41994_Australasian_Dentist_100_EMAG

CATEGORY LINICAL

Adequate treatment of adjacent interproximal defects

Dr Walter Denner

By Dr Walter Denner, Dres. Denner & Denner, Zahnärzte im Medicum Flemingstraße 5, 36041 Fulda-Münsterfeld (Germany) http://dr-denner.de Email: walter@dr-denner.de

Introduction Matrices

and polished should the second be started. e corresponding steps for medium-sized defects are described in the following case documentation. Case description In a 31-year-old male patient with no previous medical history several posterior tooth llings had to be replaced and renewed due to primary and secondary caries. Tooth 26 and tooth 27 had older composite llings. e existing restorations were defective with poor marginal sealing allowing food residues to deposit (Fig. 1). e bite-wing con rmed the clinical ndings (D2), i.e. secondary caries which had only slightly in ltrated the dentin (Fig. 2). e caries excavation, preliminary preparation, and smoothing of the margins of teeth #26-27 was carried out without a rubber dam. After applying the rubber dam, the adhesive lling therapy should be

started (Fig. 3). e thin sectional matrix for molars (contouredmatrix Quickmat Deluxe 0.04 x 6.4 mm, Polydentia) for lling tooth 27 could be easily adapted and tightened cervically (Fig. 4). After the application of an adhesive (Futurabond U, VOCO), the surface of the cavities was covered with a rst thin layer of a owable Nano-Hybrid ORMOCER composite (Admira Fusion Flow, VOCO). Timeline along the treatment steps In order to convert the Class II into a Class I cavity, the marginal ridge was rst built up with a high-viscosity nano-hybrid bulk- ll composite (GrandioSO x-tra, VOCO) (Fig. 5 and 6). Since the material was easy to model and the 0.04 mm thick steel matrix was su ciently stable, the use of a matrix ring was not necessary for this step. is also improved the view and access with the modelling instruments. While building the marginal ridge, it was crucial

and layering technique with a high-viscosity bulk- ll composite adjoining, class II cavities should step-by-step be lled in layers. Nevertheless, a good matrix technique is a prerequisite for a correct composite layering. e following patient case shows how this can be done carefully and rationally. Background Anyone who has successfully treated deep class II cavities with a composite needs a good application technique (DGZ, DGZMK, 2016). e principle has hardly changed in the last 20 to 30 years so that the improvements achieved are rather in the details. For instance, bulk- ll composites have been available for some years now. anks to their lower shrinkage stress and higher translucency, they can be applied and polymerised in layers of mostly 4 mm. As with other composites, attention should be paid to the C-factor (Ausiello et al., 2017). Studies show little di erence in success rates between the various materials and methods (Heintze et al., 2012). Nonetheless, restoration will only be successful if a tried and tested working method is used in an appropriate manner. Matrices should therefore be adapted and wedged precisely to ensure good marginal adaptation and su cient proximal contacts (Hugo, 1999; Denner, 2016). A series of ready-made systems and individually applicable components are available for this purpose. Adjacent defects Very often, two adjacent interproximal defects due to contact contamination of caries or because of existing compromised llings must be treated simultaneously in one session. If so, only one tooth with anatomy shape as perfect as possible should be completed rst. is is best achieved by building up the proximal wall, including the marginal ridge, and converting it into a class I cavity for optimal behaviour during light polymerisation (Putignano et al., 2009). Only once the rst tooth is nished incremental

Fig. 02: The X-ray confirms the clinical findings in the second quadrant. In addition, the bright spots mesially on tooth 37 and distally on tooth 36 allow concluding that there is an proximal caries (C2 = caries in the inner half of enamel).

Fig. 01: In a 31-year-old patient, the defective composite fillings with secondary caries on tooth 26 o-d-p and tooth 27 m-o led to impaction of food residues and to an unpleasant taste but not to pain.

Fig. 04: A sectional matrix band was adapted and wedged. After selective enamel etching, a universal adhesive (Futurabond U, VOCO) was first applied followed by a flowable nano-hybrid ORMOCER composite (Admira Fusion Flow, VOCO).

Fig. 03: The faulty fillings and the secondary caries were removed, and the cavity was prepared. Once the cavity margins were smoothed, the teeth to be treated were isolated with a rubber dam.

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