Page 23 - DP Vol 22 No 1

Fig 4: Rubber dam isolation. Total Etch technique with 37% phosphoric acid Fig 5: Build up complete with 3M Easy match Bright composite

was scrubbed for 20 seconds followed by air dry for 5 seconds
and curing for 10 seconds.
The isolated teeth were built using a palatal index and 3M
Supreme Flowable as a thin layer acting as a palatal shell. The
incisal areas were built in Single shade Bright Easy match from
start to end. It was noticed that near the incisal edges the material
behaved translucent and behaved opaque in thicker sections. The
build up was cured after applying the K Y Jelly for 40 seconds
to ensure the elimination of oxygen inhibition zone before
mechanically finishing and polishing. A high gloss result was
achieved by using 3M Sof-lex discs & spirals. Lustre was achieved
using Lucida diamond polishing system with the buff. The
occlusal movements were checked and a guard was fabricated for
the lower jaw to prevent further damage. The patient was made
Fig 6: Post operative situation - Finishing and polishing done using 3M Sof- aware of the parafunctional habit and was asked to come for
lex discs and spirals showing seamless blending of the Easy match with the
tooth surface. Lucida with buff was used at slow speed for final gloss. regular follow ups to keep a watch on the restorations.

CASE 2
A 39-year-old male presented to the practice concerned about his failing
restorations. Further clinical examination showed leaking and fractured
composite and amalgam fillings leading to sensitivity and food impaction.
It was decided to remove the existing fillings and replace them with
fibre reinforced composite restorations.

Polymerization shrinkage and stress
Composite intrinsically has a tendency to undergo polymerization
shrinkage. This shrinkage can lead to stress at the bonding interface
leading to postoperative pain, discomfort, cuspal flexure, marginal
staining and secondary decay. For large restorations it is imperative
that the clinician uses appropriate bulk fill materials and decoupling Fig 7: Pre op situation - Patient was concerned about his failing
concepts that can control shrinkage and ensure the restoration is durable fillings and amalgam related mercury toxicity. It was decided to
and functional. change these fillings under rubber dam isolation to prevent any
accidental ingestion
Using the Intuitive colour Shade selection, we decided to use Natural
Easy Match Universal Restorative material in this case. The Easy Match is
a Nanofilled composite with silica and zirconia particles. The inorganic Substrate preparation
loading is 78.5% by weight making it an appropriate material for Air abrasion with 29 micron alumium oxide particles was carried
posterior teeth while offering the ease of shade matching and aesthetics out. Selective etch using 37% phosphoric acid was used to etch
needed for a seamless restoration. enamel. After application of 3M Single bond universal and air
The teeth were isolated using Rubber Dam and amalgam was removed drying, it was cured for 10 seconds .
using a medium sized round bur. Once the fillings were removed, a Build up: 3M Supreme Flowable was used in a thickness of
caries indicating dye – Sable seek (Ultradent) was used to determine if 1 mm as a base layer. The Bulkfill flowable was then used along
the area is caries free. The Peripheral Seal Zone is established to ensure with Composite fibres to counteract polymerization shrinkage.
that the walls are completely caries free thus achieving predictable bond The proximal walls were built using Palodent sectional matrices
strengths. (Dentsply) using the snow plough technique. The occlusal 1.5 to

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