Dental Tribune UK Edition, October 25-3, 2010, No.26 Vol.4

References Bichacho N. The centripetal build-up technique for composite resin posterior restorations. Prac Periodontics Aesthet Dent 1994; 6:17-23. Davidson CL, DeGee AJ. Relaxation of polymerization contraction stresses by flow in dental composites. Jnl Dent Res 1984; 63:146- 148. Dietschi D, Magne P, Hollz J. Recent trends in aesthetic restorations for posterior teeth. Quintessence Int 1994; 25:659-676. Dietschi D, Spreafico R (1997) Adhesive Metal - Free Restorations: Current concepts for the aesthetic treatment of posterior teeth. Quintessence Publishing Co. Inc, Chicago. Feilzer AJ, DeGee AJ, Davidson CL. Setting stress in composite resin in relation to configuration of the restoration. Jnl Dent Res 1987; 66:1636-1639. Inside Dentistry (2009). Surefil SDR flow Posterior Bulk Fill Flowable Base. October, p124. Jensen ME, Chan DCN. Polymerization shrinkage and microleakage. In: Posterior composite dental restorative materials. Vanherle G, Smith DC, editors. Utrecht. The Netherlands: Peter Szulc Publishing Co., pp. 243-262. Liebenberg WH. Posterior composite resin restora- tions: assuring restorative integrity. FDI world 1997;6: 12-17, 19-23. Lutz F, Krejci I, Luescher B, Oldenburg TR. Improved proximal margin adaptation of class II composite resin restorations by use of light-reflecting wedges. Quintessence INt 1986; 17:659-664. Pearson GJ, Hegarty SM. Cusp movement of molar teeth with composite filling materials in conventional and modified MOD cavities. Br Dent J 1989; 166:162-165. Sherrer S, de Rijk WG, Belser UC, Meyer JM. Effect of cement film thisckness on the fracture resistance of a machina- ble glass-ceramic. Dent Mater 1994; 10:172-177. Van der Vyver PJ, Bridges PN. Posterior composite resin restorations: Part 1. Isolation. SADJ 2002;57:142-146. Walshaw WS, McComb D. Microscopic features of clinically successful dentine bonding. Dent Update 1998; September:281-286. Wieczkowski F, Joynt RB, Klockowski R, Davies EL. Effects of incremenntal versus bulk fill technique on resistance to cuspal fracture of teeth restored with posterior composites. J Prosthet Dent 1988; 60:283-287. Fig 4: Final cavity preparation after caries removal and the enamel margins of the proximal surfaces prepared with the Son- icSys Prep Ceram Tips (KAVO) to ensure removal of any unsupported enamel. Fig 6: Hawe Contoured Tofflemire Bands (KERR) were used in a Tofflemire holder to ensure correct contour of the definitive restoration. A circular matrix was selected above a sectional matrix because of the missing upper first molar. Fig 7: V-Ring (Triodent) was utilized to create separation between the canine and premolar in order to ensure a tight inter- proximal contact point. Fig 8: Different sizes of the Wave Wedges (Triodent) that were utilized to seal the matrix band against the mesial gingival cavity margin to gain a tight marginal seal, reducing the chance for contamination to ensure the establishment of an uncompro- mised bond strength. Fig 9: Matrix assemblage: Hawe Con- toured Tofflemire Band in a Tofflemir holder activated V-Ring and small Wave Wedge (white). Note the inadequate adap- tation of the matrix band to the gingival mesial margin on the buccal aspect of the cavity preparation. The small wedge was replaced with a larger Wave Wedge (pink) (Fig.12) to achieve improved adaptation of the matrix band against the gingival enamel margin. Fig 11: SDR- Smart Dentine Replacement (Dentsply) compula tip, which incorpo- rates a fine, needle like nose for precise dis- pensing of the material with the attached macro dispensing tip. Fig 10: Enamel and dentine surfaces were etched for 15 seconds with 36per cent phosphoric acid, rinsed with water and lightly air-dried. Two coats of XP Bond (Dentsply) was applied to the etched enamel and dentine surfaces, agitated with a micro-brush for 15 seconds, lightly air- dried and light-cured for 20 seconds with a Valo Light-curing unit (Ultradent). Fig 12: After the bonding protocol, the SDR material was dispensed using slow, steady pressure from the deepest portions of the mesial and distal proximal box prepara- tions. After a 4mm increment was dispensed the material was left undisturbed for a few seconds to self-level before it was light-cured for 40 seconds from the occlusal aspect. Fig 13: Another 4mm increment of SDR was dispensed on top of the previous layer up to approximately 3mm from the cavo- surface margin. The material was