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News Bulletin : ADA News Bulletin September 2010
24 SEPTEMBER 2010 aesthetic update CLINICAL TECHNIQUE Once the occlusal problem had been diagnosed, the patient was rescheduled for a two to four hour appointment. (Treatment times will vary depending upon the practitioners experience with the technique). TOOTH PREPARATION On the upper arch, plaque and pellicle were removed with pumice and water. A slow speed diamond point was used to assure there were no deposits at the gingival margins. Caries and unsatisfactory restorations must be removed and cavities prepared for restoration prior to placing the build-ups. The upper teeth were then etched for five seconds with 35% phosphoric acid, washed with copious amounts of water and dried with oil-free air, followed by isolation with cotton wool rolls in the buccal sulcus. RESTORATION PLACEMENT A preferred bonding adhesive was applied to the upper canines and first bicuspids. Working from either the left or right hand sides; a Tofflemire matrix band was prepared so as to fit over a first bicuspid. A small amount of flowable composite was applied to the internal matrix margins followed by partially filling the matrix band with a microhybrid resin. The restoration was photo cured for 10 seconds. To act as a stress breaker, a thin layer of RMGIC bond was applied over the resin increment followed by the application of a microhybrid resin to complete placement of the restoration. The restoration was photo cured for a further 10 seconds. After removal of the matrix band, a further 10 second photo cure of the resin was applied. Next the matrix band was applied to the upper canine so as to extend out on the lingual aspect of the canine. An increment of flowable resin was applied at the internal perimeter and the preparation partially filled with a microhybrid resin and photo cured for 10 seconds. A thin layer of RMGIC bonding agent was applied as a stress breaker and composite resin was applied to fill the preparation. The restoration was photo cured for a further 10 seconds and again after the matrix band had been removed (Fig 3). This procedure was replicated again on the opposite upper arch. The canines and first bicuspids in the lower arch were similarly prepared as the upper and isolated with cotton rolls. After application of a preferred bonding adhesive and prior to placement of the Tofflemire band, increments of micro-fill composite resin were placed freehand onto the facial margins of these teeth extending from the cervical margin to just below the contact areas of these teeth. Each increment was photo cured for 10 seconds. On a lower-first bicuspid, a Tofflemire matrix was placed from the lingual surface and lightly tightened. After placement of a RMGIC bond as a stress breaker, a small increment of flowable composite was applied at the internal margin followed by a microhybrid resin to complete placement of the restoration. The restoration was then photo cured for 10 seconds. A further 10 second photo cure was applied after removal of the matrix. This process was repeated on the adjacent canine and the canine and first bicuspid in the opposite arch (Fig 4). Direct laminate veneers were placed on the lower incisors to restore lost tooth structure.* CONTOURING Contouring was commenced by reducing the composite build- ups on the upper arch to fit into the patient's smile line. This was followed by the removal of any composite tags still remaining on the lingual surfaces of upper teeth. With the patient in a retruded mandible position, he was asked to bite together in order to estimate the location and amounts of composite removal required on the lower arch. Composite removal was commenced with a coarse disc until an approximation of build-up contact between the upper and lower arches had been achieved. With the aid of articulating paper, the contact surfaces were then carefully spheroid over with a fine disc so that there was an even occlusal contact on each tooth occurring at or close to the centre point of the build-up (Fig 5). The lower incisors were contoured until they were free from interferences in lateral and protrusive movements of the mandible. * Aesthetic Update, News Bulletin, May, July and November 2008; and March 2009. Fig 3. Fig 4. Fig 5.
ADA News Bulletin August 2010
ADA News Bulletin October 2010