DentaltownUK February 2018 - 33

Case presentation

The popular nomenclature of a dental
'filling' is still very ingrained in our profession
even nowadays, when highly developed
materials allow us to restore dental structures
almost back to their original condition.
Therefore, the word restoration is more
adequate when dental tissues are reconstructed
with biomimetic materials.
We all hope that resin restorative materials
will evolve to a stage of no contraction. Until
this happens, we need to stick with proven
methods such as the incremental technique
to overcome the drastic consequences of
polymerisation shrinkage in the long-term
prognosis of our restorations. Bulk fill composites and glass ionomer materials can be
used to speed up the protocol, but they
should not serve as substitutes for a careful,
incremental technique.
Restorative options could be indirect
ceramics or direct composite resin. Indirect
options result in destruction of sound tissue
by occlusal reduction, mechanical preparation
with geometric design, several laboratorial
steps, cementation techniques and high costs.
In contrast, direct techniques can provide
a one-step procedure, involving simplicity of
bond and restorative protocols. The main
benefit of this philosophy is prevention of
sound tissue. Neither ceramic or composite
are better than sound dental tissue. The idea
that wide MOD cavities cause dental cuspids
to fracture and that covering these structures
is the best protocol must be reconsidered.
The authors selected a case to illustrate
this philosophy.

For more information, call 0845 602
5094 or visit 3mespe.co.uk. ■

Fig. 1

Fig. 2

Fig. 3

Fig. 4

T

he patient presented with an infiltrated occlusal composite on the
LL6, followed by recurrent decay
(Fig. 1), as well as lack of correct morphology (Figs. 2 and 3). Soft dentine was
removed, resulting in a deep and wide
cavity with unsupported enamel (Figs. 4
and 5). The pulp-dentine complex was
protected using a modified glass ionomer
resin, 3M Oral Care's Vitremer Core
Buildup/Restorative (Fig. 6). The chosen
bonding technique was a selective etching
of enamel with 35 percent phosphoric acid
and a self-etching Scotchbond Universal
bonding system from 3M on dentine.
Filtek Supreme XTE Bulk Fill composite from 3M, shade A1E, was used
firstly in a flowable consistency to re-enforce

the unsupported enamel (Fig. 7), then in
a restorative consistency to substitute the
dentine in the pulpal wall of the occlusal
cavity (Fig. 8). The final layers that act as
a substitute for the enamel were restored
with a nanohybrid composite, 3M's Filtek
Supreme XTE Universal Restorative in
shade A1, using one increment for each
cusp and allowing a correct sculpture of
natural morphology (Figs. 9 and 10).
With a final restoration that effectively
mimics the natural tooth, chewing efficiency is increased and the loads supporting
the tissues are more evenly distributed.
Like artisans, we can employ our knowledge
and skills to forge a unique piece of art in
every patient, through provision of a
long-lasting and beautiful restoration. ■

Fig. 5.

Fig. 6.

Fig. 7.

Fig. 8.

Fig. 9.

Fig. 10.

3M, Vitremer, Filtek and Scotchbond are trademarks of 3M Co.
dentaltownuk.com \\ FEBRUARY 2018

