Australasian Dentist Magazine March April 2021

Category 68 Australasian Dentist The Garrison premolar sized Slickband (FX100) was selected for this case, due to slight microdontia generally in this case. Slickband sizes should be selected so that at full apical seating the occlusal limit of the band is coincident with or slightly beyond the desired marginal ridge level. A wedge was placed (FXYL) to secure the Slickband and cervical marginal seal checked at this stage. If any gaps were to eventuate with placement of the tension ring (FX400), this would require removal of the ring and packing of PTFE tape in the area of the void before replacing the tension ring. The mesial wall was selected for reconstruction as a first step (Fig. 3). Microlayers of an A2 flowable (Majesty Esthetic, Kuraray Noritake) were placed after the total etch adhesive approach with MPa Bond (Clinicians Choice). This was allowed to decouple with time to allow for maturation and ultimate hybridization of the link to dentin for maximal microtensile bond strengths. The proximal wall was reconstructed in horizontal 1mm increments layering occlusally as prescribed by the technique advocated by Nikolaenko et al, allowing for maximal microtensile bond strength values. Following curing for 20 seconds, the sectional matrix assembly was removed, the contact point anatomy and strength assessed with flossing before assembly of the matrix to reconstruct the distal wall in a similar manner. (Fig. 4) Following construction of the distal wall and relevant checks, a Class I situation has been created, devoid of tension rings and other paraphernalia that can impede access for occlusal layering (Fig. 5). The author’s preference to reconstruct and build one wall at a time with separately placed mesial and distal matrix assemblies through the process is in contrast to proximal contact strength (PCS) findings by Saber et al, which promote simultaneous mesial and distal assembly placement. The author finds the first method to be more predictable especially on smaller teeth such as premolars, where there may be physical difficulty with simultaneous placement of mesial and distal matrix assemblies due to the need to overlap SlickBands and the along with the risk of matrix accordian-bunching. The occlusal aspect was microlayered horizontally also with a white opaque flowable composite (Herculite Ultra flowable XL2 shade, KavoKerr) to block out the dark dentin (Fig. 6) before completion of layering was using an A2 shade of Voco Grandio SO. Occlusal tints were applied using Brown (Final Touch, Voco) (Fig. 7) Overall, a very satisfying restorative session by adhering to a step-by-step protocol that decreases stress, increases predictability and allows for optimal performance of materials and esthetic reconstruction of missing tooth structure in an enjoyable procedure for both patient and clinician. u References Keogh TP, Bertolotti RL. Creating tight, anatomically correct interproximal contacts. Dent Clin North Am. 2001 Jan;45(1):83-102. PMID: 11210702. Nikolaenko SA, Lohbauer U, Roggendorf M, Petschelt A, Dasch W, Frankenberger R. Influence of c-factor and layering technique on microtensile bond strength to dentin. Dent Mater. 2004 Jul;20(6):579-85. doi: 10.1016/j. dental.2003.08.001. PMID: 15134946. Saber MH, El-Badrawy W, Loomans BAC, Ahmed DR, Dorfer CE, El-Zohairy A. Creating Tight Proximal Contacts for MOD Resin Composite Restorations. Oper Dent. 2011;36(3):304-310. About the author MEET CLARENCE TAM , HBSC, DDS, AAACD, FIADFE  Dr. Clarence Tam is originally from Toronto,Canada, where she completed her Doctor of Dental Surgery and General Practice Residency in Pediatric Dentistry at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice has a focus on restorative and cosmetic dentistry, and she strives to provide consistently exceptional care with each patient. She is well-published in both the local and international dental press, writing articles, reviewing submissions, and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally.  Figure 6 Figure 7 Figure 5 clinical Effective oral mouth rinse for use: • At home • As a pre-procedural mouth rinse as recommended by the ADA Managing Covid-19 guidelines Oral Care Mouth Rinse Swirl HEX 0.2% Chlorhexidine Digluconate (No Alcohol) Swirl Prep 1% Hydrogen Peroxide