Let us recommend reading the first “Composite Ball Technique” article describing the possibility of rehabilitating worn dentition with a simplified technique and without tooth preparation before reading this one.
Said article presented a clinical case involving a new method, where more predictable stability was achieved by a “composite ball technique”.
Some clinicians who have been using the technique have reported difficulties with replicating a correct premolar anatomy due to the flexibility of the transparent silicone, leading to possible anatomical discrepancies as a result of pressing the heated composite resin material. The smaller dimensions of premolars compared to molars makes the silicone index much more susceptible to discrepancy during the restoration process.
Fig.1
This photo illustrates the wax up with the precut silicone index.
Fig.2
This photo illustrates the lower anterior wax-up with the precut silicone index.
Fig.3
The index was also scalloped with a no. 10 blade, in order to establish the reference point at the “composite ball” that was temporarily positioned in the cervical third of the buccal surface (that should be obtained before taking impressions in order to fabricate the wax up with the “composite ball” in place).
Fig.4
Then, in each silicone block, the occlusal chimney was created and the passage was evaluated with the Fissura instrument (LM).
Fig.5
Pattern resin was mixed according to the manufacturer’s instructions and placed onto the index surface in order to make it more rigid and less susceptible for the volume distortion. Prior to applying the pattern resin, the occlusal surface of the index was covered by a layer of universal tray adhesive.
Fig.6
Precut silicone blocks, reinforced with the pattern resin – ready to use for direct restorations.
Fig.7
Heated composite resin was pressed with the cut and stiffened silicone index.
Fig.8
The direct composite restoration after a 3-second occlusal pre-polymerization. As you can see, resin excess flowed through the chimney. This pre-polymerization enables easy and predictable excess removal (with a cutting motion of blade no 12) before final curing.
Fig.9
The clinical situation after removing composite excess and curing, before finishing and polishing.
Fig.10
Direct restorations of lower, right premolars with the rigid silicone index.
Fig.11
The posteriors were restored with cut transparent silicone index, while a conventional layered technique based on hard, laboratory silicone index (as described in the previous article) was used for the anteriors.
Fig.12
In case of indirect restorations are needed (35, indirect onlay; 36, screw retained FPD), they are obtained after VDO augmentation with direct restorations and adequate balancing.
Fig.13
Recall at 3 months.
Conclusions
- The Full Occlusal Rehabilitation with direct composite restorations is a conservative no-prep option that can be widely applied to our clinical practice today.
- The index technique can be the recommended method of transferring the occlusal anatomy from the wax up, especially when structural loss does not severely compromise the proximal walls.
- “The composite ball” technique seems to be an accurate solution in order to facilitate the stable position of the index and to avoid the index displacement.
- “The Stiff index” technique prevents discrepancies in the final restoration anatomy.
- “The Stiff index” technique allows for a more secure handling of the index blocks during the restoration process.
- “The Stiff Index” technique is easy to replicate in every clinical practice.
Bibliography
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