Direct MO restoration with a new universal composite material

A 27-year-old female presented with deep initial decay on tooth no. 15. Clinical testing indicated normal pulpal response to cold, a negative response to percussion and palpation, and an asymptomatic tooth. An MO restoration was necessary to restore the tooth to proper form and function.

In this case, conservative caries removal allowed the clinician to maximize bond strength while minimizing pulpal trauma and reduce the risk of exposure in a vital asymptomatic tooth.

Restoring the proximal wall initially allows more time for the dentin bond to mature before adding subsequent dentin replacement layers, thus lessening polymerization stress. Preoperative radiographs of the affected tooth were taken, confirming deep initial decay on tooth no. 15 (figure 1). An ideal restorative environment and isolation were achieved with a rubber dam. A light blue Isodam (Four D) was utilized, which provides better visual clarity and light reflection. The Isodam was anchored with a W8A clamp (Hu-Friedy) for better restorative access when placing sectional matrices after cavity preparation

(figure 2).Methodic caries removal using traditional techniques with a high-speed pear diamond was utilized. Gross removal of outer carious dentin and approaching inner carious dentin was accomplished with a high-speed round diamond. As inner caries dentin was reached, the Caries Detector (Kuraray Noritake) was utilized for a visual aid in caries removal. Once a clean peripheral seal zone was achieved, the cavosurface was smoothed with a flame-shaped finishing carbide in the interproximal and a football-shaped carbide for the occlusal (figure 3).

Next, a sectional matrix (Garrison Dental) was placed and burnished with a spoon to facilitate a broad adaptation of the band to the adjacent tooth (figure 4). A Palodent V3 ring (Dentsply Sirona) was placed for separation and to ensure a tight resultant contact.

Clearfil Majesty ES-2 Universal composite (Kuraray Noritake) was selected as the restorative material. It provides easy adaptation due to its creamy consistency that prevents adherence to instruments. This composite material maintains its shape and contours prior to curing, allowing the clinician to create anatomy during placement. As this composite is a universal shade, it allows the

clinician to streamline inventory and accomplish efficient procedures by having a single shade for many clinical scenarios.

Selective-etch technique was employed on the exposed and uncut enamel, followed by an application of Clearfil SE Protect Primer and Clearfil SE Bond. The bonding agent was lightly thinned with air and cured. The composite was placed along the dentin and proximal box margins to achieve a seal around the matrix band.

The mesial proximal wall was completed first using the universal composite to avoid additional stress on the dentin, similar to a class I restorative scenario. Next, Clearfil AP-X was placed in 1 mm horizontal increments as a dentinal replacement, followed by placement of final layers of the composite in cuspal increments for easy shade matching and blending with surrounding natural tooth structure.Finishing and shaping was completed using a flame carbide, high-speed Arkansas flame stone, and polishing was achieved with a Brownie (figure 5). At the conclusion of the case, we were able to provide this young patient with an excellent esthetic and functional outcome while saving treatment time

(figure 6). Editor's note:This article appeared in the July 2021 print edition ofDental Economics.

Jason Boeskin, DMD, is a 2017 graduate of A.T. Still University. He practices in Yuma, Arizona, focusing on CEREC and conservative preparation and bonding techniques, as well as traditional restorative dentistry.