A healthy 38-year-old male presented with a large resin restoration in tooth No. 14 with poor margins and recurrent decay (Figure 3). His periodontal condition was relatively healthy except for the inflammation of the papilla around the defective restoration. The tooth was asymptomatic and the radiographs were within normal limits. The patient was given the option of either placing an all-ceramic onlay or a direct resin restoration. He chose the direct restoration because of time and financial limitations.
Treatment
Tooth No. 14 was anesthetized with articaine 4% with 1:100,000 epinephrine and a rubber dam placed. After pre-wedging with a wooden wedge, the old
resin was removed using a diamond bur with water spray. The decay was removed with a round bur at slow speed without pulpal damage (Figure 4). Calcimol LC (VOCO) was placed over the pulpal wall and light-cured (Figure 5). A sectional matrix was placed and a Composi-Tight 3-D Fusion wedge (Garrison) was inserted with moderate force (Figure 6). A Composi-Tight 3-D Ring (Garrison) was then placed over the wedge to help separate the teeth and create an ideal contact (Figure 7).
The enamel was then etched with 35% phosphoric acid for 20 seconds (Figure 8). After rinsing and drying thoroughly, the VOCO Futurabond U dual-cure adhesive was applied and agitated for 20 seconds (Figure 9). A 1 mm layer of VOCO’s GrandioSO Heavy Flow was applied along the floor of the mesial box and thoroughly cured (Figure 10). A 4 mm layer of VOCO’s Admira Fusion x-tra was then applied and cured (Figure 11).
Per VOCO, this bulk-fill restorative material does not require capping off with a universal restorative. In this case, I used a 1–2 mm final layer of VOCO’s Admira Fusion for optimal esthetics (Figure 12). The completed resin restoration was thoroughly cured from both facial and lingual after removing the matrix and ring. The final shaping was accomplished using a 7901 and a 7406 finishing bur (Figure 13). The Admira Fusion nano-ORMOCER was then brought to a final polish using rubber polishing points and zinc oxide polishing paste (Figure 14).
Discussion
With good isolation and a sectional matrix system, a predictably excellent result can be obtained with a direct resin restoration. With the introduction of the all-ceramic Admira Fusion’s nano ORMOCER material, we have the added benefits of exceptional biocompatibility, very low shrinkage and shrinkage stress, and high surface hardness. The completed restoration has the potential to last for many years.
