Australasian Dentist Magazine May June 2021

Category Australasian Dentist 53 REFERENCES: 1) Ayush Goyal, Vineeta Nikhil, and Ritu Singh, “Diastema Closure in Anterior Teeth Using a Posterior Matrix,” Case Reports in Dentistry, vol. 2016, Article ID 2538526, 6 pages, 2016. 2) Fellippe L. A., Monteiro S. Jr, De Andrada C. A., Di Cerqueira A. D., and Ritter A. V.. 2005. Clinical strategies for success in proximo-incisal composite restorations. Part II. Composite application technique. J. Esthet. Restor. Dent. 17:11–21. 3) 2015 Oct;31(10):1214-24. doi: 10.1016/j.dental.2015.07.005. Epub 201Aug21.Anterior composite restorations: A systematic review on long- term survival and reasons for failure Flávio F Demarco 1, Kauê Collares 2, Fabio H Coelho-de-Souza 3, Marcos B Correa 2, Maximiliano S Cenci 2, Rafael R Moraes 2, Niek J M Opdam 4 4) A systematic approach to contouring and polishing anterior resin composite restorations: A checklist manifesto. Vargas MA, Margeas R. J Esthet Restor Dent. 2021 Jan;33(1):20-26. doi: 10.1111/jerd.12698. Epub 2020 Dec 25. clinical Dr. Troy Schmedding is a 1993 honors graduate of the Arthur A. Dugoni School of Dentistry in San Francisco, California. He maintains a private practice in Walnut Creek, Ca. where he focuses on aesthetic and functional dentistry. An Accredited member of the American Academy of Cosmetic Dentistry, he lectures both nationally and internationally on aesthetics and restorative materials. He has also written and published numerous articles on restorative materials and protocols in numerous dental magazines. Dr Schmedding also serves as a Key Opinion Leader for numerous manufacturers helping develop and bring new products to market. He can be reached at Troyschmeddingdds@gmail.com Figure 5: Application of composite continues from the lingual til preparation is sufficiently filled. Figure 6: Removal of the matrix reveals proper contact, contours and minimal flash on the facial surface. Figure 7: Final polished restoration with wonderful aesthetics and ideal anatomical form and function. distorting the anatomical contour, unlike the mesial aspect of this same tooth where a wood wedge was used to seal the margin of that particular restoration (Figure 1). A smaller wedge may have been an option in this case as you can you see the orange wedge rotated slightly when placed but due to the lack of distortion of the band and the great seal achieved I did not change. Access to both the facial and lingual of the preparation achieved a 35% phosphoric acid (K-Etchant Kuraray) was placed in a selective etch protocol and allowed to sit for 30 seconds prior to rinsing off (Figure 2). Universal Bond Quick (Kuraray) was then applied to the preparation in agitating motion for 10 seconds, air thinned and light cured for 20 seconds from both the facial and lingual to ensure polymerization. In the case of using a metal matrix that doesn’t promote light passage as friendly as a clear matrix I felt more comfortable taking the extra time to polymerize. The flexibility of the Fusion Matrix system allows you to sculpt composite in an open fashion where you have access from the lingual as well as the facial while still benefiting from the anatomically correct inter-proximal contours. In this particular case I took the approach of using my finger to push the matrix from the facial while adding a small increment of Majesty ES-2 Universal composite (Kuraray) from the lingual (Figure 3). Composite instrument was then used from the lingual to manipulate the composite (Figure 4) and then light cured for 20 seconds. Repeated this process (Figure 5) until the restoration was filled to completion and light curing finished from the lingual. The matrix was then peeled away on the facial side and again cured for 20 more seconds to ensure complete polymerization. Anterior Fusion Wedge and Matrix were then removed to show minimal excess composite on the facial surface as well as ideal anatomical contours (Figure 6). A fine flame diamond and a fine football shaped diamond (Meisinger) did most of the heavy refinement and adjustment of occlusion. The final polish was achieved using a two step diamond polishing system (Meisinger)(Figure 7). Understanding the limitations of the material in every situation and adapting newer techniques should be our focus to make our restorations more predictable and durable. The case presented featured a great new product that can help you establish good contacts and contours in the anterior region where paramount importance is not just from an aesthetic but also a functional point of view. u