Dental Tribune India Issue

Clinical Dentaltribune|July-September, 201012 teeth, but due to appearance, mass and an increasing price, it is becoming more unaccept- able in today’s image-conscious society. The prep This patient came in with a dental emergency. The filling had fallen out of his broken, lower right molar the day before he was going overseas for three weeks on business. He wanted a “quick & permanent solution” (Fig. 1). The tooth was anesthetized. Next, a FenderWedge (Directa Dental) was used to further isolate the involved tooth, pro- tect the adjacent interproximal surface and pre-wedge the teeth for optimal contacts (Fig. 2). The Isolite (Isolite Systems) was placed to obtain a dry & ill- uminated field. We used caries detector to ensure complete de- cay removal (Fig. 3). The tooth was then microetched, etched and desensitized with Hema- Seal & Cide (Advantage Dental Products, Inc.). Two layers of self-etching bonding agent (OptiBond All-In- One Unidose, Kerr Dental) were applied to provide reduced post- operative sensitivity and high dentin bond strength. This was thenair-thinnedandlight-cured. Flowable composite (Premise Flowable, Kerr Dental) was ad- ded to the internal walls and floor, creating an even floor and filling in undercuts that were originally prepared for caries removal and amalgam retention (Fig. 4). After the tooth was insula- ted, the prep was refined with a flat-end cylinder, fine-grit, short shank diamond. Two Identic hydrocolloid impressions (Dux Dental) were taken to make the onlay in the lab (Fig. 5). Lab work After disinfecting the impres- sions, the assistant immediately poured them with MACH-SLO (Parkell) and based them with a rigid, fast-setting bite registra- tion material such as BluMousse (Parkell) (Fig. 6). Within two minutes, we had a silicone working model on which to build the onlay (Fig. 7). The undercuts were then blocked out with a waxer, paying special attention to avoid the margins (Fig. 8). Starting with the Premise Indirect (Kerr Den- tal) dentinal shades and ending with incisal shades, the onlay was incrementally fabricated in layers. The onlay was then placed in the Premise curing oven (Kerr Dental). In approximately 10 minutes, the onlay was ready to be fini- shed with various finishing burs (Fig. 9). The onlay was polished for a high shine and then checked on the model to verify accurate interproximal contacts & margin (Fig. 10). Seating the onlay When seating the onlays, the Iso- lite (Isolite Systems) was reapp- lied for isolation, ease of place- ment & patient comfort during cementation of the onlay. Prior to cementation, Expasyl (Kerr Dental) was gently packed into the sulcus, creating a dry space between the tooth & tissue without any risk of rupturing the epithelial attachment (Fig. 11). The aluminum chloride dries the tissue, reducing the risk of sulcal seepage & contamination. The FenderMate (Directa Dental) was then inserted ben- eath the interproximal floor to slightly separate and isolate the adjacent teeth & to help facilitate seating the onlay (Fig. 12). The Expasyl (Kerr Dental) was rinsed off thoroughly and Fend- erMate (Directa Dental) was adapted to the adjacent inter- proximal surface with a con- denser (Fig. 13). The enamel and composite core were then etched for 15–30 seconds. A single component fifth generation adhesive (OptiBond Solo Plus Unidose, Kerr Dental) was applied in two coats and air-thinned until there was no more movement. Flowable com- posite (Premise 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 further seated using a condenser with gentle pressure. Complete seating was facili- tated using the contra-angle pac- ker/condenser (Fig. 14). An explorer is helpful in re- moving excess flowable before curing. The restoration was cured from all angles, starting at the interproximal gingival floors where leakage is most likely to occur. Occlusal flash and excess flowable composite was “buf- fed”with a short flame carbide while the interproximal margin were adjusted with bullet or needle carbides. A Bard Parker #12 scalpel was used to remove interpro- ximal cement. Once the proper occlusion was established, a diamond- impregnated point and/or cup was used to polish the restora- tion (Fig. 15). Conclusion There are certainly clear advan- tages for both the patient and the dentist when doing indirect composite 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 techniques, mate- rials and equipment. These restorations not only save time and conserve healthy tooth structure, they are a valu- able service to provide to your patients. Wherever you practice, how- ever you practice, these resto- rations are durable, esthetic, economical and very much appreciated! DT Dr. Lorin Berland, a fellow 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 publica- tions and major dental journals, including Time magazine. In 2008, he was honored by the AACD for his contributions to the art and science of cosmetic dentistry. For more information on The Lorin Li- brary Smile Style Guide, www.den- turewearers.com, and Biomimetic SameDayInlay/Onlay8AGDCred- its CD-ROM, call (214) 999-0110 or visit www.berlanddentalarts.com. About the author