the amount of amalgam ingested by the patient. It also offers isolation, higher visibility and bet- ter dentistry for our patients. If doing quadrant dentistry, I like to use the split-dam technique, which stretches to include several adjacent teeth in a quadrant. A FenderWedge (Directa) was then placed to separate and protect the ad- jacent tooth during prep, air abrasion, etching, bonding and refining while continuing to wedge the teeth for a tighter interproximal contact in the final restoration. To facilitate removal of the remaining amal- gam restoration, an hourglass-shaped diamond bur was used as diamonds are less likely to pro- ducethefractureandcrazelinesassociatedwith carbide burs. High-speed evacuation was used throughout the procedure to help decrease pos- sible inhalation and ingestion during amalgam removal. Caries detector was painted onto the pre- pared surface, and it was noted that cracks associated with the long-time expansion and contraction of the mercury-filled amalgam re- storation had contributed to the apparent inter- proximal decay. Once the decay was carefully and completely excavated using a small, round diamond bur and a spoon excavator, the tooth was insulated in a few important steps (Fig. 3). First, disinfectant was placed on the prepared dentinal surface (Hemaseal & Cide, Advantage Dental Products) and air-thinned. Then, two coats of self-etching bonding agent (OptiBond All-In-One Unidose, Kerr Dental) were placed to provide reduced postoperative sensitivity and high dentin bond strength. After air thinning and light curing, a flowable composite (Premise Flowable, Kerr Dental) in the lightest shade was added to the internal walls and floor to create an even floor and to fill in undercuts that were originally prepared for amalgam retention. A flat-end cylinder, fine- grit, short shank diamond was used to refine the tooth preparation after insulation was com- pleted (Fig. 4). Next, two identical hydrocolloid alginate impressions (Dux Dental) were taken fast and accurately. They take only 90 seconds to set with our chosen materials, so they are ideal for same-day inlay/onlays. Before expressing the hydrocolloidmaterialintothepreppedtooth,we squirted a little surfactant (Prep-Wet Plus, Dux Dental) onto the tooth to wet the prep while my assistant mixed the alginate. Fig. 12_Tooth #30 pre-op. Fig. 13_FenderWedge in place. Fig. 14_Caries detector. Fig. 15_Prep with liner. cosmeticdentistry 3_2013 Fig. 12 Fig. 13 Fig. 14 Fig. 15 “Adhesive dentistry offers a more conservative restorative approach to conventional dentistry. Why take away healthy tooth structure when there’s a viable alternative? Why not attempt to save the good and just replace the bad?”