DENTAL TRIBUNE | April 2010 Clinical 13A AD About the author Dr. Lorin Berland, a fel- low of the AACD, pioneered the Dental Spa concept in his multi-doctor practice in the Dallas Arts District. His unique approach to dentistry has been featured on television (“20/20”) and in national publications and major dental journals, includ- ing Time magazine. In 2008, he was honored by the AACD for his contribu- tions to the art and science of cosmetic dentistry. For more information on The Lorin Library Smile Style Guide, www.denturewearers. com, and Biomimetic Same Day Inlay/Onlay 8 AGD Cred- its CD-ROM, call (214) 999- 0110 or visit www.berland dentalarts.com. in layers. The onlay was then placed in the Premise curing oven (Kerr Dental). In approximately 10 minutes, the onlay was ready to be finished with various finishing burs (Fig. 9). The onlay was polished for a high shine and then checked on the model to verify accurate inter- proximal contacts and margins (Fig. 10). Seating the onlay When seating the onlays, the Iso- lite (Isolite Systems) was reapplied for isolation, ease of placement and patient comfort during cemen- tation of the onlay. Prior to cementation, Expasyl (Kerr Dental) was gently packed into the sulcus, creating a dry space between the tooth and tissue without any risk of rupturing the epithelial attachment (Fig. 11). The aluminum chloride dries the tissue, reducing the risk of sul- cal seepage and contamination. The FenderMate (Directa Den- tal) was then inserted beneath the interproximal floor to slightly sep- arate and isolate the adjacent teeth and to help facilitate seating the onlay (Fig. 12). The Expasyl (Kerr Dental) was rinsed off thoroughly and Fender- Mate (Directa Dental) was adapted to the adjacent interproximal sur- face with a condenser (Fig. 13). The enamel and composite core were then etched for 15–30 sec- onds. A single component fifth genera- tion adhesive (OptiBond Solo Plus Unidose, Kerr Dental) was applied in two coats and air-thinned until there was no more movement. Flowable composite (Prem- ise Flowable, Kerr Dental) was dispensed into the prepped tooth prior to inserting the onlay into the tooth. The FenderMate (Directa) was removed and the onlay was fur- ther seated using a condenser with gentle pressure. Complete seating was facilitat- ed using the contra-angle packer/ condenser (Fig. 14). An explorer is helpful in remov- ing excess flowable before curing. The restoration was cured from all angles, starting at the inter- proximal gingival floors where leakage is most likely to occur. Occlusal flash and excess flow- able composite was “buffed” with a short flame carbide while the inter- proximal margins were adjusted with bullet or needle carbides. A Bard Parker #12 scalpel was used to remove interproximal cement. Once the proper occlusion was established, a diamond-impreg- nated point and/or cup was used to polish the restoration (Fig. 15). Conclusion There are certainly clear advan- tages for both the patient and the dentist when doing indirect com- posite resin restorations. These restorations have helped me save my patients’ teeth, time and money. Over the last 20 years, I have tweaked, updated and modified these restorations in terms of tech- niques, materials and equipment. These restorations not only save time and conserve healthy tooth structure, they are a valuable ser- vice to provide to your patients. Wherever you practice, howev- er you practice, these restorations are durable, esthetic, economical and very much appreciated! DT f DT page 2A