(Afternoon tea pics 2022.5: Kerr Simplishade | Garrison Dental Solutions – North America | Ultradent Products, Inc. Omnimatrix, Peak Universal Bond, Dermadam)
The threshold for requiring bonded indirect porcelain restorations to bolster/restore the coronal stiffness or elastic modulus of a tooth is when 65% of the surface area is restored or greater. Certainly, this threshold has been exceeded in this case, however, due to financial constraints, indirect BPRs are not always possible.
The strategy in this case after reaching caries removal endpoints was to reduce all cusps with a basal thickness of <3mm before utilizing the Aquacare system (29 micron aluminum oxide) to optimize the substrate for adhesive bonding. Peak Universal Bond from Ultradent was utilized prior to a DME procedure utilizing the Omnimatrix with plenty of microlayers placed against the dentin floor to hybridize this zone in the first 5 minutes. After establishing supragingival margins, the matrix is swapped for a conventional Garrison Compositight to build each wall individually, thus controlling ideally the contact point strengths, essentially converting a Class II situation into a Class I.
Layers of a short fiber-reinforced composite, Ever-X (GC America) Flow was applied to increase the fracture toughness of the dentin. The capping composite was applied in a lobe-by-lobe fashion using the adjacent triangular ridge form and angle of declination to the fissure system as a guide. A single shade of #KerrSimplishade Medium was employed with an excellent chameleon effect.
One should consider the tooth sealed, but still susceptible to working and non-working interferences, and thus the occlusion should be dialed in to only contact in light centric if possible.
