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cosmetic dentistry_beauty & science No. 1, 2017

direct composite restorations case report | Fig. 5: The buccal lobes were built-up individually, starting with the mesiobuccal lobe. Fig. 6: After all buccal lobes were fully cured, FinalTouch brown shade (VOCO) was added to the base of the lobes as part of the Tam interlobe staining technique. Fig. 5 Fig. 6 at the base. The margins were strongly bevelled to maximise the amount of the planned restorative material with minimal reduction in the cusp region, and thus achieve a large contact surface. No centric contacts or other extensive functional contacts were planned for the cavity areas being treated. The preparations were micro air abraded using 27 micron aluminium oxide. Then a selective enamel etch technique using 33 % orthophosphoric acid was performed, followed by bonding with Futurabond U (VOCO). The lingual cusps of tooth 46 were created free-hand using the universal shade Admira Fusion x-tra, a purely ceramic-based bulk-fill composite. The cusps were widened towards the centro- occlusal aspect progressively in 2 mm increments. The key factor here was not applying this bulk-fill material in bulk, and thereby ensuring maximum depth of cure at all times. The benefit of Admira Fusion x-tra is the increased depth of cure, which is inherent to this restorative. After curing of the base of the lingual cusps, a sec- tional matrix system (V3, Triodent) was used. In the gingival floor area of the proximal box, a small quan- tity of the flowable Admira Fusion Flow (shade A3, VOCO) was used in three 0.25 mm increments (extremely thin) to ensure complete and maximum marginal hybridisation and adaptation. The mar- ginal ridges were then incrementally completed using Admira Fusion x-tra (shade U). The buccal lobes were layered individually with Admira Fusion x-tra before the Tam interlobe staining technique was utilised (brown, FinalTouch, VOCO) to customise the colour tone. In the next step, the lingual cusps were shaped individually, thus completing the design of the occlusal anatomy. Following complete finishing of tooth 46, the matrix system was placed on tooth 47 (Omnimatrix, Ultradent: distal marginal ridge; V3 Triodent: mesial marginal ridge). Tooth 47 was layered in a similar manner, again using a universal shade bulk-fill material (Admira Fusion x-tra). A small amount of white shade for customisation was applied to the triangular ridges of teeth 46 and 47 (FinalTouch, VOCO) to imitate the enamel hypo- calcification. A glycerine layer was then applied, and the composite was polymerised fully through the glycerine in order to avoid the oxygen inhibition layer. Only minimal occlusal adjustments were necessary. Taking the material properties of the ORMOCER into consideration (high compressive strength and low flexibility), the occlusion was ground in to establish light centric point contacts without extensive lateral contacts or interferences. The restorations were finished under water spray with a single-stage polisher (Dimanto, VOCO) to a high lustre. Rationale for material selection Geriatric dentistry is becoming an increasingly prominent part of everyday general dental practice. The main objective of treatment for this section of the population is essentially ‘to preserve function without high cost’. The majority of older individuals Fig. 7 Fig. 8 Fig. 7: The mesiolingual cusp was shaped and finished with a brush to create the infoldings into the mesiolingual and mid-lingual lobes. The brown stain was partially covered, leaving it only slightly visible and thus giving a natural appearance. Fig. 8: The distolingual cusp was shaped and finished with a brush to create the infoldings into the other surrounding lobes and to complete the occlusal surface. The shade is extremely natural. The marginal ridges were finished before preparing tooth 47. Selective etching, bonding and restoration were performed in a similar fashion to tooth 46. 23 cosmeticdentistry 1 2017

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