Dentaltown November 2019 - 34

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case study

Case

Fig. 1: Preoperative smile view.

Fig. 2: Preoperative retracted view.

Fig. 3: Rubber dam application.

34

NOVEMBER 2019 // dentaltown.com

A 35-year-old patient presented in good overall health. His chief
complaint was the appearance of black triangles between his lower
teeth after receiving orthodontic treatment (Figs. 1-2). He wanted
them gone. After consulting with his usual dentist, he was told they
could use veneers or crowns to close the black triangles. (Keep in mind
there was no decay on the teeth.) Thankfully, the patient didn't like
the idea of cutting away healthy tooth structure, so he did what so
many patients do nowadays: search for other options online. This is
how he found our clinic.
The consultation appointment included taking photographs, and
we treatment-planned the Bioclear method to close the black triangles,
to which the patient agreed.
Because there was no removal of tooth structure, we applied a topical
anesthetic. Typically, local anesthetic is not needed for black-triangle
resolutions. I applied a rubber dam to isolate the teeth and to further
retract the papilla (Fig. 3). This gave us better access to the interproximal tooth structure. Note: The rubber dam has to be applied first,
because when using a slurry polisher or air abrasion, it's possible to
cause gingival bleeding. The dam protects the gingiva and provides
an isolated environment. Once this was completed, we used a slurry
polisher (Bioclear Blaster) to remove any biofilm and make sure we were
bonding to tooth structure and avoiding future composite staining.
After this cleaning, we used a Bioclear black triangle gauge to
determine the size of our matrices for the injection-molding process.
There is a real advantage in using anatomical matrices vs. Mylar strips,
so make sure you are choosing matrices carefully. This stems from the
matrices' gingival curvature. This curvature allows for an early and
aggressive transition from gingival to incisal, which will reposition
contact points closer to the gingiva, thereby increasing the ability to
resolve black triangles. Additionally, the curvature will help provide a
better seal at the gingival area and smooth emergence profiles.
Once the matrices were selected, we started with the central incisors.
Each tooth was filled by scrubbing in the adhesive (Scotchbond Universal,
3M Oral Care), then utilizing injection molding with warmed bulk-fill
flowable (Filtek Bulk Fill Flowable, 3M Oral Care) and warmed universal
composite (Filtek Universal, 3M Oral Care). Care is taken to ensure
that the matrices are fully fi lled, and no visible bubbles or voids are
observed. This process was then repeated for teeth #22-27 (Fig. 4).
Once all teeth are completed, excess composite from the buccal and



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Dentaltown November 2019

Table of Contents for the Digital Edition of Dentaltown November 2019

Dentaltown November 2019 - Intro
Dentaltown November 2019 - Cover1
Dentaltown November 2019 - Cover2
Dentaltown November 2019 - 1
Dentaltown November 2019 - 2
Dentaltown November 2019 - 3
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