Dental Sales Flyer - July 2021 - 103

The Class II composite restoration is the most common restoration in
many restorative practices. Despite its widespread placement, postop
sensitivity, unpredictable proximal contours and contacts as well
as clinical inefficiency can still cause frustration. Bulk fill composites
have become popular due to their increased efficiency of the Class
II technique. Challenges with increased translucency and handling,
compared with layered composites, have largely been overcome with
some bulk fill composites. However, where esthetics are emphasized,
layered paste composites will provide a more desirable restoration. The
following case illustrates a technique utilizing dental materials that can
lead to minimizing or even eliminating these many current challenges.
Isolation of the preparation is key to the predictability and longevity
of the bonded restoration. Rounded internal line angles facilitate the
adaptation of the adhesive and composite to the preparation. Beveled
occlusal enamel exposes the ends rather than the sides of the enamel
rods, mitigating marginal microleakage. (FIG. 1)
Ring is designed to sit at a 20° angle to the occlusal plane, and full seating
of the ring is ensured with gentle finger pressure applied to the plastic
portion only. The two concentric rings produce more separation force
than other sectional rings. Each ring applies force to a pair of independent
separation prongs that adapt well to a variety of heights of contour and
tooth alignment while creating a balanced separating force in both mesial
and distal directions. Note the seal of the matrix band at the proximal line
angles. This will greatly reduce flash and finishing time. (FIG. 4)
Whether a total etch or selective etch technique is used, the importance
of maximizing the enamel adhesive bond is critical. It is this bond that
prevents micro-leakage and extends the lifespan of the restoration. The
total etch technique was used here with a 35% phosphoric acid etch. The
enamel was etched first followed by a 15 second etch of the dentin which
will effectively remove the smear layer, enabling the adhesive to reach the
mineralized dentinal surface and obturate the dentinal tubules. (FIG. 5)
Care not to over-etch the dentin is important to controlling post-op
sensitivity. The etch is then rinsed off and the dentin is left moist.
FIG. 1
FIG. 2
FIG. 5
DualForce™ Ultra-Wrap™ Matrix Bands (Clinician's Choice®
) are precontoured
in the contact area as well as at the marginal ridge. Careful
sizing of the band places the contact point and marginal ridge in their
ideal positions. With the marginal ridge already established, the long,
tight " U " shape of the Ultra-Wrap band minimizes flash and finishing
time especially in the wider proximal box form. Placement of the UltraWrap
matrix is aided by the occlusal tab (shown folded out of the way)
and the hardened metal of the matrix band resists crimping, even with
conservative preparations. (FIG. 2)
(FIG. 3) shows the DualForce Active-Wedge™
locked in place. The ActiveWedge's
tip collapses to ease its insertion then re-expands preventing
backing out, and ensures complete buccal to lingual seal of the gingival
margin. Placement of the Active-Wedge is made by grasping the serrated
handle with cotton pliers and guiding the Active-Wedge interproximally
using a suture-like motion. The stiff skeleton of the Active-Wedge will
exert up to 2 lbs of separation force once in place.
The new Scotchbond™
Universal Plus Adhesive (3M) is then scrubbed
into the enamel and dentin for 20 seconds. This newer version is similar to
Scotchbond™
Universal but now has an incorporated dual-cure activator,
Universal Plus Adhesive could have
is radiopaque, and can be used to bond to caries-affected dentin. As a
universal adhesive, Scotchbond™
been used in the selective-etch mode while still maximizing the enamel
bond strengths, or the self-etch mode. This universal adhesive is designed
to be used in one application due to its thicker viscosity, and scrubbing
the adhesive will drive it onto the dentin surface and into the dentinal
tubules for optimal bond strengths and prevention of post-op sensitivity.
Once this is thinned and the ethanol solvent is evaporated (approx. 5 sec),
the adhesive is light cured for 10 seconds. (FIG. 6)
FIG. 6
FIG. 7
FIG. 8
FIG. 3
FIG. 4
The DualForce Molar Ring (green) is expanded with little hand strain
and brought to the prepared tooth at a 45° approach angle. The DualForce
With such a large preparation, using a bulk fill composite will increase
the technique's efficiency. First, as a means to wet the surface of the
preparation to assist in the adaptation of the paste bulk fill composite, a
very thin layer of Filtek™
One Flowable Bulk Fill (3M) was applied to the
entire preparation and is not light cured. (FIG. 7)
clinicianschoice.com |
CLINICAL LIFE
| SUMMER 2021 |
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Dental Sales Flyer - July 2021

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