33


http://www.3Mespe.co.uk http://www.dentaltownuk.com

Table of Contents for the Digital Edition of DentaltownUK February 2018

Cover
Mike Gow: Contracts & the Hit Man
Howard Speaks
Message Board: Predictable Marginal Ridge
Dr. Harry Singh’s Financial Freedom Formula
Private Removable Prosthetics
Message Board: Large Composite Restorations
Quiz: Name that Oral Lesion!
The Boxing Dentist
Don't Make Assumptions
A Combined Digital Orthodontic and Restorative Approach
To Fill or Restore?
Back to Birmingham: BDC & Dentistry Show 2018
Temporomandibular Joint
Spin Me Right Round: Crown Preparations
Through the Keyhole-Dr. Alif Moosajee
Wish List-Dr. Yogi B. Savania
DentaltownUK February 2018 - Cover
DentaltownUK February 2018 - Cover2
DentaltownUK February 2018 - 3
DentaltownUK February 2018 - 4
DentaltownUK February 2018 - Mike Gow: Contracts & the Hit Man
DentaltownUK February 2018 - Howard Speaks
DentaltownUK February 2018 - 7
DentaltownUK February 2018 - 8
DentaltownUK February 2018 - 9
DentaltownUK February 2018 - Message Board: Predictable Marginal Ridge
DentaltownUK February 2018 - Dr. Harry Singh’s Financial Freedom Formula
DentaltownUK February 2018 - 12
DentaltownUK February 2018 - 13
DentaltownUK February 2018 - Private Removable Prosthetics
DentaltownUK February 2018 - 15
DentaltownUK February 2018 - Message Board: Large Composite Restorations
DentaltownUK February 2018 - 17
DentaltownUK February 2018 - Quiz: Name that Oral Lesion!
DentaltownUK February 2018 - 19
DentaltownUK February 2018 - 20
DentaltownUK February 2018 - 21
DentaltownUK February 2018 - 22
DentaltownUK February 2018 - The Boxing Dentist
DentaltownUK February 2018 - 24
DentaltownUK February 2018 - 25
DentaltownUK February 2018 - 26
DentaltownUK February 2018 - 27
DentaltownUK February 2018 - Don't Make Assumptions
DentaltownUK February 2018 - 29
DentaltownUK February 2018 - A Combined Digital Orthodontic and Restorative Approach
DentaltownUK February 2018 - 31
DentaltownUK February 2018 - To Fill or Restore?
DentaltownUK February 2018 - 33
DentaltownUK February 2018 - Back to Birmingham: BDC & Dentistry Show 2018
DentaltownUK February 2018 - 35
DentaltownUK February 2018 - Temporomandibular Joint
DentaltownUK February 2018 - 37
DentaltownUK February 2018 - 38
DentaltownUK February 2018 - Spin Me Right Round: Crown Preparations
DentaltownUK February 2018 - 40
DentaltownUK February 2018 - 41
DentaltownUK February 2018 - Through the Keyhole-Dr. Alif Moosajee
DentaltownUK February 2018 - 43
DentaltownUK February 2018 - 44
DentaltownUK February 2018 - 45
DentaltownUK February 2018 - 46
DentaltownUK February 2018 - 47
DentaltownUK February 2018 - 48
DentaltownUK February 2018 - 49
DentaltownUK February 2018 - Wish List-Dr. Yogi B. Savania
DentaltownUK February 2018 - Cover3
DentaltownUK February 2018 - Cover4
http://www.nxtbook.com/farran/dentaltown/2020February
http://www.nxtbook.com/farran/dentaltown/2020January
http://www.nxtbook.com/farran/dentaltown/2019December
http://www.nxtbook.com/farran/dentaltown/2019November
http://www.nxtbook.com/farran/dentaltownuk/2019OctoberNovember
http://www.nxtbook.com/farran/dentaltown/2019October
http://www.nxtbook.com/farran/dentaltown/2019NewGrad
http://www.nxtbook.com/farran/dentaltown/2019September
http://www.nxtbook.com/farran/dentaltown/2019August
http://www.nxtbook.com/farran/dentaltown/2019July
http://www.nxtbook.com/farran/dentaltownuk/2019JuneJuly
http://www.nxtbook.com/farran/dentaltown/2019June
http://www.nxtbook.com/farran/dentaltown/2019May
http://www.nxtbook.com/farran/dentaltownuk/2019AprilMay
http://www.nxtbook.com/farran/dentaltown/2019April
http://www.nxtbook.com/farran/dentaltown/2019March
http://www.nxtbook.com/farran/dentaltown/2019February
http://www.nxtbook.com/farran/dentaltownuk/2019FebruaryMarch
http://www.nxtbook.com/farran/dentaltown/2019January
http://www.nxtbook.com/farran/dentaltownuk/2018Winter
http://www.nxtbook.com/farran/dentaltown/2018December
http://www.nxtbook.com/farran/dentaltown/2018November
http://www.nxtbook.com/farran/dentaltownuk/2018November
http://www.nxtbook.com/farran/dentaltown/2018October
http://www.nxtbook.com/farran/dentaltownuk/2018October
http://www.nxtbook.com/farran/dentaltown/2018NewGrad
http://www.nxtbook.com/farran/dentaltown/2018September
http://www.nxtbook.com/farran/dentaltownuk/2018September
http://www.nxtbook.com/farran/dentaltown/2018August
http://www.nxtbook.com/farran/dentaltownuk/2018July
http://www.nxtbook.com/farran/dentaltown/2018July
http://www.nxtbook.com/farran/dentaltownuk/2018June
