GAP Australasian Dentist Sept Oct 2020

Category 40 Australasian Dentist with the active matrices. The matrixed tooth #41 is acid etched, rinsed and dried. Scotchbond Universal adhesive is placed on enamel, massaged into dentin for 20 seconds, air thinned but not light cured. Then heated Filtek Supreme Ultra Flowable, followed with heated Filtek Supreme paste are injected into the “aquarium” (Fig. 17). The matrices are massaged back to shape with the unique paddle instrument, and gingival excess in the “umbilicus” area is brushed away with dry brushes. The supragingival excess in the umbilicus is maintained as to not disturb the composite. Little to no hand manipulation of the composite is the goal with injection molding. Once thoroughly light cured, the shepherd matrices and the active matrices are removed. The excess areas are quickly amputated with a coarse flame bur (Komet) dry. Then the tooth is taken to 80% of the final shape with the 3M Sof- Lex coarse disc. Then we move on and set the “aquarium matrices and shield matrix the next teeth, #31 and 32 (Fig. 18). The process is repeated one tooth at a time until the canine spaces are closed. clinical Figure 12. The contacts are sanded in sequence to lighten the tension of the contacts. This will in turn allow full seating of the matrices. A secondary benefit is to remove hard and soft biofilm which is common to the peri-contact area. Figure 11. The teeth are isolated with a heavy rubber dam (Hygienic), dried, then disclosed with the dual colour disclosing solution, then blasted with the Bioclear Blaster with aluminum tri-hydroxide powder with high pressure air and water. Figure 13. The tandem of disclosing solution and then Bioclear Blaster are pictured. Biofilm is almost invisible to clinicians, even when we use microscopes. Staining and then blasting is critical to the additive process of injection overmolding in order to adequately etch and then bond to un-cut enamel and dentin. Figures 14,15. The Bioclear Black Triangle Gauge (patent pending) is shown in two of the five embrasures that will subsequently be treated. Color coded matrices will subsequently be utilized that match the coloured area of the gauge where it binds when viewed from the incisal. Warming up to the concept of heated composite Pre-operative radiographs and four year follow up radiographs (Figs. 6 & 7) demonstrate the exquisite adaption of composite to the root of the tooth apical to the gingival sulcus. Those who are first-time observers of post-operative bitewing radiographs of well-done Bioclear cases are often surprised at the marginal integrity, and the ability to inject composite into a very acute matrix-tooth interface. Heating of both the flowable and paste composites is incredibly helpful when doing injection molded composite dentistry. 3M has published and/ or commissioned studies to demonstrate the safety and efficacy of warming for select 3M composites. 4-6 In short, heating of Filtek Composites is proven be safe to both the composite and the patient. 7 Two other independent studies by Dr Richard Price at Dalhousie and Alex Fok at MDRCBB in Minnesota have shown significant reduction in voids when the Bioclear method with heated Filtek flowable and paste composites are utilized, when compared cold hand layered composites. In all there are four keys to achieving these types of results on a routine basis: The final step: the rock star polish There are three phases of the final polish. First a worn Sof-Lex XT disc is used to create a matte finish and to remove any deep scratches left by the diamond bur. Next Magic Mix (Bioclear) is used in a disposable cup to create omni-directional finer scratches. Next, the teeth are carefully cleaned off and then a diamond impregnated cup (RSP Polisher Bioclear) is used dry with light pressure. Care should be taken with any polisher used dry, as it can create ferocious heat. Then the same diamond impregnated cup is used in the final segment with copious air-water spray and heavy pressure to get the ultra-glossy appearance that sets 14 15