Custom Shield

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.

style italiano styleitaliano dentistry

Fig.1
Preoperative image. We can see the old restoration on 27.

style italiano styleitaliano dentistry

Fig.2
Old occlusal resin restoration, thin proximal ridge and mesial lesion 27.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.4
The silicone matrix hardened in place and ready to be taken out.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.6
With the scalpel blade we remove the excess that can interfere with the rubber dam.

style italiano styleitaliano dentistry

Fig.7
Cavity preparation completed.

style italiano styleitaliano dentistry

Fig.8
Proximal view of the cavity

style italiano styleitaliano dentistry

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

style italiano styleitaliano dentistry

Fig.10
Adaptation of the composite inside of the Custom Shield Matrix.

style italiano styleitaliano dentistry

Fig.11
Positioning of the Custom Shield on the 27.

style italiano styleitaliano dentistry

Fig.12
Occlusal view of the Custom Shield in contact with the tooth.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

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.

style italiano styleitaliano dentistry

Fig.15
Final result of the restoration with the Custom Shield Technique.

Bibliography

1. Fabianelli A, Sgarra A, Goracci C, Cantoro A, Pollington S, Ferrari M. Microleakage in class II restorations: open vs closed centripetal build-up technique. Oper Dent. 2010 May-Jun;35(3):308-13.Erratum in: Oper Dent. 2010 Jul-Aug;35(4):487.
2. Baratieri L. Soluciones Clínicas: Fundamentos y Técnicas. São Paulo: Livraria Santos, 2009:255–295.
3. Baratieri LN, Monteiro S. Jr., Spezia de Melo T, Routes For Excellence in restorative Dentistry mastery for beginners and experts: Quintessence International 2014. Vol 1.
4. Baratieri LN, Monteiro S. Jr., Spezia de Melo T, Routes For Excellence in restorative Dentistry mastery for beginners and experts: Quintessence International 2014. Vol 2.
5. Spreafico R. Direct and semi-direct posterior composite restorations. Pract Periodontics Aesthet Dent 1996;8:703–712.
6. Winter R. Visualizing the natural dentition. J Esthet Dent 1993;5:102–117.

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