CATEGORY 48 AUSTRALASIAN DENTIST CLINICAL Introduction ere is a pensive moment that is experienced when a clinician is faced with the prospect of restoring a multisurface restoration that in reality exceeds the physical threshold for requiring an indirect porcelain restoration for optimal long-term prognosis. e placement of composite restorations has historically been fraught with complexities that range from appropriate shade selection in deep substrate staining cases to the technique sensitive hybridization of dentin, innate strength of the restorative proper, all the while completing the nal restoration morphology in a naturomimetic fashion. A recent systematic review and meta-analysis revealed that under static compressive load, there is no signi cant di erence between direct and indirect composite restorations, whether subjected to cuspal coverage or not2. is analysis, however, does not highlight the Achilles heel of large volume composite restorations. Indeed, both decreased exural strength and lower elastic modulus are variables that fall short when composite is directly compared to the enamel and dentin biomaterials they are meant to replace. Magne and Oganesyan correlated signi cant exural strength recovery to when a bonded ceramic inlay was utilized over a composite restoration with lower cuspal exure created, as this can be attributed to its ability to mimic and restore the exural modulus of the enamel shell1. In the modern dental surgery, clinicians not only need to be empathetic and exible to patients’ demands for resin placement in situations that historically would have meant certain compromise; they also need to be cognizant of new generation composite materials that expedite placement, minimize required armamentarium, and exhibit superior polishability with optimized exural strength designed to maximize placement indications. Background A 21 year old ASA I male with controlled epilepsy presented to the practice for a comprehensive dental examination. His chief concern revolved around a history of molar-incisor hypomineralization, with a history of multiple repeated restorative episodes from an early age. Despite having no overt sensitivity, he was aware that many of the restorations on his teeth were failing and in a state of disrepair, which was con rmed clinically, along with a number of new carious lesions with radiographic depths of penetration indicating treatment. Treatment was planned to restore failing composite restorations on teeth 3.7 occlusobuccal, 3.6 occlusal with a separate buccal pit and radiographically-determined caries a ecting 3.4 occlusodistal. Using the CLEARFIL MAJESTY™ ES Flow and CLEARFIL MAJESTY™ ES-2 Universal combination: Expediting Excellence in Direct Functional Esthetics By Clarence P. Tam, HBSc, DDS, AAACD, FIADFE Clarence P. Tam Figure 1 & 2. Pre-operative situation Figure 3. Initial preparations Figure 4. Completed preparations Figure 5. Matrix assembly e patient was anesthetized using 1 carpule of a 2% Lignocaine solution with 1:100,000 epinephrine via inferior alveolar nerve block. A rubber dam was a xed (Nictone Synthetic Rubber Dam Medium, MDC Dental) and the preparations completed. e cavosurface margins were A Garrison dead soft metal matrix was placed on the distal aspect of tooth 3.4 prior to being secured by a suitable wedge. gently bevelled prior to adhesive substrate optimization using air particle abrasion (29 micron aluminum oxide) and calcium sodium phosphosilicate powder (AquaCare Sylc Powder, Veloplex International) at a pressure of 3 bar. e Strata-G™ tension ring (Garrison) applied a signi cant separation force to the teeth, allowing the re-creation of maximum contact strength. e enamel was selectively etched for 15 seconds prior to extending onto dentin for an additional 10 seconds, followed by copious water
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