Using Occlusal Stamping Technique with The Greater Curve

1,315 views

Introduction to the case

Examined one of my original Sonicfills. It was a 2 years old large MO composite on #31. Margins were excellent except for a small hard pit void on an occlusal margin. I don’t blame that on the SonicFill material, I can be guilty of such a thing with any composite material. This is conjecture, but I believe the downward forceful pressure of the stamp technique will reduce the occurrence of marginal defects.

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Lengthening Anterior Teeth With Composite

Terry Shaw

General Dentist

Perth-Ando​ver, N.B, Ca​nada

1,874 views

Introduction to the case

69 year old gentleman came in for consult on bonding. Recent crown on right canine had broken off and he was balancing it in place. Lots of wear on remaining anterior teeth. He came back 2 weeks later for an elective root canal so I could place a prefab metal post and bond his crown in place. He was back a month later when I bonded his 5 remaining anterior teeth.

Some one placed a case asking for help with lengthening anterior teeth and I discovered these pictures buried in my computer so thought I’d post them to maybe help answer some questions about the problem.

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Anterior Composite Buildup Using Bioclear Matrices

Introduction to the case

This is my 2nd Bioclear case, just looking for feedback again from all you bondadontists. This one is more Doc Terry style.

91 y.o. male, didn’t like how worn his teeth were.

Filtek SU and Beautifil flow+ again.

It’s a lot of composite, but at age 91 I may have time on my side. You can’t tell from the pictures but the “crowns” are very thick, which I hope will compensate for the lack of posterior occlusion.

Still figuring out the technique. Big thanks to Doc Terry for making it seem possible, in the past I would have told him he needed RCT/post/crowns or a denture. This seems like a good compromise.

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Composite Full Mouth Rehab Using Activa Bioactive Restorative

Introduction to the case

This is one of my most MacGyver cases to date. This patient has extensive damage from wear and erosion and was ready to restore his mouth before it gets any worse. He is now a faithful nightguard wearer but nonetheless, those masseters made me really nervous.

I like to test drive big cases in composite before committing to porcelain because if they’re going to be breaking stuff, it sure helps to figure out why and correct it before proceeding to finals. You can certainly do it with just a bisacryl overlay but it tends to pop off and you can’t really leave it on as a buildup. Doing the mockup in a real composite allows you to break the teeth up individually for flossing and allow them to wear it longer. It also serves as a buildup by filling in deficient areas of tooth.

In this case, I generated a template from a waxup and used it to injection mold the intraoral mockup. The contacts were broken by inserting mylar strips interproximally.

I chose to use Activa here for a variety of reasons. It is injectable, it’s dual cure, it doesn’t have to have a bonding agent, and it is very resistant to wear and chipping. The bioactive aspect is icing on the cake making it far less likely to have secondary decay.

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16yo Non-Compliant Ortho Patient with Large Anterior Carious Lesions

Jonathan Held

General Dentist

Sioux Falls, SD

1,719 views

Introduction to the case

16 year old female presented with full ortho maxilla and Mandible. Patient had been in ortho for 2 years. Patient had very poor oral hygiene and presented with generalized decay in posterior and anterior, as well as deep carious lesions around ortho brackets. I called referring orthodontist to discuss case and patient’s hygiene regimen. Orthodontist stated that patient’s ortho treatment plan would last at minimum another year if we continued treatment. We made the decision to discontinue orthodontic treatment to address deep decay and improve oral hygiene. A few posterior teeth with deeper decay were addressed first and then we addressed anterior teeth following prophylaxis and a few weeks of healing. Full extent of decay was visualized following removal of brackets. Treatment plan included restoring anterior teeth with composite restorations with future need for full coverage crowns once patient’s homecare improves. Patient was seen in one visit to remove maxillary anterior decay and restore with Filtec Supreme Ultra composite. Greater curve bands were used for all restorations. Pictures show pre-treatment and post treatment, with a 2 week follow-up.

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Creating a Color Blend for Class V’s

2,566 views

Introduction to the case

Creating a color blend for Class V’s can be frustrating. Give this technique a try. As an added bonus you will realize a stronger bonded restoration.

Using SureFil SDR flow as the first layer over the entire surface of the prep creates a low stress strong bond to dentin. The SureFil also creates a semi translucent layer which is covered by the Filtek Supreme Ultra “Body” layer. The result is a blended composite that reflects light much like the surrounding tooth structure. If the color is off, the result will still look respectable.

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The “Poor Man’s” CEREC Crown

Introduction to the case

I posted this technique before but wanted to show it with a little more detail: link to technique.

#3 has distal decay, existing large MO filling, separate buccal and lingual amalgam fillings and some ugly looking cracks. Tooth is periodontally involved and is also unopposed. What do you do for this tooth? In my view it’s only value is for esthetics unless she opts to restore the bottom. Considering that and the perio, I hate to recommend an expensive crown. I would also hate to try an MODBLXYZ filling. This is the perfect scenario for the poor man’s cerec crown.

  • 1. Preop dual arch impression.

  • 2. Remove all decay and old restorative – in this case that didn’t leave me with much othere than a few thin cusp tips.

  • 3. Prep for full coverage staying supra G where possible and preparing a nice readable should margin and smooth edges- much like a cerec prep.

  • 4. Using the impression, place dual cured composite (I use Injectafill) in the tooth site just as you would to make temporary.

  • 5. Remove at exactly 1:30 sec.

  • 6. Allow to self cure or hit it with light.

  • 7. Trim as you would a temp- gotta get this part right becaus this is the definitive restoration. You can leave a little excess buccal and lingual as you’ll have access to finish the margins.

  • 8. Try in and verify fit.

  • 9. Sandblast internal.

  • 10. Bond as you would any other composite/all ceramic crown.

  • 11. Clean excess, finish margins, adjust occlusion (shouldn’t be much to adjust given that it is identical to their original tooth.

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Restoring a Fractured Tooth with a Deep Sub-gingival Fracture

Terry Shaw

General Dentist

Perth-Ando​ver, N.B, Ca​nada

4,090 views

Introduction to the case

25 years ago I started restoring these fractured cusps this way and have only lost a couple of the 20-30 plus teeth I have restored this way. Conventional treatment has been extraction in many cases. Some have had previous RCT.

Procedure:
I percolate Javex or bleach (same stuff I use for RC) into the fracture to clean any organic crap out and help just clean the fracture line. Then I wash profusely for 20 seconds to get rid of the bleach. Then dry and etch moving the piece open and close to suck and pump the etch down the crack. Then wash for 3 seconds and since I am using a 4th generation bonding system I place 5-6 coats of primer on the tooth and use a little more than usual to get the primer down the crack. This will take me close to 60 seconds to place these coats of primer and let it evaporate for several seconds between coats. I will sometimes write up my chart while I wait for the primer to evaporate but I know I will get a hybrid layer and good bonding results this way. Then I dry for 5 seconds and liberally apply my bonding resin and push the piece together and cure with my Valo for 20 seconds. My resin is dual cure so it cures well. The tooth is sealed and should function just fine as have the other couple of dozen I have restored this way. Some were restored this way 25 year ago and still working!

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