http://www.nxtbook.com/farran/dentaltown/2018June
http://www.nxtbook.com/farran/dentaltownuk/2018May
http://www.nxtbook.com/farran/dentaltown/2018May
http://www.nxtbook.com/farran/dentaltownuk/2018April
http://www.nxtbook.com/farran/dentaltown/2018April
http://www.nxtbook.com/farran/dentaltown/2018March
http://www.nxtbook.com/farran/dentaltownuk/2018March
http://www.nxtbook.com/farran/dentaltown/2018February
http://www.nxtbook.com/farran/dentaltownuk/2018February
http://www.nxtbook.com/farran/dentaltown/2018January
http://www.nxtbook.com/farran/dentaltown/2017December
http://www.nxtbook.com/farran/dentaltownuk/2017Winter
http://www.nxtbook.com/farran/dentaltown/2017November
http://www.nxtbook.com/farran/dentaltown/2017October
http://www.nxtbook.com/farran/dentaltownuk/2017october
http://www.nxtbook.com/farran/dentaltown/NewGrad2017
http://www.nxtbook.com/farran/dentaltown/2017September
http://www.nxtbook.com/farran/dentaltownuk/2017September
http://www.nxtbook.com/farran/dentaltownuk/2017August
http://www.nxtbook.com/farran/dentaltown/2017August
http://www.nxtbook.com/farran/dentaltown/2017July
http://www.nxtbook.com/farran/dentaltownuk/2017July
http://www.nxtbook.com/farran/dentaltown/2017June
http://www.nxtbook.com/farran/dentaltownuk/2017may
http://www.nxtbook.com/farran/dentaltown/2017May
http://www.nxtbook.com/farran/dentaltownuk/2017April
http://www.nxtbook.com/farran/dentaltown/2017April
http://www.nxtbook.com/farran/dentaltown/2017March
http://www.nxtbook.com/farran/dentaltownuk/dentaltownuk/2017march
http://www.nxtbook.com/farran/dentaltown/February2017
http://www.nxtbook.com/farran/dentaltown/2017January
http://www.nxtbook.com/farran/dentaltown/2016December
http://www.nxtbook.com/farran/dentaltown/2016November
http://www.nxtbook.com/farran/dentaltown/2016October
http://www.nxtbook.com/farran/dentaltown/2016nge
http://www.nxtbook.com/farran/dentaltown/2016september
http://www.nxtbook.com/farran/dentaltown/2016august
http://www.nxtbook.com/farran/dentaltown/2016july
http://www.nxtbook.com/farran/dentaltown/2016june
http://www.nxtbook.com/farran/dentaltown/2016may
http://www.nxtbook.com/farran/dentaltown/2016april
http://www.nxtbook.com/farran/dentaltown/2016march
http://www.nxtbook.com/farran/dentaltown/2016february
http://www.nxtbook.com/farran/dentaltown/2016january
http://www.nxtbook.com/farran/dentaltown/2015december
http://www.nxtbook.com/farran/dentaltown/2015november
http://www.nxtbook.com/farran/dentaltown/2015october
http://www.nxtbook.com/farran/dentaltown/2015nge
http://www.nxtbook.com/farran/dentaltown/2015september
http://www.nxtbook.com/farran/dentaltown/2015august
http://www.nxtbook.com/farran/dentaltown/2015july
http://www.nxtbook.com/farran/dentaltown/2015june
http://www.nxtbook.com/farran/dentaltown/2015may
http://www.nxtbook.com/farran/dentaltown/2015april
http://www.nxtbook.com/farran/dentaltown/2015march
http://www.nxtbook.com/farran/dentaltown/2015february
http://www.nxtbook.com/farran/dentaltown/2015january
http://www.nxtbook.com/farran/dentaltown/2014december
http://www.nxtbook.com/farran/dentaltown/2014decemberb
http://www.nxtbook.com/farran/dentaltown/2014november
http://www.nxtbook.com/farran/dentaltown/2014october
http://www.nxtbook.com/farran/dentaltown/2014newgrad
http://www.nxtbook.com/farran/dentaltown/2014september
http://www.nxtbook.com/farran/dentaltown/2014august
http://www.nxtbook.com/farran/dentaltown/2014july
http://www.nxtbook.com/farran/dentaltown/2014june
http://www.nxtbook.com/farran/dentaltown/2014may
http://www.nxtbook.com/farran/dentaltown/2014april
http://www.nxtbook.com/farran/dentaltown/2014march
http://www.nxtbook.com/farran/dentaltown/2014february
http://www.nxtbook.com/farran/dentaltown/2014january
http://www.nxtbook.com/farran/dentaltown/2013december
http://www.nxtbook.com/farran/dentaltown/2013november
http://www.nxtbook.com/farran/dentaltown/2013october
http://www.nxtbook.com/farran/dentaltown/2013newgrad
http://www.nxtbook.com/farran/dentaltown/2013september
http://www.nxtbook.com/farran/dentaltown/2013august
http://www.nxtbook.com/farran/dentaltown/2013july
http://www.nxtbook.com/farran/dentaltown/2013june
http://www.nxtbook.com/farran/dentaltown/2013may
http://www.nxtbook.com/farran/dentaltown/2013april
http://www.nxtbook.com/farran/dentaltown/2013march
http://www.nxtbook.com/farran/dentaltown/2013february
http://www.nxtbook.com/farran/dentaltown/2013january
http://www.nxtbook.com/farran/dentaltown/2012december
http://www.nxtbook.com/farran/dentaltown/2012November
http://www.nxtbookMEDIA.com