GAP Australasian-Dentist-May June 2019

Category 38 AustrAlAsiAn Dentist D irect posterior restoration procedures are frequently carried out in dental practices – especially the pizza technique in which the final layer of universal composite is modelled, cusp by cusp, to produce an aesthetic result. Although this technique achieves great outcomes, it can be very time consuming. essential lines is a new process that simplifies this process by imitating the anatomical fissures of a posterior tooth. Complex occlusal anatomy is no longer required when essential lines is combined with the use of bulk fill materials. this saves a lot of time in day-to-day dentistry compared to the pizza technique – without compromising aesthetics. increasing efficiency in direct posterior restoration procedures is something that can save lots of time every day, as the treatment is carried out quite frequently in virtually every dental office. Who would not love to skip the laborious cusp-by-cusp build-up procedure and still obtain aesthetically pleasing outcomes? Most probably, every dental practitioner does. the good news: it is possible today, thanks to simplified techniques and innovative materials, as shown by Dr Jordi Manauta and Dr Anna salat from styleitaliano™ in a 3M-sponsored workshop held at the BACD 14th Annual Conference in london. Pizza technique When the first generation bulk fill materials were launched, they allowed for some simplification in posterior restorative procedures: With the option of applying the material in 4 mm instead of 2 mm layers, it became possible to fill many cavities in one go. On top, a layer of universal composite had to be applied to provide for the required mechanical strength. in order to ensure aesthetic results, this final layer is usually modelled cusp-by-cusp (pizza technique). Great outcomes can be achieved with this technique, however, for everyday clinical procedures, it is still too time-consuming. Essential lines With this in mind, styleitaliano developed a new technique called essential lines. the team started from the assumption that anatomy is the most important factor in the posterior area, and that the fissures are an essential part of it: “A posterior tooth without fissures is like a face without eyes. if we put lines into the right place, we are even able to fool the eye and create a 3D effect on an almost flat surface,” explains Dr Anna salat. Hence, given that the fissures are imitated correctly, a complex occlusal anatomy is no longer required. to ensure that each tooth is given the right lines (fissures), different teeth were compared and the essential lines which are found in every tooth of a certain position determined. For the first practical exercise, the participants received a card with those lines. they were asked to extrude the content of one capsule of 3M™ Filtek™ supreme Xte universal restorative on the card, and condense it to create a flat surface. “When you start drawing the lines, you should proceed with the instruments like you do with your feet when walking through deep snow,” said Dr Jordi Manauta. the participants defined the central point of the tooth first with the Fissura instrument (lM Arte) and then proceeded as demonstrated. After opening the fissures, they were closed again carefully using the instrument and a brush. Clinical workflow subsequently, a clinical procedure was demonstrated – with lots of tips and tricks from the workshop instructors. According to them, diagnostics in the posterior region should start with transillumination – a strong light source used to screen teeth with possible lesions. When the required information about the type and size of the defect is available, further steps can be planned more accurately. if a box preparation needs to be carried out, it may be useful to copy the available anatomy with a custom ring. it is produced by applying a small amount of light-curing block-out resin or flowable composite in the proximal areas. After light curing, the ring is placed in the desired position and more resin is applied, so that the ends of the ring are completely embedded in the material. “in case of a short crown, you will have to struggle with a lack of space: rubber dam, wedge, matrix and ring may not remain in the desired position. this Joanne Lipman A faster path to posterior aesthetics By Joanne Lipman, uK The speakers: Dr Jordi Manauta and Dr Anna Salat. lInICal Production of the custom rings in the workshop.