Smile Restoration Using a Single-Shade Omni-Chromatic Material - Marty Jablow, DMD
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Date: 08-30-2021 16:16:31 pm
A 38-year-old man presented for a routine dental examination. His chief complaint was, in his words, “I have a lot of cavities.” In fact, he had caries in all 4 quadrants and requested that his teeth be restored without metal fillings. His medical history was normal, so we obtained radiographs to determine the extent of the caries (Tuxedo intraoral sensor and XrayVision 4 software, Apteryx). In addition to radiographs, the caries diagnosis and extent of the decay was confirmed visually under surgical loupe magnification (EyeZoom, Orascoptic) (Figure 1).
Diagnosis
Fortunately, the diagnostics revealed no caries into the pulp, so the only treatment required for the patient’s affected teeth were composite restorations. We obtained intraoral photographs (EyeSpecial C-III, Shofu) and discussed the proposed treatment plan with the patient. He was delighted that he would not have to receive unsightly metal fillings to restore his teeth, and quickly scheduled the necessary appointments to receive his tooth-colored restorations.
Caries Removal and Prep
The patient was anesthetized via a PDL injection (Septocaine, Septodont), and a mouth prop (DryShield) was placed into his mouth to ensure a dry field environment (Figure 2). Caries was removed using an LED micromotor attached to an electric handpiece controller (iOptima, Bien Air), which allowed me to precisely adjust the bur speed. The gross caries was removed using highspeed round burs at 200,000 RPMs and ceramic burs running at 1,500 RPMs were used to remove the deeper decay (Figure 3).
Following caries removal, the enamel was etched with 35% phosphoric acid, and a universal bonding adhesive (Futurabond M+, VOCO) was placed on the enamel and dentin (Figure 4). The preparation was rubbed for 20 seconds, and then air dried for 5 seconds. The bonding adhesive was then light-cured for 20 seconds (Demi Plus, KaVo Kerr). The light output and material curing times were verified using a wireless smart radiometer (checkUP, BlueLight Analytics).
Creating an Esthetic Restoration
A single-shade, all-ceramic-based restorative material (Admira Fusion x-tra, VOCO) was selected for the restorations. This omni-chromatic material provides low polymerization shrinkage and is very easy to polish. Due to its nano-particle filler technology, Admira Fusion x-tra draws color from surrounding tooth structure to match any patient’s dentition with a single shade.
The material was placed into the preparations using a heated composite gun (Phasor, Vista) to improve the flow. The restorations were then cured and polished with finishing burs and polishers (Figure 5).
Conclusion
Postoperative instructions were given to the patient, who was pleased with the restoration and very happy to see the dark areas around his gums looking much better. He shared that he was enthusiastic about completing his remaining caries treatment. I feel enthusiastic, too, because I know that by using Admira Fusion x-tra to restore his smile, these future restorations will blend seamlessly into his existing dentition and create long-term esthetic results.
