Dentaltown November 2020 - 50

Fig. 5a

Fig. 5b

Fig. 7

Fig. 6
Fig. 8

CASE 1
The bulk-fill technique has been suggested in an attempt to simplify steps,
seriously reducing procedure time and
making us much more efficient.
A 68-year-old patient presented complaining of cold sensitivity, along with pain
upon chewing, and requested an immediate
solution. The clinical examination and
X-ray demonstrated a failing Class II resin
restoration in Tooth #13 (Fig. 5a). A preoperatory periapical X-ray was taken (Fig. 5b).
A mesial-distal crack was present with no
apparent periodontal pocket. All other
maxillary teeth were checked and found
asymptomatic. The diagnosis was cracked
tooth syndrome.
The patient was advised against the
questionable long-term prognosis of cracked
teeth, yet decided to keep it. She understood if
the crack extended into the root, a periodontal
pocket could develop. An extraction and an
implant replacement may then be indicated.
A rubber dam (split dam technique)
was placed to achieve isolation. This technique is essential, per the UCLA restorative
recommendation, and no other isolation
method provides better control over fluids
and moisture contamination,10 removal

50

of the failing composite restoration and
infected dental structure are effectuate.
No additional dentin should be removed
beyond what is needed.11 The preparation was
complete, with all internal angles rounded
to reduce stress concentration (Fig. 6). This
improves composite resin adaptation to the
dental structure.12 No bevels were placed
on occlusal or gingival margin. A standard
Tofflemire metal band was placed to protect
the adjacent tooth.
Every surface was etched (MicroEtcher,
Danville Materials) with 35 microns (Crystal Air, Crystalmark Dental Systems) to
increase the bond strength.13 Two percent
chlorhexidine (Cavity Cleanser, Bisco)
was applied to disinfect the preparation,
then gently air-dried. After removing the
Tofflemire band, a contact matrix ring was
placed (Fig. 7), along with wedges and a
sectional metal band (Garrison Dental
Solutions). The primer (OptiBond XTR,
Kerr) was applied with moderate pressure
for 30 seconds (Fig. 8), then gently air-dried
before applying adhesive (OptiBond XTR,
Kerr) using gentle agitation (Fig. 9) for
15 seconds.
The bulk-fi ll technique included two
layers, beginning by applying one small
increment of bulk composite (SonicFill,
Kerr, Fig. 10), then two 2mm pieces of

NOVEMBER 2020 // dentaltown.com

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Dentaltown November 2020

Table of Contents for the Digital Edition of Dentaltown November 2020

Dentaltown November 2020 - Intro
Dentaltown November 2020 - Cover1
Dentaltown November 2020 - Cover2
Dentaltown November 2020 - 1
Dentaltown November 2020 - 2
Dentaltown November 2020 - 3
Dentaltown November 2020 - 4
Dentaltown November 2020 - 5
Dentaltown November 2020 - 6
Dentaltown November 2020 - 7
Dentaltown November 2020 - 8
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Dentaltown November 2020 - Cover3
Dentaltown November 2020 - Cover4
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