Dentaltown October 2016 - 34


show your work
case study

Continued from p. 32
In this technique, a putty matrix is made
without doing any chairside mockup on the
tooth. Once the base and catalyst of silicone
putty are mixed, the putty is adapted on the
palatal aspect of the teeth involved. Once
set, it's modified with a bur to create the
final restoration desired. This putty matrix
then serves as the palatal index needed to
make an anatomically precise palatal shelf.
It's necessary to have a definite stop on
the palatal aspect of our buildup in any Class
IV or Class III restoration. This ensures
we have the correct amount of enamel and
dentin shades in the layering.
Correct layering of the enamel and dentin
is one of the most important goals in aesthetic
stratification. The controlled-body-thickness
philosophy advocates that enamel and dentin
are more than enough to obtain ordinary
or high-end aesthetic results in most cases.
This technique was developed by Walter
Devoto and Angelo Putigano.
After thorough studies of the composite
enamel and composite dentin refraction
indexes, opacity values and other optical
features, clinical evidence and research
suggests that a 0.5mm enamel thickness gives
the most consistent result in its systematic
use and in a wide range of materials. Use
of a 0.5mm gauge (the Misura instrument)
ensured that the topmost layer of enamel is
limited to 0.5mm.
The patient wanted to reduce a diastema
between 11 and 12, which I did by making
the restoration on the central slightly overcontoured. She also didn't want to change
the old, discolored composite restoration
on the distal aspect of 12 in this sitting.
Once I completed the restoration on
the central, I used an interproximal strip on
the restoration to do some gross finishing,
which removed the oxygen-inhibited layer
on the restoration. The composite resin
that was in contact with ambient oxygen
was not able to polymerize; this apparent
"disadvantage" was the factor that allowed
composite to bond from layer to layer.
Newly placed material covered the
previously oxygen-inhibited layer, and the
two layers polymerized together. Removal

34

OCTOBER 2016 // dentaltown.com

Fig. 1: Preop view

Fig. 8: Etching

Fig. 9: Bond applied
Fig. 2: Freehand putty

Fig. 3: Shade matching done with
composite buttons

Fig. 4: Modification of the putty done
with a bur

Fig. 10: Enamel layer loaded directly
onto the putty and cured once in
place

Fig. 11: Palatal shelf in place

Fig. 5: Modified putty

Fig. 12: Correction made: slow speed
with no water spray

Fig. 6: A short bevel was prepared.
Retraction cord was packed before
isolation.

