GAP Australasian Dentist Sept Oct 2020

Category Australasian Dentist 47 over contour of the 1st restoration and difficult placement of 2nd band due to tight contact. Composite Resin Layering Technique To minimize the effects of polymerization shrinkage, composite resin layering can be performed using different techniques: horizontal, oblique, or three-sites. In this clinical case, we used a combination of these techniques with soft-start curing (i.e. incremental light-curing programs), which starts at a low intensity of 100 to 250 mW/cm², allowing better composite resin adaptation at the cavity margins before increasing to a standard intensity. Tooth #45 was restored first to help increase visibility during restoration of tooth #46. As the cavity on the premolar was a shallow proximal box, horizontal incremental layering was used with Shofu range of Bioactive composites, Beautifil Injectable XSL shade A2 (Self- Leveling composite resin) injected in small quantity followed by Beautiful II LS shade A2 (packable composite) in snow plow technique. In the final increment the marginal ridge and distal pit area were carved to achieve a more natural occlusal morphology. (Pic 04) The sectional matrix on premolar and ring were removed carefully with the help of artery forceps without dislodging the matrix band placed on molar. The band was burnished with light to medium pressure on the adjacent premolar tooth to ensure proper contour and contact. (Pic 05) To restore the Class II cavity of the molar, a combination of vertical, horizontal and oblique layering technique was adopted. A thin layer of Beautifil Injectable XSL (Self-Leveling composite resin) shade A2 was first injected and spread in the proximal box area and light cured to ensure a complete seal. (Pic 06) clinical Figure 4 – Tooth #45 is restored first. Figure 6 – Spreading of Beautifil Injectable XSL (Self-Leveling composite resin) shade A2 Figure 9 – Final occlusal morphology was achieved with build-up of each cusp Figure 10 – Buccal pit on the same tooth was directly filled with Beautifil Injectable X shade A2 Figure 11 – Final Invisible Restorations post op 7 days. Figure 7 – Converting Class II to Class I Figure 8 – Leaving 1.5mm space for final anatomy Figure 5 – Band from premolar is removed and molar band is burnished with light to medium pressure on the adjacent premolar tooth to ensure proper contour and contact. Followed by the proximal wall and marginal ridge build-up with Beautifil LS II shade A2 to convert the original Class II into a Class I cavity. Once the proximal wall and contact was achieved the matrix band and ring were removed. (Pic 07) The Class I cavity build-up was completed using a combination of Beautifil Injectable XSL and Beautifil II LS packable composite, leaving 1.5mm space for final occlusal anatomy. (Pic 08) Final occlusal morphology was achieved with build-up of each cusp (oblique layering laying technique) using the peripheral grooves as reference. (Pic 09) Buccal pit on tooth same tooth was directly filled with Beautifil Injectable X shade A2 universal restorative where you inject and shape at the same time. (Pic 10) Brown stains were used on the occlusal surface to mimic the adjacent teeth. High points were checked with 40-micron paper and removed with a small round diamond bur while following the tooth anatomy. Finishing and polishing of composite resin even though often neglected with posterior restorations is essential to increase longevity of the restoration. For this case the following finishing & polishing protocol was used: finishing with Dura Green Stone, polishing with OneGloss and super polishing with Super Buff (optional) to achieve a high gloss for the extra enamel like lustre. (Pic 11) Conclusion  Restoration of adjacent posterior teeth with good contour and ideal contacts is essential to ensure predictable outcomes. Simplifying the restorative process with the following helps to increase efficiency and save chair time. Pre-wedging to separate the teeth during restoration and achieve good proximal contact, placement of both matrix bands at one time on