Dentaltown November 2020 - 52
Fig. 16
Fig. 17b
Fig. 17a
Fig. 18
CASE 2
Layering technique: The use of incremental layers helps decrease stress generated
by composite polymerization shrinkage,
because it reduces the configuration factor.16
A 65-year-old patient came in for a
routine checkup, with no complaints of
sensitivity or other symptoms. Examination
revealed that Tooth #15 displayed numerous
cracks into the dentin (Fig. 19), which
indicated a structurally compromised tooth.
The dentin cracks were a result of flexing
under function of the tooth weakened by
an old occlusal amalgam.
It is appropriate to treat cracks even
when a patient demonstrates no symptoms,
because 50-100-micron openings allow for
bacterial growth and penetration into the
dentin. Untreated cases ultimately result in
a fractured tooth, requiring endodontics,
periodontics or possible extraction.
Again, total isolation was achieved with
a rubber dam. After amalgam removal and
preparation completion, all internal angles
were rounded (Fig. 20) to reduce stress
concentration. This improves composite
resin adaptation to the dental structure. No
bevels were placed on occlusal or gingival
52
margins. Tooth structure bond strength
was increased after sandblasting (MicroEtcher) with 35 microns13 (Crystal Air).
Thirty-five percent phosphoric acid (Select
HB Etch, Bisco) was applied for 15 seconds,
then washed thoroughly. To avoid bond
strength degradation,17 an antibacterial
agent such as chlorhexidine 2% (Cavity
Cleanser) was applied for 30 seconds, with
excess eliminated with sterile sponges. In
this case, etch rinse adhesive (OptiBond FL,
Kerr) was also used.
Multiple layers of primer were applied,
then left alone for 40 seconds to dry and
evaporate the solvent. In this layering technique, three different composite layers are
used.18 First, a warm composite layer is placed
on the pulpal floor; next, two 2mm-width
pieces of high-strength polyethylene fibers
(Ribbond) that have been blotted with an
unfi lled bonding adhesive. The excess is
eliminated with lint-free gauze.
One piece of fiber is firmly inserted onto
the uncured composite in the mesial-distal
direction (Fig. 21, p. 54), while the other is
firmly inserted in the buccal-lingual direction
(Fig. 22, p. 54). The fibers are adapted and
pressed as close to the pulpal floor as possible,
then light-cured.
In one study, SEM found when fibers
were inserted into the proximal box depth,
NOVEMBER 2020 // dentaltown.com
DT1120_Íñiguez_Cracked-Teeth_AG_V5.indd 52
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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
Dentaltown November 2020 - 9
Dentaltown November 2020 - 10
Dentaltown November 2020 - 11
Dentaltown November 2020 - 12
Dentaltown November 2020 - 13
Dentaltown November 2020 - 14
Dentaltown November 2020 - 15
Dentaltown November 2020 - 16
Dentaltown November 2020 - 17
Dentaltown November 2020 - 18
Dentaltown November 2020 - 19
Dentaltown November 2020 - 20
Dentaltown November 2020 - 21
Dentaltown November 2020 - 22
Dentaltown November 2020 - 23
Dentaltown November 2020 - 24
Dentaltown November 2020 - 25
Dentaltown November 2020 - 26
Dentaltown November 2020 - 27
Dentaltown November 2020 - 28
Dentaltown November 2020 - 29
Dentaltown November 2020 - 30
Dentaltown November 2020 - 31
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Dentaltown November 2020 - 33
Dentaltown November 2020 - 34
Dentaltown November 2020 - 35
Dentaltown November 2020 - 36
Dentaltown November 2020 - 37
Dentaltown November 2020 - 38
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Dentaltown November 2020 - 40
Dentaltown November 2020 - 41
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Dentaltown November 2020 - 53
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Dentaltown November 2020 - 76
Dentaltown November 2020 - 77
Dentaltown November 2020 - 78
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Dentaltown November 2020 - 80
Dentaltown November 2020 - Cover3
Dentaltown November 2020 - Cover4
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