Australasian Dentist Magazine March April 2021

Category 64 Australasian Dentist About the Case The patient, a male in his mid-30s presented to the practice requesting improved aesthetics of the lower anterior teeth. Dark/black triangles had developed after fixed orthodontic treatment implemented to correct moderate to severe anterior crowding of the lower anterior teeth. Initially a referral was made to a periodontist for possible gingival and bone grafting procedures, but it was deemed unpredictable in this case. Other restorative options offered to the patient included indirect restorations; veneers and crowns. These were not a conservative option due to the aggressive nature of the required preparations to achieve the desired aesthetic result. Patient opted for a minimally invasive approach. Challenge Traditional composite bonding techniques including the use of cellular strip and sculptable composite resin can be cumbersome to manage interproximal embrasure areas and contacts. Patient was happy with ortho treatment result but very conscious of the resultant dark triangles. Outcome The use of Bioclear matrices (anterior) allowed the achievement of anatomical form. The combination of Filtek supreme flowable composite and warmed Filtek Supreme XTE sculptable composite created the perfect viscosity to wrap around the interproximal surfaces of the lower anterior teeth making what was once a difficult task, very simple. Also, the very challenging colour match with B1 resulted in a pleasing aesthetic outcome for the patient. u clinical Before After Fig 1: Pre ortho photo of lower arch. Depicting moderate to severe crowding of lower anterior teeth. Ortho Treatment was approximately 12 months duration. Fig 2: Pre-treatment smile frontal. Presentation of black triangles in the lower anterior region. Patient also had a fixed lingual retainer that needed to be removed before the restorative procedure commenced. Fig 6: Anterior Bioclear matrices inserted and application of Scotchbond™ Universal Etchant. Note: no requirement of wedges to stabilise matrices. Fig 10: Frontal smile photo, final result after finishing and polishing. Fig 3: Pretreatment intra oral retracted photo. Fig 7: Bioclear matrices with application Scotchbond™ Universal adhesive. Rub 20s, air thin and cure 10s. Fig 11: Pre-ortho Intra oral retracted. Fig 4: Close up – of black triangles between 42, 41, 31 and 32. Fig 8: Filtek Supreme Flowable injected followed by warmed Filtek Supreme XTE (B1) sculptable composite resin, then cured for 20s. Fig 12: Post-ortho and Restorative Intra oral retracted. Fig 5: Rubber dam isolation. No LA required as this procedure is atraumatic and does not require any removal of tooth structure. Meticulous removal of biofilm before commencing bonding procedure is essential to allow optimal bond strength to uncut enamel and infinity edge margins. Fig 9: Composite curing completed, matrices removed, pre-polishing. Fig 13: Post-treatment occlusal after lingual fixed retainer reapplied. 3M Australia Pty Limited, Building A, 1 Rivett Road, North Ryde, NSW 2113. Ph: 1300 363 454 3M .com.au Unsightly black triangles, a tricky restorative procedure made easy with flowable composites and warming By Dr Michael Cai