GAP Australasian Dentist Sept Oct 2020

Category Australasian Dentist 39 HeatSync composite heater is shown (Fig. 9) loaded with Unidose compules with Filtek Supreme Ultra Restorative “Body” shade regular composite and the matching Filtek Supreme Ultra Flowable Restorative in a syringe. In 2019 a simpler and prescriptive Bioclear Black Triangle kit was introduced to treat maxillary and mandibular black triangles. Because of the popularity of the new kit, I will show a similar case with the new Black Triangle Kit. The kit is shown in Figure 10 with the four important components, the large tooth tub and small tooth tub of colour coded for curvature types, a gauge with corresponding colours that binds at one of four triangle widths, contact sanders, and disclosing solution. Additional components are explained in the body of the article. Before the rubber dam is placed, the TruContact sanders are used to groom the contacts to remove calculus and to lighten the tension of the contact areas, allowing the matrices to seat fully (Fig. 12). Once the rubber dam is placed, the teeth are disclosed and then blasted with an air/ water/ abrasive slurry of aluminum try- hydroxide (Figs. 11 & 13) with the Bioclear Blaster. This step is critical because the 37 per cent phosphoric acid used to condition the teeth does not remove the soft, sticky biofilm that covers the tooth. In addition, it is critical to remove the protein pellicle on the tooth to achieve an ideal bond. Nowhere is biofilm removal more challenging and more critical than the interproximal area where access by traditional scalers and prophy cups is difficult. Next, the Black Triangle gauge inserted buccal-lingually below the contact to assess the mesio-distal size of the black triangle (Figs. 14 & 15). The gauge will bind at one of the four colours that correspond to curvature shapes of appropriate matrices with the matching colour. In this case the midline embrasure between 31 and 41 was measured to a “yellow” space and the central-lateral space between the 31 and the 32 measured smaller with a “pink” portion of the gauge. Then a pair of correspondingly coloured Bioclear Black Triangle matrices are tried in for each embrasure. Although we measure and pair the matrices for each embrasure, the injection molding is performed one tooth at a time to allow for a monolithic, stain resistant outcome. There are two cups of colour-coded matrices, one cup is for ”small” teeth and one cup is for “large” teeth. For this lower arch, lower incisors are considered small teeth and the canine teeth are considered as large. Tooth #41 is injectionmolded first. The yellow matrices are placed at the midline (Fig. 16). The other embrasures were a mix of yellow and pink gauged spaces. “Shield” matrices (inactive matrices that shield the neighbouring teeth) are on either side of the tooth and will later be used as active matrices. These shield matrices help maintain the embrasure shape as the activematrices, or “aquarium” becomes pressurized and secondarily aid the clinician by keeping the neighbouring tooth clean from resin contamination during injection molding clinical Figure 8. Four-year post-operative portrait of Bridgette who is ecstatic about her Bioclear Treatment. I asked Bridgette what surprised her most about her treatment. Her answer: “I am still in shock that there was a treatment that did not destroy my natural teeth! The Bioclear method is simply an amazing enhancement. I now have a natural looking and flawless smile!” Figures 2,3. Retracted views show multiple aesthetic and functional compromises of the completed orthodontic and slightly relapsed case, including mild rotations, undersized maxillary lateral incisors, an uneven incisal edge display on the lower incisors, in addition to the wide range of black triangle sizes resultant from adult orthodontics. Figures 4,5. Immediate postopeartive view shows immediate tissue remodeling with some clotting tissue completing the space closure on the day of treatment. Figure 5 is the 4-year postoperative result. The robust papillae have been described by Dr Peter Nordland, a California periodontist who routinely performs microsurgical regenerative periodontal procedures, as restoratively driven papilla regeneration. The Filtek Supreme Ultra flowable plus paste combination has perfect color matching and the monolithic, shrink wrapped tooth-restoration complex shows remarkable stain resistance and shine retention. Figures 6,7. Pre-operative (Fig. 6) and 4-year follow-up radiograph (Fig. 7) of the lower incisors is shown. After viewing the radiographic integrity and the long term favourable soft tissue response, most periodontists and orthodontists feel comfortable with the Bioclear Method as a conservative, permanent and healthy option for treating dental black triangles. Figure 9. The Bioclear HeatSync composite warmer is shown with full view and close-up view of the receptacles for both the loose compule oven, compule in syringe receptacles, and flowable receptacles. Figure 10. The Bioclear Black Triangle kit is shown with the gauging instrument, disclosing solution, TruContact sanders, and small and large incisor tubs with the 4 colour-coded curvatures. 2 3 4 5 6 7