CATEGORY 72 AUSTRALASIAN DENTIST CLINICAL Quadrant Direct Case MO-DO Backto-Back + Single Class II Ring Stack By Matthew Burton, DDS Matthew Burton Figures 1a and 1b Patient is a 20-year-old male with failing composite restorations. He reports the restorations were done about two years ago, and he keeps getting food stuck when he eats. Clinical and radiographic exam shows failing existing Class II direct restorations. Open contacts were present, along with chipped marginal ridge forms. This was causing food impaction, secondary caries, and gingival irritation/ inflammation. Furthermore, there are multiple overhanging margins present, which irritate the gingival tissues and trap food, resulting in Class II restoration failure. Since the upper left was the most sensitive area for the patient, we elected to begin with #14–MO, #13–MO & #12–DO. Figures 4a and 4b Field is now clear and the gingival tissues are under control for restoration placement. Notice the concave shape to the mesial gingival margin of #14. These slight concavities are difficult to seal and can result in flash or contamination of the restorative filed. Furthermore, if you look at this image, along with the pre-op bitewing, you will notice the uneven margins on #12–DO and #13–MO. When performing back-toback restorations, uneven margins are common and can be difficult to securely wedge/seal both margins with a single wedge. Figure 2 Patient was anesthetised and failing composite restorations were removed with a 856016 diamond bur. The margins were finished with a Meisinger Fine Flame. All contacts were broken. As is common with failing Class II composite restoration removal, the gingival tissue was very inflamed and irritated. It is important to get this under control for improved vision and access to the restorative field. Figure 3 A hemostatic paste, Traxodent, was placed on the irritated gingival tissues for three minutes and then rinsed off. A simple way to assist patients with periodontal problems using two proven anti plaque formulations. Patients using this system have experienced rapid improvements in gingival inflammation, and over time, a gradual reduction in periodontal pocket depths. WWW.PROFDENT.COM.AU
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