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ePaper created 2018-05-25, 10:54:03 | version 1.38.0
4 RESTORATIVE Dental Tribune Middle East & Africa Edition | 3/2018 Following a simpler path from prep to crown A case study by Dr. Carlos Eduardo Sabrosa, DDS, MSD, DScD featuring 3M™ RelyX™ U200 Self-Adhesive Resin Cement Introduction Indirect restorative procedures can be time-consuming and complicat- ed: many different processes from impression taking to cementation are carried out in the dental office, and in each of them, different strat- egies may lead to success. However, some of the available materials and techniques will involve a lot of effort, while others enable users to proceed quickly and simplify the complete procedure. A simplified workflow from prep to crown that really make life easier for the dental practitioner is described below. Comments The described patient case shows that it is possible to significantly re- duce the number of working steps in an indirect restorative procedure. In this way, potential sources of er- ror are eliminated and chair-time is decreased. Key to success is the use of innovative, high-quality materi- als that offer ease of use and lead to increased efficiency in the den- tal office. These include the above- mentioned monophase impression material, the bulk fill composite, the temporization material that does not require polishing and the self- adhesive resin cement all offered by a single manufacturer. Before using the products described, please refer to the instructions for use provided with the product pack- ages. The featured 3M product may be known with an alternative name in different regions. Fig. 1: Initial situation. The failed composite restoration covering a large part of the left mandibular first molar’s occlusal surface needs to be re- placed. Fig. 2: Due to the size of the restoration, the amount of remaining tooth structure might not be sufficient to ensure the required stability for a direct composite restoration. Fig. 3: Upon removal of the old filling, it becomes clear that a crown is needed to ensure the required stability. The tooth is built up with 3M™ Filtek™ Bulk Fill Posterior Restorative, which may be placed in con- junction with 3M™ Single Bond Universal Adhesive and in increments of up to 5 mm. Fig. 4: Following tooth preparation, a temporary crown is produced chairside with 3M™ Protemp™ 4 Temporization Material. This material exhibits a high strength and a natural gloss without polishing. Fig. 5: One week after the preparation procedure, healthy soft tissue conditions are obtained. They lay the foundation for a high-quality pre- cision impression. Fig. 6: In order to allow for a detailed capture of the preparation mar- gin, the gingival tissues are retracted using the double-cord technique. Alternatively, a single cord may be applied in combination with 3M™ Astringent Retraction Paste. Fig. 7: Monophase impression taken with 3M™ Impregum™ Penta™ Soft Medium Body Polyether Impression Material. A very detailed rep- resentation of the preparation margin is obtained with this simple technique. Fig. 8: Situation at intraoral try-in of the crown. It is made of a 3M™ Lava™ Zirconia coping and an IPS e.max® Ceram (Ivoclar Vivadent) por- celain layer. Ideal intraoral conditions (smooth margins, healthy tissues) are visible. Fig. 9: Sandblasting of the crown’s intaglio surface to create a microre- tentive surface structure that is beneficial for cementation. This proce- dure is recommended for oxide ceramic materials. 3M, Filtek, Impregum, Lava, Penta, Protemp and RelyX are trade- marks of 3M or 3M Deutschland GmbH. Used under license in Canada. All other trademarks are owned by other companies. © 3M 2018. All rights reserved. Dr. Sabrosa has received an hon- orarium from 3M Oral Care. Fig. 10: Situation after crown placement, removal of the excess cement and thorough cleaning. The crown blends in nicely with the surround- ing tooth structure. Fig. 11: At the check-up several days after crown placement, a great overall picture is obtained. The patient is happy with the final restoration in terms of aesthetics and function. Dr. Carlos Eduardo Sabrosa, Brazil Dr. Sabrosa is an Associate Professor at the State University of Rio de Janeiro Dental School. He received his DDS in 1992 from the State University of Rio de Janeiro Dental School and the Clinical Advanced Graduate Studies (CAGS) in Prosthodontics from Boston University Goldman School of Dental Medicine in 1996. He earned the Steven Gordon Research/Clinical Award in 1995 and 1996 and the Tylman Research Grant Award in 1993 from the American College of Prosthodontics. Dr. Sabrosa also received his MSD and DScD in Prosthodontics/Biomaterials from Boston University Goldman School of Dental Medicine in 1997 and 1999 consecutively. He has a private practice, focused in Oral Rehabilitation and Implantology, in Leblon, Rio de Janeiro, Brazil.