again left undisturbed to allow for self leveling before it was lightcured for 40 seconds. Fig 14: The remaining part of the cavity prep was filled with Teric N Ceram (Vi- vadent), a regular viscosity composite resin. Fig 15: The Class II cavity was transformed into a Class I cavity according to the Bicha- cho technique (Bichado, 1994): mesial and distal marginal ridges were built up with a regular viscosity composite resin, one at a time and light-cured. Fig 16: Successive increments of composite were applied in an oblique layering tech- nique, sculpted with a pointed composite instrument and lightcured for 40 seconds. The inclination of the rmaining cavo- surface slopes were used as indication to reconstitute the occlusal morphology. Fig 17: Completed restoration after finish- ing and polishing with an egg-shaped 30 fluted carbide finishing bur (Endenta) and sequential finishing with OptiDiscs (Kerr). Fig 18: Angulated view of the buccal cusp demonstrating no signs of enamel cracking that could have been caused by polymeriza- tion shrinkage of the bulk fill flowable SDR base material. Fig 19: Immediate post-operative oc- clusal view after polishing with diamond polishing paste (Ultradent) illustrating the optimal aesthetics, improved interproximal contour and the shape of the composite restoration. Note the optical integration of the composite resin and SDR with the sur- rounding tooth structure. Fig 20: Pre-operative view of the upper right maxillary sextant. Clinical and ra- diographic examination of the upper right first molar revealed a previously placed occluso-palatal amalgam restoration and interproximal decay on the mesial aspect of the tooth. Fig 21: Pre-operative view of the isolated upper right maxillary molar. This magni- fied view revealed a fracture in the amal- gam restoration (arrow) and extensive creep of the restoration margins. Case Report 2 - SDR as base material un- der posterior ceramic inlay restoration Fig 22: Cavity outline after removal of the defective amalgam restoration and decay on the mesial marginal ridge. Caries Indi- cator (Ultradent) was ultilised to identify some caries affected tooth structure. Fig 23: Final cavity preparation after removal of caries left undercuts on axial wall preparations and an irregular pulpal floor plane. Fig 24: After etching with phosphoric acid and application of XP Bond (Dentsply) (Fig. 10) according to the manufacturer’s instructions, the SDR flowable base mate- rial (Fig. 11) was applied to the treated tooth structure. The objective was to block out undercuts on the axial wall prepara- tions and to level the pulpal floor plane. After light-curing, the ideal cavity prepa- ration was achieved by using a medium grit diamond bur. Fig 25: After making an impression with Aquasil soft-putty and Aquasil light body (Dentsply) the tooth was temporized with Integrity (Dentsply). A porcelain inlay fabricated in the laboratory from pressed Emax (Ivoclar, Vivadent) was etched with 9.5per cent Hydrofluoric acid (Ultradent) for 20secs, rinsed with water and air-dried. Silane Coupling Agent (Dentsply) was applied and left to dry for 1min before the treated porcelain surface was coated with a thin layer of Prime & Bond NT mixed with Self-cure Activator (Dentsply) Fig 27: The cavity preparation was pre- pared for bonding using XP Bond mixed with the Self-Cure Activator (Dentsply) ac- cording to the manufacturer’s instructions. The translucent shade of Calibra Resin Cement (Dentsply) was used as a luting cement for cementation of the prefabricated inlay. Fig 29: Immediate post-operative view after removal of the rubber dam. The final resto- ration reflects optimal restoration of aesthet- ics, occlusal anatomy, marginal ridges and interproximal integrity. 27October 25-31, 2010United Kingdom Edition Clincal Fig 26: At the cementation appointment the upper right sextant was isolated with rubber dam and the temporary inlay re- moved. A single floss ligature was utilized around the upper first molar to guarantee optimal isolation. The cavity preparation line angles were cleaned with OptiClean (Kerr) to ensure removal of any remnants of the temporary cement. Plumbers Tape was folded around the upper first premo- lar to act as an isolation medium during cementation. Fig 28: Occlusal view after cementation of the porcelain inlay. Final light-curing of the cement was done from the occlusal and palatal direction for 30 secs respectively, us- ing a Valo light-curing unit (Ultradent).