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ePaper created 2018-02-16, 10:54:19 | version 1.38.0
| case report direct composite restorations Complex direct ORMOCER composite restorations in the posterior region Author: Dr Clarence Tam, New Zealand Fig. 1: Pre-operative situation showing large restorations and minimal residual tooth structure. Fig. 2: Completed preparation with strongly bevelled margins as an alternative to straight cuspal height reduction. The cusps were at least 3 mm thick at their base. The occlusal shaping must be very thorough to minimise the lateral excursion load on the cusps. Fig. 3: The teeth were micro air abraded using 27 micron aluminium oxide. A selective enamel etch technique was then applied using Futurabond U. The lingual cusps were built-up with a purely ceramic-based bulk fill ORMOCER (Admira Fusion x-tra, shade U, VOCO). Fig. 4: The marginal ridges were built-up using a sectional matrix system (V3, Triodent, Dentsply Sirona). In this fashion, we have converted a complex Class II into a Class I situation. 22 Fig. 1 Fig. 2 For reasons of cost, patients and dentists today often find themselves obliged to use restorative materials for the treatment of large structural, functional and aesthetic defects. This case report demonstrates how an innovative, organically mod- ified ceramic composite with extremely low shrink- age stress and volume contraction can be used to restore teeth while preserving tooth substance. Occlusal functionality is key to the longevity of the restoration. A 71-year-old female patient presented in my practice requiring replacement of insufficient, ex- cessively large composite resin restorations of the lower right first and second molars (46 and 47). The natural crown still retained a small amount of residual structure, and the patient did not wish any further removal of tooth substance. For cost rea- sons, the patient also did not wish any prosthetic treatment, e.g. in the form of ceramic restorations. The patient was recommended a direct complex resin onlay requiring functional and non-functional cusp reduction. With this unconventional approach, it was important that the occlusal design should take into consideration the strengths and weak- nesses of both the restorative material and the residual tooth structure. The patient was given a local anaesthetic with one cartridge of 4 % articaine with 1:100,000 adreno- line, and the teeth were isolated with a rubber dam prior to removal of the existing restorations. In order to ensure a caries-free, hard dentine base, three suc- cessive checks were performed with a caries detec- tor (Caries Marker, VOCO). The thickness of the re- maining cusps was measured, and found to be 3 mm Fig. 3 Fig. 4 cosmeticdentistry 1 2017