A new black coat for the best seller LM Arte

It is quite common for patients to suffer from multiple cavities that require a restorative treatment. The choice to treat them in more than one appointment is also very common among dentists for several reasons, above all time-related and financial.
Ergonomically, though, restoring a full quadrant in one single appointment should be our goal, as we can reduce the total chair-time, manage isolation, adhesion, cavity preparation, finishing, polishing and occlusal check all at once for all the affected teeth, and we can keep our fares as low as reasonable, in accordance with the time saved. We do only need to follow a few easy steps, and be handling the right instruments.

style italiano styleitaliano multiple proximal cavities

Fig.1
A 24 years old patient came to my clinic showing proximal caries on 24, 25 and 26, and old infiltrated fillings on the occlusal surfaces of 26 and 27.

style italiano styleitaliano isolation of entire quadrant

Fig.2
For the reasons stated above, I decided to treat the whole quadrant in one single appointment. I placed the rubber dam from 27 to 11, the wider the operative field, the more comfortable.

style italiano styleitaliano multiple clean cavities

Fig.3
After preparing the cavities, I sandblasted them with the AquaCare with 29 microns Alluminium Oxyde, to prepare them to be etched and bonded.

style italiano styleitaliano selective etching

Fig.4
Starting from 27, I selectively etched the enamel, leaving the etching gel on the tooth surface for 30 seconds. As I etched, I start to rinse generously the gel starting from 27 up to 24.

style italiano styleitaliano light curing bonded sufaces

Fig.5
A universal adhesive is my first choice in posterior areas, as etching the dentine is not required. After brushing it for 30 seconds I cured it for 20 seconds.

style italiano styleitaliano lining cavities with flowable composite

Fig.6
A thin layer (0.5 mm) of flowable composite can be easily and uniformly spread with the Fissura (LM instrument Dark Diamond Edition) to cover the exposed dentine entirely.

style italiano styleitaliano packing composite for proximal build up

Fig.7
Once I placed a sectional matrix for molars (QuickMat 0.25 – Polydentia) and its dedicated myRingFORTE (Polydentia), I built up the proximal walls to the class II cavities one by one by using Condensa first, and the Applica (LM instrument Dark Diamond Edition) after, to get the marginal ridge of each tooth correctly angulated.

styleitaliano style italiano LM Arte Dark Diamond instruments
styleitaliano style italiano LM Arte Dark Diamond instruments
style italiano styleitaliano shaping proximal wall inclination

Fig.8
By using the Applica (LM instrument Dark Diamond Edition – FIN) with an angulation of 45° I could build an almost perfect proximal area can be properly polished and flossed by the patient.

style italiano styleitaliano packing composite following residual anatomical features

Fig.9
After removing the sectional matrix, filling up the cavities becomes really easy thanks to the same instruments and Essential Lines rules. First, I packed the composite altogether with the Condensa in a maximum 2 mm thick layer. The bigger tip can be placed on the existing cusp exploiting the direction of the primary ridge.

style italiano styleitaliano excess composite removal

Fig.10
Working around the crestal perimeter, and keeping the instrument laying on the cavity margins, all the anatomical information is transferred to the composite. Using the smaller tip, I can detail the restoration being even more precise in excess removal.

style italiano styleitaliano modeling occlusal anatomy

Fig.11
The Fissura allows me to trace the center of the modeling and draw the Essential Lines that simulate the natural grooves and can actually make a restoration looking like a natural tooth. The Fissura (LM instrument Dark Diamond Edition – FIN) is highly recommended for this step.

style italiano styleitaliano removing bonding excess

Fig.12
After finishing the restorations, the Eccesso, a scaler-shaped instrument, is used to remove some bonding excess that usually surrounds the cervical area and the composite-tooth interface in the proximal area.

style italiano styleitaliano restored multiple cavities

Fig.13
The final outcome is highly predictable and the finishing and polishing procedures very quick.

style italiano styleitaliano occlusal check after composite restorations

Fig.14
Occlusal check.

style italiano styleitaliano multiple posterior restorations after rubber dam removal

Fig.15

Conclusions

Facing multiple cavities doesn’t have to be stressful. If each step is followed, as shown above, the occlusal check becomes very quick and highly predictable, just having used a single layer of composite and a few, very performing, tools. This allows for huge time savings and for a more predictable result in terms of shape and precision, as the management of multiple proximal areas is accurate and actually a real improvement of the perceived quality by the patient who can floss properly and can be treated in just one, overall shorter, appointment.
The new Dark Diamond Edition of LM instruments is ideal to work faster without renouncing to comfort because of a black coat that makes them non-stick, as stickiness really bothers us when we want to be precise. Moreover, as we usually work with a magnifying system and its dedicated light, the black coat minimizes light reflection. Last but non least, the hygienic maintenance becomes much easier without unpleasant excess of material that often occurs on traditional instruments. The right instruments do really make the difference in this sense.

Bibliography

  1. Chiodera G. Essential Lines. Styleitaliano.org
  2. Giuseppe Chiodera, Giovanna Orsini, Vincenzo Tosco, Riccardo Monterubbianesi, Jordi Manauta, Walter Devoto, Angelo Putignano –  “Essential Lines: a simplified filling and modeling technique for direct posterior composite restorations” – Int J Esthet Dent. 2021 May 10;16(2):168-184.
  3. Kwon Y, Ferracane J, lee IB. “Effect of layering methods, composite type, and flowable liner on the polymerization shrink- age stress of light cured composites.” Dent Mater 2012;28:801–809.
  4. Demarco FF, Corrêa MB, Cenci MS, Mo- raes RR, Opdam NJ. longevity of posterior composite restorations: not only a matter of materials. Dent Mater 2012;28:87–101.
  5. Kwon Oh, Kim Dh, Park Sh. The influ- ence of elastic modulus of base material on the marginal adaptation of direct composite restoration. Oper Dent 2010;35:441–447.
  6. hirata R, Clozza E, Giannini M, et al. Shrinkage assessment of low shrinkage composites using micro-computed tomog- raphy. J Biomed Mater Res B appl Biomater 2015;103:798–806.
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