GAETANO PAOLONE DIRECT POSTERIORS CUSTOM SHIELD PART 2

Transcription

1 GAETANO PAOLONE DIRECT POSTERIORS CUSTOM SHIELD PART Views - Feb 2015 When treating class II cavities very often the buccal, palatal or lingual cusp thickness is too thin. Generally when the thickness is less than 2-2.5mm reducing cusp s height is a recommended procedure. After that a direct or an indirect restoration solution has to be taken. If a direct restoration is chosen, it is very difficult to restore cusp s height and shape in a free-hand method. With the Custom Shield technique the height and the anatomy of the cusp are registered before its reduction through the use of a silicone index. This index is then used to mold directly the cusp exactly as it was before reduction. Fig. 1- Initial situation: an old filling with secondary caries has to be treated on this upper molar. Page 1 of 6

2 Fig. 2- Isolation is performed Fig. 3- During the preparation it is suddenly clear that buccal cusp will be very thin, for sure less than 2mm thick. Fig. 4- The custom shield is obtained placing a small amount of impression material buccally and slightly occlusally. Page 2 of 6

3 Fig. 5- Once the silicone has polymerized, the cavity is completed and the cusp reduced. Fig. 6- The custom shield is then marked with a sharpened instrument (Fissura LM Arte) and the composite is placed on the marked area without curing. Fig. 7- The custom shield is then placed on the teeth after adhesive procedures and the composite adapted with brushes or instruments. After the adaptation, composite is cured. Page 3 of 6

4 Fig. 8- After curing, the buccal wall of the interproximal space has to be finished with a bur or with a disc. In this way a conventional sectional matrix can be placed along with a wedge and a ring. Class II is then transformed in class I. Fig. 9- The Simultaneous Modelling Technique (SMT) is used to achieve a natural anatomy in an easy way. Fig. 10- The final result after polishing Page 4 of 6

5 Fig. 11- Right after dental dam removal Fig. 12- Occlusal check 1 week post-op Page 5 of 6

6 Fig months post-op. To read about the first part of the article click here Custom Shield Part 1 [1] Lopes GC1 et al. Direct composite resin restorations: a review of some clinical procedures to achieve predictable results in posterior teeth. J Esthet Restor Dent. 2004;16(1):19-31; discussion 32. [2] Boer WM. Simple guidelines for aesthetic success with composite resin part II: posterior restorations. Pract Proced Aesthet Dent May;19(4):243-7; quiz 248. [3] Schlichting LH, Monteiro S Jr, Baratieri LN. A new proposal to optimize the occlusal margin in direct resin composite restorations of posterior teeth. Eur J Esthet Dent Winter;3(4): [4] Klaff D. Blending Incremental and Stratified Layering Techniques to Produce an Esthetic Posterior Composite Resin Restoration with a Predictable Prognosis. J Esthet Restor Dent 2001;13: [5] Dietschi D., Spreafico R. Adhesive metal free restorations current concepts in the aesthetic treatment of posterior teeth. Quintessence Publ [6] Baratieri LN, Monteiro Júnior S, Correa M, Ritter AV. Posterior resin composite restorations: a new technique. Quintessence Int Nov;27(11): [7] Bichacho N. The centripetal build-up for composite resin posterior restorations. Pract Periodontics Aesthet Dent 1994;6: [8] Kano P. Challenging Nature: Wax-up Techniques in Aesthetics and Functional Occlusion. Quintessence Publishing Co Ltd [9] Krifka S, Anthofer T, Fritzsch M, Hiller KA, Schmalz G, Federlin M. Ceramic inlays and partial ceramic crowns: influence of remaining cusp wall thickness on the marginal integrity and enamel crack formation in vitro. Oper Dent JanFeb;34(1): [10] Fichera G., Re C. Restauri estetico-adesivi indiretti: modello per diagnosi di configurazione cavitaria. Dentista Moderno 2006:21-57 [11] Denehy G, Cobb D. Impression matrix technique for cusp replacement using direct composite resin. J Esthet Restor Dent. 2004;16(4): Visit: Page 6 of 6