Using Occlusal Stamping Technique with The Greater Curve

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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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Palatal Shelf Technique on #8 MIFL

Introduction to the case

Pipe to the face chipped the MIFL composite on #8. The most predictable way to do these for me is to use the “palatal shelf” technique with the shelf being made of a super thin layer of enamel shade composite, then a dentin shade composite to replace all the dentin, and then the last .5 mm being enamel shade again.

To create the palatal shelf, a matrix is needed and there are 3 methods to get it:

  1. Do a preop waxup and create a putty on the model (most ideal)
  2. Do an intraoral mockup very quickly and then create the putty in the mouth
  3. Finally, what I usually do just for the sake of time is I’ll make the putty with no mockup and then use a bur to create the “negative impression” to where the tooth should be (BRB technique). This is obviously easier when there’s not a lot of tooth missing.

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Immediate Implant with Cement Retained Provisional Crown

Introduction to the case

Pt. presented w/ #8 w/ severely resorbed root (from ortho extrusion) and symptomatic. Pt. has very low smile line which works in our favor. Tx. planned for extraction, immediate placement and provisional. 4.3X13mm Nobel replace select groovy implant placed and temped using nobel screw down temp abutment. Picked up the white cylinder w/ luxatemp and tooth taken out of occlusion and all movements. Immediately temping this case with the temporary abutment and cement retained provisional crown worked nicely.

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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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