Case Report
A 19-year-old patient came to our clinic reporting pain experienced while eating in the upper right quadrant. Following a comprehensive clinical examination, carious lesions were identified on the occlusal surfaces of teeth 15, 16, and 17. Notably, the enamel of these teeth has been largely preserved, presenting an opportune scenario for anatomical replication. However, it is crucial to note that the dentine of these teeth has sustained significant damage due to the severity of the carious lesions.
Figure 1 distinctly illustrates a brownish discolouration within the teeth, and upon probing, it was evident that these cavities exhibited considerable depth.
Figure 2: In every restorative procedure, a rubber dam (Nic Tone Medium) is employed for effective isolation. This practice is paramount to ensuring both patient comfort and the long-term durability of the composite fillings.
Figure 3: The preservation of the original occlusal anatomy will serve as an invaluable guide in our approach to replicate it. We carefully inject a modest quantity of flow composite (e.g., Liquidam) into the central region of the tooth. A small microbrush is then introduced into this composite-filled area, and polymerization is performed for a duration of 10-20 seconds. Additional flow composite is then applied around the microbrush and the existing dental anatomy intended for replication. A subsequent polymerization step is undertaken to solidify this composite layer, forming a stent that will be used to reproduce the original occlusal anatomy of the patient post-restoration.
Figure 4: The carious lesions were removed and the cavities were sandblasted. We are now ready for adhesion.
Figure 5: In this case, the selective etch method was employed. The enamel was subjected to a 37% phosphoric acid etching process for a duration of 30 seconds, followed by thorough rinsing and drying.
Figure 6: After the etching process, the following step involves bonding. In this case, we used GC G Premio Bond.
Method of use: Rub the bond on all surfaces of the cavity for at least 10 seconds, maximum air dry for 5 seconds, and then polymerise for 10 seconds.
Figure 7: Once the Immediate Dentin Sealing (IDS) process is initiated, the bonding to dentin starts, and the hybrid layer gradually matures. It's important to note that the bond strength doesn't instantly achieve its maximum potential; rather, it evolves over time.
The dentin bond reaches approximately 90% of its ultimate strength after 5 minutes.
Following the placement of IDS, the Resin Coating (in this case GC Injectable A2) is applied. It is meticulously distributed in a uniform 0.5 mm thickness across the dentin and the Dentin-Enamel Junction (DEJ) with a periodontal probe. The Resin Coating layer advances towards the developing hybrid layer during polymerization. Allowing the dentin bond to undergo a process known as Decoupling With Time (DWT) ensures that the bond reaches its full potential without being influenced by the faster-forming enamel bond. DWT is also instrumental in addressing potential challenges related to the Hierarchy of Bondability, enabling each dental substrate to attain its maximum bond strength in a stress-free environment (Source: The Hybrid Layer).
In the context of a direct restoration, it is advisable to let the dentin bond mature in a stress-free environment for a minimum of 5 minutes. This period allows the hybrid layer ample time to develop and mature (Source: The Hybrid Layer).
Upon the completion of the maturation process of the bond, the next step involves the filling of the cavity with composite material. For this specific case, we opted for the utilization of G-ænial A’CHORD A2.
G-ænial A’CHORD stands as a universal composite restorative, and introduces a simplified unishade system. This product embodies the perfect equilibrium of simplicity, aesthetic quality, and advanced technology.
Catering to both anterior and posterior restorations, G-ænial A’CHORD presents dentists with a versatile universal composite. Its streamlined unishade system achieves the aesthetic appeal of the classic 16 Vita shades through the incorporation of 5 core shades, facilitating invisible restorations. This not only reduces inventory requirements but also expedites the polishing process, enhancing both time efficiency and cost-effectiveness.
Distinguished by its unique filler technology, G-ænial A’CHORD introduces natural fluorescence that replicates the reflection of natural light. This characteristic ensures imperceptible restorations under various lighting conditions, including natural daylight.
The material's non-sticky consistency, a result of combining a Bis-MEPP monomer and an optimised filler-monomer, empowers dentists to easily sculpt the material using hand instruments or brushes.
G-ænial A’CHORD has remarkable strength, minimal wear, gloss retention, low discolouration, and exceptional radiopacity (Source: GC Europe).
Figure 8: A small ball of G-ænial A’CHORD A2 composite was placed into the cavity and condensed against all walls. The composite is condensed to reach the level of the enamel without overfilling the cavity —a critical consideration.
To facilitate the replication of the initially recorded anatomy, a strategic process is employed. A Teflon tape is positioned above the filled cavity, followed by the placement of the blue stent (the stent we made before drilling the cavity) in accordance with the occlusal anatomy. The stent is then delicately pressed against the teflon into the cavity, applying the necessary pressure to transfer the recorded anatomy to the newly filled space. Subsequently, the Teflon tape is carefully removed, and any excess composite is eliminated.
Once all teeth are filled, glycerine gel is placed all over the cured restorations and then light cured. This results in a composite surface that is harder and easier to polish. The glycerine is then rinsed and the restorations are ready to be polished.
Figure 9: Rubberdam was removed and occlusal adjustments was not necessary due to the fact we copied the patients initial anatomy.
Figure 10: Recall of the patient after 3 weeks shows a beautiful integration of the composite to the tooth surface.
In summary, single-shaded universal composite systems, exemplified by G-ænial A'Chord, has significantly streamlined the process of posterior restoration for dentists, offering exceptional aesthetic and functional outcomes. As a preferred choice for my posterior restorations, this composite enables me to deliver outstanding aesthetic results to patients without compromising on strength or requiring time-consuming steps.
Furthermore, the revolutionary aspect of this composite extends to its simplified three-step polishing procedure, which is essential in achieving a beautiful gloss. This simplification is transformative in our daily filling procedures, underscoring the importance of simplifying processes for enhanced efficiency while consistently yielding outstanding results.
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