DentaltownUK March 2018 - 29

by Heintze, et al., in meta-analyses that
resin-based restorations are significantly
more likely to reduce in performance if there
is inadequate moisture control.7
A rubber dam is used regularly for any
adhesive dentistry in restorative practice;
however, its use is compounded when removing amalgam. It has been shown that the
mercury in amalgam restorations are held
in a lattice as an alloy and therefore do not
confer any health risks. When it comes to
removal, some studies have found reduction
in a patient's peak levels of mercury in plasma
when employing the use of rubber dam for
amalgam removal.8 In most cases, therefore,
a rubber dam is employed as the isolation
method of choice (Fig. 2).

Caries removal
The process of caries removal is conducted
in a minimal manner. Ensuring that the ADJ
is cleared. All infected dentine is cleared;
however, discoloured dentine that remains
firm on probing can be left to keep the cavity
as minimal as possible.
A combination of the dental turbine
for gross tooth/caries removal is used, and
finer softened dentine is removed using the
dental air motor.
Advances in conservative dentistry have
employed the use of air abrasion. This has
been proven to provide several advantages,
including maximisation of tooth structure
preservation, increasing micromechanical
bonding,9 and providing a more seamless blend
of restorative and tooth junction interface.
In this case, 27um aluminium oxide
particles were used at a pressure of no more
than 4-bar for 20 seconds. The cavity preparations are shown in Fig. 3.

37.5 percent phosphoric acid of the enamel
for 30 seconds and 10 seconds on dentine.
This is washed for 30 seconds to ensure
all enamel salts are removed, with the enamel
being completely dried without desiccating
the dentine.
The bonding system used in this case
was Optibond FL, the fourth-generation
Total Etch three-bottle system. Besides
having won several awards, Optibond FL
is the gold standard in current bonding
technology. In addition, this has 48 percent
filler loading, which further reduces the
chances of postoperative sensitivity.
The primer is applied within the cavity
with a light scrubbing motion for 15 seconds.
This is air-dried for 5 seconds, then the
adhesive is applied with the same scrubbing
motion for 15 seconds. This is air-dried to
ensure that a thin film of adhesive gently
coversthe entire cavity surface and margins
of the cavity with no more displacement of
the bond.
This is then light-cured perpendicular
to the tooth, ensuring that the light cure is
being monitored behind a light shield, for
20 seconds.

Bonding
This stage is the most sensitive to moisture
control, but as the tooth has been isolated
with a rubber dam there is minimal if any
moisture ingression into the cavity or work
field. This case used selective etching with

Fig. 2. Rubber dam isolation.

Fig. 3. Caries removal.

Fig. 4. Composite layering.

dentaltownuk.com \\ MARCH 2018

29


http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK March 2018

Cover
Mike Gow editorial
Howard Speaks
Continuing Education Update
The Hall Technique
Message Board - Am I too Conservative?
Top 10 Tips for starting a successful clinic
Message Board - Knock to a Front Tooth 12yo
The British Dental Confeerence and Dentistry Show 2018
Anterior Surgical Crown Lengthening
Cover Story - The Dancing Dentist
Posterior Composite Stratification
Indirect vs. Direct Restorations
Orthodontic Restorative Interface
BACD News
Through the Keyhole
Lifestyle
Dental Aid Network
Students
Wish List
Quiz
DentaltownUK March 2018 - Cover
DentaltownUK March 2018 - Cover2
DentaltownUK March 2018 - 3
DentaltownUK March 2018 - 4
DentaltownUK March 2018 - Mike Gow editorial
DentaltownUK March 2018 - Howard Speaks
DentaltownUK March 2018 - 7
DentaltownUK March 2018 - Continuing Education Update
DentaltownUK March 2018 - 9
DentaltownUK March 2018 - The Hall Technique
DentaltownUK March 2018 - 11
DentaltownUK March 2018 - 12
DentaltownUK March 2018 - Message Board - Am I too Conservative?
DentaltownUK March 2018 - 14
DentaltownUK March 2018 - Top 10 Tips for starting a successful clinic
DentaltownUK March 2018 - Message Board - Knock to a Front Tooth 12yo
DentaltownUK March 2018 - 17
DentaltownUK March 2018 - 18
DentaltownUK March 2018 - The British Dental Confeerence and Dentistry Show 2018
DentaltownUK March 2018 - 20
DentaltownUK March 2018 - Anterior Surgical Crown Lengthening
DentaltownUK March 2018 - 22
DentaltownUK March 2018 - 23
DentaltownUK March 2018 - Cover Story - The Dancing Dentist
DentaltownUK March 2018 - 25
DentaltownUK March 2018 - 26
DentaltownUK March 2018 - 27
DentaltownUK March 2018 - Posterior Composite Stratification
DentaltownUK March 2018 - 29
DentaltownUK March 2018 - 30
DentaltownUK March 2018 - Indirect vs. Direct Restorations
DentaltownUK March 2018 - 32
DentaltownUK March 2018 - 33
DentaltownUK March 2018 - Orthodontic Restorative Interface
DentaltownUK March 2018 - 35
DentaltownUK March 2018 - 36
DentaltownUK March 2018 - BACD News
DentaltownUK March 2018 - Through the Keyhole
DentaltownUK March 2018 - 39
DentaltownUK March 2018 - Lifestyle
DentaltownUK March 2018 - 41
DentaltownUK March 2018 - Dental Aid Network
DentaltownUK March 2018 - 43
DentaltownUK March 2018 - 44
DentaltownUK March 2018 - 45
DentaltownUK March 2018 - 46
DentaltownUK March 2018 - Students
DentaltownUK March 2018 - 48
DentaltownUK March 2018 - Wish List
DentaltownUK March 2018 - Quiz
DentaltownUK March 2018 - Cover3
DentaltownUK March 2018 - Cover4
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