Fig. 13: Unfilled resin applied

Fig. 7: Palatal matrix checked before
proceeding

Fig. 14: Misura used on dentin layer
to ensure 0.5mm space for enamel
layer


http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown October 2016

On Dentaltown.com
Howard Speaks: Repeatedly Reap the Rewards of Selling Your Practice
Professional Courtesy: Waiting For Something Better
Continuing Education Update
Industry News
New Products
Poll
Show Your Work: Putty in My Hands
Message Board: I Could Give a Flip About TMD, and Here is Why!
Message Board: Fixed Lingual Retainer Wire
Message Board: Paying at Time of Service
Message Board: Buffering Anesthetic Carpules
You Be The Judge: A Dose of Reality
Building a Mandible
Patient Financing Programs
Sealing The Gaps
Beyond Clinical Care
Message Board: Your Best Advice in 5 Words or Less
Corporate Profile: An Inside Look at an Implant Giant
Product Profile: Wand Dental
Ad Index
Product Profile: Scheduling Institute
Product Profile: 3M
CE: Magnification in Endodontics
Dentally Incorrect
Dentaltown October 2016 - Intro
Dentaltown October 2016 - Cover1
Dentaltown October 2016 - Cover2
Dentaltown October 2016 - 1
Dentaltown October 2016 - 2
Dentaltown October 2016 - 3
Dentaltown October 2016 - 4
Dentaltown October 2016 - 5
Dentaltown October 2016 - 6
Dentaltown October 2016 - 7
Dentaltown October 2016 - 8
Dentaltown October 2016 - 9
Dentaltown October 2016 - 10
Dentaltown October 2016 - 11
Dentaltown October 2016 - On Dentaltown.com
Dentaltown October 2016 - 13
Dentaltown October 2016 - Howard Speaks: Repeatedly Reap the Rewards of Selling Your Practice
Dentaltown October 2016 - 15
Dentaltown October 2016 - 16
Dentaltown October 2016 - 17
Dentaltown October 2016 - Professional Courtesy: Waiting For Something Better
Dentaltown October 2016 - 19
Dentaltown October 2016 - Continuing Education Update
Dentaltown October 2016 - 21
Dentaltown October 2016 - 22
Dentaltown October 2016 - 23
Dentaltown October 2016 - Industry News
Dentaltown October 2016 - 25
Dentaltown October 2016 - New Products
Dentaltown October 2016 - 27
Dentaltown October 2016 - Poll
Dentaltown October 2016 - 29
Dentaltown October 2016 - 30
Dentaltown October 2016 - 31
Dentaltown October 2016 - Show Your Work: Putty in My Hands
Dentaltown October 2016 - 33
Dentaltown October 2016 - 34
Dentaltown October 2016 - 35
Dentaltown October 2016 - Message Board: I Could Give a Flip About TMD, and Here is Why!
Dentaltown October 2016 - 37
Dentaltown October 2016 - 38
Dentaltown October 2016 - 39
Dentaltown October 2016 - 40
Dentaltown October 2016 - 41
Dentaltown October 2016 - 42
Dentaltown October 2016 - 43
Dentaltown October 2016 - 44
Dentaltown October 2016 - 45
Dentaltown October 2016 - Message Board: Fixed Lingual Retainer Wire
Dentaltown October 2016 - 47
Dentaltown October 2016 - 48
Dentaltown October 2016 - 49
Dentaltown October 2016 - 50
Dentaltown October 2016 - 51
Dentaltown October 2016 - 52
Dentaltown October 2016 - 53
Dentaltown October 2016 - Message Board: Paying at Time of Service
Dentaltown October 2016 - 55
Dentaltown October 2016 - 56
Dentaltown October 2016 - 57
Dentaltown October 2016 - Message Board: Buffering Anesthetic Carpules
Dentaltown October 2016 - 59
Dentaltown October 2016 - 60
Dentaltown October 2016 - 61
Dentaltown October 2016 - 62
Dentaltown October 2016 - 63
Dentaltown October 2016 - 64
Dentaltown October 2016 - 65
Dentaltown October 2016 - You Be The Judge: A Dose of Reality
Dentaltown October 2016 - 67
Dentaltown October 2016 - 68
Dentaltown October 2016 - 69
Dentaltown October 2016 - Building a Mandible
Dentaltown October 2016 - 71
Dentaltown October 2016 - 72
Dentaltown October 2016 - 73
Dentaltown October 2016 - 74
Dentaltown October 2016 - 75
Dentaltown October 2016 - Patient Financing Programs
Dentaltown October 2016 - 77
Dentaltown October 2016 - 78
Dentaltown October 2016 - 79
Dentaltown October 2016 - Sealing The Gaps
Dentaltown October 2016 - 81
Dentaltown October 2016 - 82
Dentaltown October 2016 - 83
Dentaltown October 2016 - 84
Dentaltown October 2016 - 85
Dentaltown October 2016 - Beyond Clinical Care
Dentaltown October 2016 - 87
Dentaltown October 2016 - 88
Dentaltown October 2016 - 89
Dentaltown October 2016 - Message Board: Your Best Advice in 5 Words or Less
Dentaltown October 2016 - 91
Dentaltown October 2016 - Corporate Profile: An Inside Look at an Implant Giant
Dentaltown October 2016 - 93
Dentaltown October 2016 - 94
Dentaltown October 2016 - 95
Dentaltown October 2016 - Product Profile: Wand Dental
Dentaltown October 2016 - Ad Index
Dentaltown October 2016 - Product Profile: Scheduling Institute
Dentaltown October 2016 - 99
Dentaltown October 2016 - Product Profile: 3M
Dentaltown October 2016 - 101
Dentaltown October 2016 - CE: Magnification in Endodontics
Dentaltown October 2016 - 103
Dentaltown October 2016 - 104
Dentaltown October 2016 - 105
Dentaltown October 2016 - 106
Dentaltown October 2016 - 107
Dentaltown October 2016 - 108
Dentaltown October 2016 - 109
Dentaltown October 2016 - 110
Dentaltown October 2016 - 111
Dentaltown October 2016 - Dentally Incorrect
Dentaltown October 2016 - Cover3
Dentaltown October 2016 - Cover4
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