The Closing Gap technique in the Styleitaliano way

A clinical case by our Community member Dr. Francisca Micola

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Restoring class V can be challenging in some cases, depending on the depth of the lesion in the gingival sulcus.
There are several different etiological factors that may lead to a class 5 lesion: caries due to poor hygiene (or after orthodontic treatment), abrasion/erosion (due to the contact of acids with teeth, brushing the teeth too aggressive), abfraction which is common when the forces are not properly distributed.

cervical carious lesions on lower canine and premolar

Fig.1
In this specific case, the lesions are located in the cervical area, deep below the gingival sulcus. In such cases, the rubber dam is mandatory to obtain a good isolation and retraction of the soft tissues.

isolation and clean class V cavities on lower teeth

Fig.2
The decayed tissue was removed using a high speed round diamond bur, followed by a low speed carbide bur for debris removal.

detail of inspiration and cavity cervical margin

Fig.3
Close-up shows good isolation and retraction of the soft tissues after caries removal. Selective etching of the enamel with 37% orthophosphoric acid was followed by rinsing and drying (thoroughly). Application of a universal bonding adhesive in a thin layer and extended 1 minute polymerization were carried out to ensure a perfect hybrid layer.

layering of composite in the closing technique

Fig.4
Composite stratification, from the incisal to the cervical surface following Closing Gap technique by Jordi Manauta . I helped myself with a spatula to obtain a better retraction of the papilla. Composite was applied on the buccal and adapted to recreate the morphology of the tooth. With a spatula (LM Arte Applica) a gap was opened in the cervical area, which would be filled up with composite as the following step.

light curing of class V restorations

Fig.5
Polymerization of the composite was made. After restoration of tooth 43 was done, the cervical gap on tooth 44, which would be then closed.

polishing paste for class V composite restorations

Fig.6
Restorations were polished using diamond paste and a low speed brush, and silicone wheels.

restored cervical lesions with rubber dam isolation

Fig.7
The final result.

detail of perfect margin adaptation of class V composite

Fig.8
Close-up on the final result. The margins are perfectly sealed.

Conclusions

The secret to reducing the polymerization shrinkage, and to avoiding cervical debonding is to create a gap in the cervical area and adapt very well the composite. The use of rubber dam simplifies all the clinical steps because it provides good visibility and perfect isolation.

Bibliography

1. Young D, Nový B, Zeller G, Hale R, Hart T, Truelove E. The American Dental Association Caries Classification System for Clinical Practice. A report of the American Dental Association Council on Scientific Affairs. JADA 2015;146(2).
2. Veneziani M. Adhesive restorations in the posterior area with subgingival cervical margins: new classification and differentiated treatment approach. Eur J Esteth Dent. 2010;5:50-76.

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