Dentaltown August 2018 - 85

capping and when increased resistance and retention form
are needed. With 5-year-old amalgam fillings, there was
no difference in the performance of pin-retained amalgam
and bonded amalgam.28

Case study No. 2
A 62-year-old patient in good general health presented
with sensitivity in the right side of his mouth. The clinical
exam revealed a mandibular right first molar with an
extensive amalgam fracture and a missing distobuccal cusp
(Fig. 1). The procedure was performed with a rubber dam
to achieve total isolation. This technique is essential29 and
no other isolation method provides better control over oral
fluids and moisture contamination.30
After completing the preparation of all internal angles,
they must be rounded to reduce stress concentration31 and
improve the adaptation of composite resin to the dental
structure. No bevels were placed on the occlusal or gingival
margins. It is suggested to use one pin per missing cusp32;
in this case, only one was needed. Displaying enough
room from the base to the cusp tip (4mm) is crucial for the
placement of the pin. Sufficient dentin is necessary to attain
adequate strength to avoid external fractures of the tooth
structure and to protect the pulp. Once the channel location
is decided, a pinhole guide is formed with a ¼-round bur
(slow speed) in dentin, 1.5mm on the external surface. The
Max 021 system of pins from Coltene/Whaledent (Fig. 2)
was used in this case.
Using a pilot drill, with a slow-speed contra angle, a
pinhole was prepared until the drill shoulder came to a
stop. The channel preparation was done to full depth and
a pin was inserted into the handpiece and covered with
primer adhesive from Bisco (Fig. 3) while operating at very
low speed with light pressure until the pin sheared and the
placement was completed (Fig. 4).
Every surface is microetched with 35 microns aluminum
oxide (Crystal Air by Crystalmark Dental Systems). Two percent chlorhexidine (Cavity Cleanser by Bisco) was used to
disinfect the preparation and it was then dried with light
air. A selective-etch technique was chosen and phosphoric
acid (Select HV Etch by Bisco) was applied on the enamel
for 15 seconds (Fig. 5, p. 86), then rinsed thoroughly and
dried. Then, OptiBond XTR primer (Kerr) was applied by
scrubbing with moderate pressure for 30 seconds (Fig. 6, p. 86).
The adhesive from OptiBond XTR was used with gentle
agitation for 15 seconds (Fig. 7, p. 86), followed by a warm
air dry to thin out the layer and evaporate the solvent.

Fig. 4: Rubber dam has been positioned after the
amalgam was removed. (Note the access to the
gingival extent of the fractured cusp.) During the
pin placement, use a very low speed and slight
pressure downward until the pin shears. This
means the pin placement has been completed.

FREE FACTS, circle 21 on card

dentaltown.com \\ AUGUST 2018

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