A clinical case by our Community member Dr Hugo Palma
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.
During my professional practice, I’ve been searching for a technique that’s simple, yet effective. Trying to speed up restorations without losing any details and getting every step right was not to be taken for granted until I came to know the “essential lines” technique. I will present to you a clinical case to try and show you why I do think this technique is the most effective one.
Fig.1
Female patient, 30 years old, presented pain upon biting at tooth 46, which had an amalgam restoration with surrounding tooth wear and thermal change sensitivity. We decided to remove the restoration, clean and seal the tooth properly with a composite restoration.
Fig.2
The field was isolated using the Flexi dam by Coltene, fixed with a W3 Clamp from Hu-Friedy. I like to use these wingless clamps when I have to recover a proximal face. A ligature was used around the premolar to keep the rubber dam in place.
Fig.3
Here we can see the amalgam removed and the tooth already cleaned and sandblasted with 29-micron aluminum oxide. We can see quite a healthy dentin because of the “few” years that the amalgam was there. Also, we noticed some cracks on the mesial and buccal going through the enamel but stopping on the DEJ.
Fig.4
For this case I used a sectional matrix, wedges and ring system Composi-Tight® 3D Fusion by Garrison. Usually the blue one has the perfect cervical-occlusal height in between premolars and molars.
Fig.5
I chose a selective etching technique with a 35% acid Etchant Gel S by Coltene. Leaving it for 20 seconds and then washing it off for 20 seconds. Placing the acid where you want is very easy when you work with a viscoelastic material like that one and a high magnification (6.0x).
Fig.6
In this case I went with a self etch adhesive, as I only etched the enamel. I leave total etch approaches to cervical lesions mostly, and the reconstruction of endodontically treated teeth. In this case I used FL Bond II by Shofu.
Fig.7
Photopolimerization done with Valo Grand by Ultradent, 20 seconds each for the adhesive and every composite layer.
Fig.8
Here we can see the proximal wall already reconstructed, and the dentin sealed with a flowable resin. For the proximal I used an A2 Body, Brilliant Everglow by Coltene and molded with the Condensa instrument by LM Dental. I prefer to leave the wedge until the very last moment.
Fig.9
For the dentin layer I chose an A3.5 dentin Shade, Herculite Precis, Kerr, which is a very chromatic shade that goes very well when replacing dentinal tissue. Always staying on dentin and never unifying dentin and enamel with the same layer. Combining two shades, a more chromatic one at the bottom, and a higher value one on top, gives us a very natural look.
Fig.10
With the essential lines technique we just need to add a single layer of composite on top, remove the excess, adapt the composite to the tooth, and start sculpting. For this step I help myself with the Fissura Instrument by LM and Style Italiano, and then I approach those lines with a little dry micro brush. The same shade used on the proximal, A2 Brilliant Everglow by Coltene was used on the final layer.
Fig.11
To the final touch, I added some tints by Shofu (Lite Art), the Orange and the Dark Brown to give more depth to my restoration and make it look like a real tooth.
Fig.12
Final aspect of the restoration already polished and the occlusion checked. We can notice the premolar with a more milky aspect because of the dehydration caused by the isolation, that will balance out with the other teeth within a few hours.
Conclusions
There are many ways to recreate a correct occlusal morphology. But we can never focus solely on it. The restorative process from the foundations is much more important because surely that is where it will fail in the future. That is why the essential lines technique of “Style Italiano” is very practical. because it allows us to achieve an adequate and very realistic occlusal anatomy in a very short time, without taking our main focus that is the entire tooth.
Bibliography
- Essential Lines By Giuseppe Chiodera, 15 January 2018, Style Italiano Online published cases.
- Manauta J, Salat A. Layers An Atlas of Composite Resin Stratification. 2012. Quintessence Pub.
- Clinical Use of a Sectional Matrix and Ring, SD Cho, WD Browning, KS Walton. Operative Dentistry, 2010, 35-5, 587-591
- Hardan L, Sidawi L, Akhundov M, Bourgi R, Ghaleb M, Dabbagh S, Sokolowski K, Cuevas-Suárez CE, Lukomska-Szymanska M. One-Year Clinical Performance of the Fast-Modelling Bulk Technique and Composite-Up Layering Technique in Class I Cavities. Polymers (Basel). 2021 Jun 4;13(11):1873.
