Post by Dr. Clarence P. Tam, HBSc, DDS, FIADFE, AAACD
Happy Weekend, Tea Tribe,
This was an interesting case, completed as a treatment option for a decimated, yet vital 17 with a minimum of clinical crown present intraorally/limited ferrule. This tooth eventually may needa prophylactic root canal to complete an endo-crown, but seeing as the patient wishes to maintain the vitality of this tooth, we completed a bonded core and crown preparation on the tooth, attempting to capture as much vertical natural tooth prep wall as possible.
The amazing Ultradent Gemini dual-wavelength diode laser was used to expose the margin on the mesial aspect (810nm and 980nm) – different wavelengths for different therapeutic action – 980nm is attracted to the water content more resulting in more efficient coagulation and cutting, and has an analgesic-therapeutic function. 810nm requires carbonization of the tip to account for its lesser absorption (10 times less than 980nm) but is an efficient “cutter”).
An alginate impression was taken as we were planning to produce an A-silicone die model (Voco Die Silicone / Grandio SO Inlay Kit), and the use of Template (Clinicians Choice) or another A-silicone will result in impression and die bonding together.
After the Voco Die Silicone was poured, we waited 5 minutes before removal from the impression. At this stage, you are able to free-form composite directly against the adjacent tooth, because you can control the emergence profile after removing the crown after removing it from the elastomeric model, identifying the margin, and tapering this nicely to the contact area. A single shade of A2 Grandio SO was used and incrementally placed, light curing as we went. This technique arguably allows a more complete activation of monomer reaction or polymerization as you can remove the restoration from the model and literally have two UV curing lights at distance = 0mm blasting it from all angles. This theoretically results in a better performing product.
The fissure detail was characterized using the wonderful Voco Final Touch kit (Brown) and after adjustments, the restoration was adhesively cemented as we would any indirect restoration. The crown was prepared using 5% HF (aq) for 45 seconds, rinsed, dried and silane coupling agent applied. The tooth was micro air abraded (27 micron aluminum oxide), selectively etched, 2% CHX (aq) soak, GC G-Premio Bond + Dual Cure Activator applied x 3 coats, air thinned and cemented using G-Cem Linkforce A2. The excess was removed and the restoration finished. Incredible margins, incredible esthetics.
An example of a treatment alternative for structural reinforcement of compromised posterior teeth.
Happy Sunday y’all,
Clarrie
#Gemini #Ultradent #Voco #SemiDirectCrown #GrandioSO #InlaySystem #DieSilicone #SkulptingSkool101 #TamDentalGroup #GC #PremioBond #GCemLinkforce
