A clinical cases by our Community member Dr. Salvatore Scolavino.
When treating second-class cavities with the absence of the mesial or distal neighbor tooth, it is rather difficult to create a correct marginal seal because we cannot place a wedge. In fact, without a wedge it is very difficult and sometimes not possible to improve the closure of the sectional matrix on the cervical margin. In this case solutions as Metafix system or Automatrix system are the prime choice, both systems cannot warrant every time a good marginal fit and seal without the help of wedges.
Custom Shield, an idea of Gaetano Paolone and Salvatore Scolavino and the styleitaliano team.
In order to help overcome this issue in a constant and repeatable way, we propose a solution that can solve this everyday problem: The Custom Shield Technique.
In this clinical case we have an old restoration on 27 with proximal caries. The 26 was prepared for an overlay restoration because it was destroyed by a carious process. The proximal space between 26 and 27 is wide therefore it is difficult to have a perfect fit of the sectional matrix on the cervical margin, and also wedging becomes a difficult task. We take a soft silicone or even a putty silicone material and we take an impression of the proximal wall of tooth 27 to obtain the shape of the mesial wall. After the isolation and cavity preparation the adhesive procedures were carried out, immediately after that we put a small layer of flowable bulk fill composite on the bottom of the cavity. Inside of the silicone impression a layer of high viscosity composite was placed and then placed back in the cavity of tooth 27. With indirect vision we can adapt easily the composite and then polymerize it. After the reconstruction of the proximal wall with the Proximal Custom Shield Technique the restoration can be completed by the conventional direct technique.
Fig.1
Preoperative image. We can see the old restoration on 27.
Fig.2
Old occlusal resin restoration, thin proximal ridge and mesial lesion 27.
Fig.3
The impossibility of placing a matrix and a wedge due to the prosthetic work in this case, gives us the possibility of taking an impression of the proximal wall with Light Body silicone to obtain the shape of the mesial wall. The impression can be carried out with a putty silicone, although the light body solution is more precise.
Fig.4
The silicone matrix hardened in place and ready to be taken out.
Fig.5
Detail of the impression, the area copied corresponds to the mesial aspect of the tooth to be restored. The silicon index must be trimmed to be handled better.
Fig.6
With the scalpel blade we remove the excess that can interfere with the rubber dam.
Fig.7
Cavity preparation completed.
Fig.8
Proximal view of the cavity
Fig.9
The cavity after adhesive procedures and after the application of a very thin layer layer of bulk fill flowable to complete the adhesive procedure
Fig.10
Adaptation of the composite inside of the Custom Shield Matrix.
Fig.11
Positioning of the Custom Shield on the 27.
Fig.12
Occlusal view of the Custom Shield in contact with the tooth.
Fig.13
After the polymerization we can see the effect produced from the Custom Shield Technique. Although the wall looks thick, it is extremely thin and empty in the inside.
Fig.14
Bulk fill is placed inside of the cavity and then the occlusal anatomy of the restoration is completed with a conventional body shade or a bulkfill composite in paste.
Fig.15
Final result of the restoration with the Custom Shield Technique.
Bibliography
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