Australasian Dentist Magazine May June 2021

Category 56 Australasian Dentist C M Y CM MY CY CMY K with this band, I placed a wedge (Wedge Wand, Garrison Dental) in the mesial and it worked fine. The adaptation on the distal would have been improved had I used the Teflon tape, or further tightened the band, or both (fig. 5). Employing the selective etch technique, I etched the enamel margins with 37% phosphoric acid (Ultraetch, Ultradent). After placing a self etching primer and adhesive (Clearfil SE Protect, Kuraray) according to manufacturer’s instructions on the rest of the prep, I applied several small increments of a bulk fill flowable material (Surefill SDR Flow, Dentsply Sirona), enough to rise above the gingiva (fig. 6). I then did a freehand layered buildup of the remainder of the restoration, with the exception of the mesial box, using a light-cured core buildup material (Photocore, Kuraray) (fig. 7). At this point, I removed the Margin Elevation band and placed a sectional matrix band, wedge, and separating ring on the mesial (ComposiTight Fusion, Garrison Dental) and completed the buildup to create good contour and contact until such time that the tooth is prepared for a crown (fig . 8,9 ). After trimming the slight excess material on the distal with a finishing carbide (ET bur, Brasseler) and adjusting the occlusion, the finished restoration can be seen in fig 10. The final radiograph shows the dense, well adapted restoration (fig 11). Ideally, still allowed me to obtain results that would otherwise have been difficult or impossible to achieve. Case Study A 46 year old male was found, on radiographic examination, to have recurrent decay beneath a large MOD amalgam restoration (fig. 3). It was discussed that, given the size of the restoration, it might ultimately serve as a core for a full coverage indirect restoration in the near future. Removal of the amalgam and excavation revealed that the decay extended quite far subgingivally on both the mesial and distal (fig. 4). It became apparent that, were a crown preparation to be planned, it would be next to impossible to place retraction cord to record a finish line this deep, and at crown delivery it would be impossible to isolate to allow predictable bonding of the crown. Since the crown preparation was not anticipated this day, my goal was to place a direct restoration, with good contact on the mesial to prevent food impaction. Preparation of the crown’s finish line would then end on the newly placed composite, thus “margin elevation”. I placed Garrison’s Margin Elevation band around tooth #15. It is suggested that a wedge not be placed, but instead that Teflon tape be used to improve adaptation of the band. Having had too little practice better adaptation of the band would have obviated the need for the subgingival trimming and the resulting buildup would have had the smoothest possible subgingival finish, having been created by the band itself. The restoration of such deep lesions is a challenge practitioners too often face. Without the necessary armamentarium to achieve quality results, these cases remain a frequent source of frustration. Once the technique is mastered however, it is surprising how often the need to use it is encountered. Instead of provoking anxiety, the practitioner can confidently offer solutions to our patients when these occasions arise. u References 1. Dietschi, D., Spreafico, R. Current clinical concepts for adhesive cementation of tooth- colored posterior restorations, Practical Periodontics and Aesthetic Dentistry. 1998 10: 47-54. 2. Magne, P., Spreafico, R. Deep Margin Elevation: A Paradigm Shift , American Journal of Esthetic Dentistry. 2012; 2:86-96. 3. Ibid., 95. 4. Margin Elevation Technique Demystified with Dr. Matt Nejad, YouTube, Uploaded by Garrison Dental July 15, 2019, https://youtu. be/xxdHEpgJeLs. About the author Dr. Rosenfeld is a graduate of Cornell University and Northwestern University Dental School. He served a one year General Practice Residency, and a second year as Chief Resident, at Long Island Jewish Medical Center. He is a “wet-fingered” general dentist who practices in Westwood, New Jersey. Dr. Rosenfeld is an attending at the general practice residency program at Hackensack University Medical Center . He has advanced training in Esthetic dentistry and is on faculty at the Nash Institute for Dental Learning near Charlotte, North Carolina. Dr. Rosenfeld is a member of the American Dental Association, the American Academy of Cosmetic Dentistry and their component societies, the International Team for Implantology, and several dental study clubs. He has had numerous articles published in journals such as Dentistry Today, Inside Dentistry, Dental Economics, Dentaltown, Oral Health, Australasian Dentist, and Dental Products Report. He serves as a “key opinion leader” to several dental manufacturers and he has lectured on various subjects in restorative dentistry. Dr Rosenfeld was inducted as a Fellow in the International Academy of Dental Facial Esthetics. Figure 5 Figure 8 Figure 10 Figure 6 Figure 7 Figure 9 Figure 11 clinical