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Dental Tribune Middle East & Africa Edition | January-February 2016 19 aesthetics Supporting the future generations in dentistry Dr. Emiliano Rossi The following case was conducted under the supervision of Dr. Emiliano Rossi (Chief of Department of Dentist- ry in the same University, Padova). 1, 2,3. Pre-operative views. Note the presence of large and faulty fillings and the lack of harmony between the substrate and the restorations. 4, 5. Placement of Kerr OptiDam rubber dam; anterior and occlusal views. 6. Removal of old restorations and sec- ondary caries on teeth 12 and 22. 10. Polymerization of the composite us- ing an LED Kerr Demi Ultra curing light with applications of glycerin-based gel, in order to avoid the oxygen inhib- ited layer. 16. Surface finishing and shaping, using diamond burs (40,15 micron) and mac- ro texture performed with carbide burs. Finishing with Kerr Opti1Step polisher (Dia1Step in Italy, distributed by Ravelli S.p.a.). 17. Finishing with Kerr OptiDisc Extra- Fine 10-μm. 18. Polishing using a Kerr Occlubrush. 19, 20. Final aesthetic result. The patient shows a completely renewed, natural and harmonious smile. The procedure was per- formed in 2 hours in a single appointment, with reduced biological trauma and economic expense. 14, 15. Stratification of the Kerr Herculite XRV Ultra using enamel A2. Note that the handling features of Herculite Ultra composite allows the layering of a large mass of composite to restore the shape of tooth in a single step, without the need of using a mock-up technique. 11. Removal of the old restorations for teeth 11 and 21, as well as a vestibular layer of tooth structure to allow proper stratification of the composite. 12. Removal of the old restorations for teeth 11 and 21, as well as a vestibular layer of tooth structure to allow proper stratification of the composite. 8. Stratification of Kerr Herculite XRV Ultra enamel (Enamel A2) on tooth 22. 9. Polymerization of the composite using an LED Kerr Demi Ultra curing light. 13. After bonding with the Kerr OptiBo- nd XTR system, stratification of the Kerr Herculite XRV Ultra dentine mass (Den- tine A2) at 11 and 21 was performed. 7 – Application of OptiBond XTR Pre- mier and Bonding on the surface in two different steps. Then stratification of the Kerr Herculite XRV Ultra dentine on tooth 22. (Dentine A3 in the cervical por- tion, Dentine A2 in the middle third and incisal / neutral in the incisal third). Marco Bambace Is currently a student at the University of Padova (De- partment of Dentistry) in his fifth year of studies. He will achieve the degree of Doctor in Dentistry in 2016. With his talent for direct restorations, Marco Bambace performed this in vivo case using Kerr restorative products and fill- ing accessories. About the Author Case study: Herculite® XRV Ultra™ and OptiBond™ XTR By Kerr A 52-year-old patient pre- sented with a request to replace defective, old res- torations and improve the aes- thetics of the smile. A decision was made to remove the old restorations from teeth 11, 12, 21 and 22, as well per- forming coronoplasty to im- prove the final aesthetic results. For reasons related to the pa- tient’s health, the treatment was performed over two sessions. For the bonding procedure, the 2-step self-etching bonding sys- tem OptiBond XTR was chosen. The clinical procedure consist- ed of the application of a self- etching primer that changes the morphology of the enamel surface depending on its pH, followed by the application of the adhesive. The pH of Optibond XTR Prim- er is 2.3 and decreases to 1.7 during application. Then it switches to a value of 7, due to a chemical reaction with the cal- cium ions of the dental tissues. Optibond XTR performs very well on the dentine surface as well, dissolving the smear layer effectively. Theself-etchingprimerwasap- plied using a microbrush with gentle and active brushing for at least 20 seconds in order to promote the remineralisation and the infiltration of the sub- strate (“continuous brushing technique”). The solvent was evaporated using an indirect and gentle air stream. The adhesive was applied us- ing a microbrush with active “scrubbing”, waiting for 15-30 seconds in order to obtain the diffusion of the resin by capil- larity into the substrate and the excess was removed through a capillary action into air stream and light substrate, and for 10 seconds, using the LED curing light Kerr Demi Ultra. The main benefits of using the Optibond XTR Bonding System are: 1. Fast application and predict- able results 2. No need to rinse and there- fore no risk of issues related to moisture control of the dentine surface 3. Good bond strength to both enamel and dentine Knowing the functional and aesthetic features of Herculite XRV Ultra composite, the cav- ity was prepared by completely removing the previous restora- tions and any carious dentine, without removing the disco- loured/secondary dentine, which will be perfectly masked by the opacity of the dentine shade of Herculite XRV Ultra. The opacity of Herculite XRV Ultra Dentine shade is able to cover the dentine discoloura- tion without the need for fur- ther opaque shades. The ap- plication and sculpting of the compositewasperformedusing the Kerr Comporoller, a useful modelling tool that consists of a handle and interchangeable tips with different shapes to use depending on the type of resto- ration. Moreover, thanks to the unique material of which they aremade,thecompositedoesn’t stick to the tips and therefore its placement is fast and easy. Polishing and high-gloss pol- ishing of the restoration was performed in few fast and sim- ple steps. Unlike other materi- als, Herculite XRV Ultra makes it possible to obtain high aes- thetic results with a natural ap- pearance in few minutes. The results achieved show that use of Kerr Herculite XRV Ultra composite materials in the an- terior can achieve a significant aesthetic improvement of the smile using conservative tech- niques and without recourse to prosthetic solutions. In addition, the use of Herculite XRV Ultra as an anterior restor- ative can achieve a significantly improved aesthetic simile with- out using indirect restorations. Dental Tribune Middle East & Africa Edition | January-February 201619