Australasian Dentist Issue 89

Category 68 AustrAlAsiAn Dentist t he dreaded “black triangles” in the anterior region seem to be one of the hardest dental restorative treatments to perform, not due to the fact that they are large, complicated restorations, but due to the fact that their small size and great effect on esthetics, coupled with its possible impact on the adjacent gingival tissues, create a struggle for the practitioner. With our increasingly aging dental population, the clear professional understanding of the particular reasons for why they were formed (since the reasons for their appearance can be due to multiple causes), improvement in oral health in general, and the statistical fact that more people actually seek dental care, dentists find themselves asked to fix “black triangles” for cosmetic purposes more than before. Properly diagnosing the specific reason for the formation of the black triangles is of course the priority and addressing it will prevent their reoccurrence. For the purpose of this article, we will now forward to the cosmetic restoration technique. this particular patient had a previous diagnosis of uncontrolled periodontitis and bruxism, which were both addressed prior to the cosmetic rehabilitation. While techniques and adjunctive tools differ, our search for the easiest, most reliable and cost-effective treatment method is continuous. As dentists, we all seem to want to be able to improve on a patient’s esthetics but know that improperly performed procedures can ultimately cause more damage than help. When closing “black triangles” between anterior teeth what are the steps one needs to be mindful of? 1. tissue health. loss of interdental papillae or its fullness is always related to physical or microbiological trauma. this issue needs to be resolved prior to the commencement of any restorative treatment especially an esthetic one. 2. Bonding technique and composite choice. the success of direct bonding is directly related to the proper technique implementation rather than the choice of a certain manufacturer’s system. All reputable company’s bonding systems work very well, as long as one follows their application instructions exactly. Composite choice in modern dentistry is subjective, due to the handling and esthetic choices one has with different composites. i advocate for using a bonding system with a composite, both made by the same manufacturer, due to the fact that they were developed congruently, and have therefore the best chance of working very well together. 3. implementation of the proper matrix system. to aid in the proper sculpting and placement of the composite, one needs to carefully select a matrix system that will aid in the closing of the “black triangles” without making the treatment modality harder than it already is. We are all familiar with the dreaded Mylar bands that always leave us with huge marginal overhangs, or the more modern curved Mylar systems that, due to the fact that they are made from thin plastic, cannot be burnished into the needed space. 4. Proper curing and polishing of the placed composite. this is where the struggles begin, if one has not picked a good interproximal matrix system, the composite to tooth interface that needs to be left exceptionally smooth, could become misshapen in the process. Case study: A 60-year-old female patient presented with dissatisfaction with the “black triangles” present between her anterior teeth, after a long but ultimately successful battle with inflamed gingival tissues. this patient is also a severe nighttime bruxer who wears a tMJ appliance (splint) at night. the choice was made to use the new Fusion Anterior Matrix system by Garrison Dental solutions. this system differs in the fact that the wedges are pre-curved, and the metal interproximal matrix is pre-bent. What is particularly useful with these metal bands, is the fact that they can be burnished, and they hold their shape, throughout the procedure. the ingenious pre-curved wedges add to the proper composite placement, not allowing for marginal material seepage. Although one cannot light-cure through the metal matrix, light-curing from the side of the placed composite on facial or lingual is extremely easy, without scare of leaving uncured composite due to twomain facts: firstly, the fact thatmodern composites cure through a minimum of 3 millimeters, and secondly, composite thickness in that area is generally not thicker than that given natural anterior tooth morphology. the depicted case overleaf shows a step-by-step implementation of this new anterior interproximal matrix system and its seamless integration into our proce- dural routine for the esthetic treatment of “black triangles” in the anterior region. u Simona Cuevas Black Holes…. Not Just a Theory! By Dr Simona Cuevas, D.D.s. About the author Simona Cuevas , D.D.S. Dr. Simona Cuevas received her D.D.S. from the University of Texas, San Antonio in 1995, where, post-graduation, she also served on the faculty in the Esthetic Restorative department for several years. She is a member of numerous dental associations and has served as a contributing editor for the Journal of Cosmetic Dentistry , writing many articles. Dr. Cuevas has published numerous professional articles on direct and indirect bonding techniques. Dr. Cuevas has become known for being at the forefront of implementing new techniques and materials into the restorative esthetic dental space. She has lectured nationally and internationally on esthetic dentistry. She is an active consultant for several dental manufacturers in the area of new product development and refinement, and she is considered a Key Opinion Leader in the Dental industry. Dr. Cuevas maintains a private practice, The Institute of Esthetic Dentistry, in San Antonio, Texas, emphasizing esthetic and restorative dentistry, and is a Clinical Faculty Assistant Professor at the University of Texas School of Dentistry in San Antonio. lInICal