Dentaltown December 2019 - 29

The patient was placed on a short recall and given home fluoride
gel and oral hygiene instructions. He was advised to stop the use
of sugary sodas, candy and other products. Recurrence of decay
on these restored teeth will certainly lead to much more extensive
treatment or possible loss of teeth. To ascertain the patient's ability
to resist decay before undergoing extensive and expensive fixed
restorations, treatment with composite fillings was decided upon.
These restorations were very large and would normally
require several layers of composite to achieve a good color match.
Omnichroma allowed for a faster, less complex procedure and
resulted in a restoration that matched the natural teeth well. The
material uses technology based on structural color, which enables
the composite to match the surrounding tooth color. This saves
restorative time because a single shade can be used. This material
is very sculptable and can be usually applied in one large mass,
without slumping, and then light-cured.
Of the many decayed teeth, tooth #8 was restored first because
it had the largest carious lesions. Omnichroma Blocker, a supplementary material from Tokuyama Dental, was used to block out
dark tooth structure and to prevent shade-matching interference
from the open area on the lingual interproximal area (Figs. 1-2).

Fig. 1: The smile view shows interproximal staining and hypocalcifications.

Fig. 2: Dark, extensive decay on the mesial-facial
and distal-facial of #8.

Treatment
After the tooth was anesthetized (one carpule of Lidocaine
HCl with 1:100,000 epinephrine), the decayed tooth structure
was removed. Large decay was removed from the distal-facial
and mesial-facial of tooth #8. There was no pulp exposure, but
the restoration was very large and very deep. The underlying
tooth structure was very dark, and the lingual wall was wide
open (Figs. 3-4).
After the decay was removed, the facial margins were beveled
to increase the bond strength and to allow for a better color blend
from composite to tooth. Then, 35% phosphoric acid (Ultra Etch,
Ultradent) was used to etch the enamel and dentin. After rinsing
with water, Bond Force (Tokuyama Dental) bonding agent was
used. The bonding agent was gently blown until becoming very
thin, then light-cured with a Valo curing light (Ultradent).
Omnichroma Blocker was placed in the deep dentin areas and
on the palatal area, then light-cured. The opaque white material
"blocks out" wide-open areas to the lingual and dark tooth areas.
Omnichroma was placed in one large application for the distal
and one large application to the mesial. A mylar pull-through
technique was used to verify that the composite was pulled all
the way through the contact area without any voids.4 After the
restoration was sculpted and well adapted, it was light-cured for
20 seconds on both the mesial and distal (Figs. 5-6, p. 30).

Fig. 3: The interproximal decay has been
removed, leaving a large space to fill.

■ Decay

Fig. 4: The extent of the decay on
the facial and interproximal of #8.

dentaltown.com \\ DECEMBER 2019

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Dentaltown December 2019

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