Predictable Technique and Reliable Materials
A young male patient had neglected his dental health for many years. He presented with extensive recurrent decay under a filling in tooth No. 28 and a smaller area of recurrent decay under an old filling in tooth No. 29. The patient was informed of the extent of the decay before beginning the procedure. Tooth No. 29 also had recurrent decay, necessitating replacement of the amalgam restoration.
After the initial removal of the decay, a caries-disclosing dye, Caries Finder G (Danville Materials), was used to identify residual caries. The dye was rinsed and residual decay was identified on the internal axial wall. Using the dye helps to prevent pulpal intrusion and allows us to create the most conservative preparation possible. Leaving unseen decay can be a reason for post-operative sensitivity and, ultimately, failure of the restoration and tooth.
After completion of the preparations, Danville Materials’ Contact Matrices and Mega V retentive rings were placed over the wedges, and the preparations were air-abraded with a MicroEtcher CD (Danville Materials) and 27 m aluminum oxide powder.
Using the selective etching technique, 37% phosphoric gel etchant Sure Etch (Danville Materials) was carefully placed on the enamel. The objective was to minimize the etching of the dentin with the harsh phosphoric acid. After 15 seconds, the Sure Etch was thoroughly rinsed off with water. Next, the preparation was scrubbed with MicroPrimeG universal desensitizing agent (Danville Materials). MicroPrimeG is a great antimicrobial agent for use with self-etch adhesives without reducing bond strengths. Excess MicroPrimeG was removed with a microbrush so the dentinal surface stayed moist, but not puddled.
We applied Prelude One (Danville Materials), a single-step universal adhesive, to the dentin and enamel for 10 seconds and then air-thinned to evaporate the ethanol solvent. The adhesive was then cured for 10 seconds and the dentinal surface sealed. A layer of shade A-2 Accolade SRO (Danville Materials), a radiopaque flowable composite, was placed in the proximal boxes and on the pulpal floor, followed by multiple layers of an A2 shade universal composite. This technique was used to minimize the effect of C-factor caused by polymerization shrinkage.
After removing the matrices, rings, and wedges, a final cure was performed from the buccal and lingual sides for an additional 10 seconds to ensure complete curing of the composite at the floor of the proximal boxes.
When we completed the restorative work, our patient was pleased with the immediate comfort and improved esthetic results.