The simplicity of “ONE” shade in case of V class

Carious lesions affecting the cervical part (Miller’s class V) are common findings in patients’ oral cavities. The etiology is multifactorial, and in cases like the one presented, there is a combination of abrasion, abfraction, and erosion. A non-carious cervical lesion may develop secondary caries due to surface roughness, dentin exposure, and poor oral hygiene. The clinician’s objectives in this case are, in order:

  • Correctly isolating the operating field to work without the interference of saliva and crevicular fluid.
  • Removing carious tissue.
  • Restoring the original tooth convexity using a stable composite with good opacity and aesthetics.
style italiano styleitaliano rubber dam before inversion

Fig.1
Whenever attempting to place a rubber dam on teeth lacking convexity, the situation you see in the image often arises. The dam must be secured below the level at which we intend to finish our restoration. There are various methods to accomplish this. In this case, we will analyze two different approaches.

style italiano styleitaliano isolating cervical lesions

Fig.2
The first method, shown in the photo on the left, involves using a Hygenic B4 clamp. This approach is suitable when the tissues are not excessively dense and the lesion does not extend significantly below the gum line. However, if the lesion is deep or the tissue is dense, the clamp’s hook may struggle to secure the dam where desired. Nonetheless, the advantage here is that the field isolation does not solely rely on the operator, who has both hands free to work.
In the photo on the right, we observe another method for isolating lesions on the cervical part, utilizing the Gengiva instrument by LM. This instrument offers three different types of tips to accommodate the size of the tooth being treated. For a premolar like the one shown, the smallest tip is recommended. The instrument allows for gentle gingival retraction, enabling restoration of the ideal convexity of the tooth. However, the disadvantage of this method is that the operator needs to use one hand throughout the treatment duration to maintain the instrument’s position.

style italiano styleitaliano etching for class V restorations

Fig.3
Once the cavities have been thoroughly cleaned and the enamel surfaces have been carefully prepared to facilitate adhesion, selective enamel etching is performed. This involves applying an etchant to the enamel surfaces. Subsequently, a universal adhesive such as iBOND is applied.

style italiano styleitaliano layering class V restorations

Fig.4
For tooth 44, we opted to use a single flowable composite, specifically the Venus Bulk Flow One (Kulzer GmbH), for several reasons:
– It offers good opacity and shade matching, ensuring a natural appearance.
– Its low shrinkage stress minimizes the risk of post-operative complications.
– It helps reduce chair-side operating time, enhancing efficiency.
The composite is meticulously adapted to the tooth surface using the Fissura instrument by LM Arte (Dark Diamond), ensuring precise placement and contouring.

style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano kulzer venus Bulk flow ONE one-shade bulk filling composite
style italiano styleitaliano placing composite with lm spatula

Fig.5
For the adjacent tooth, 45, we chose to utilize the Venus Pearl One (Kulzer GmbH) composite because of its larger surface area compared to the previous tooth. This composite offers several advantages:
– Ease of modeling: Venus Pearl One (Kulzer GmbH) composite allows for easy manipulation and shaping, ensuring precise restoration.
– Chromatic adaptability: It provides excellent color matching and blending with the surrounding dentition, ensuring aesthetic results in a prominent area of the mouth.
By leveraging these features, we can achieve optimal results in terms of both functionality and aesthetics for tooth 4.5.

style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano kulzer composite venus pearl and diamond long restorations
style italiano styleitaliano modeling kulzer composite

Fig.6
The composite is carefully positioned and shaped using the Applica instrument from the LM Arte Dark Diamond kit, ensuring precise placement and contouring. Subsequently, it is evenly distributed and smoothed using the Smile Line CompoBrush, ensuring a seamless integration with the surrounding tooth structure.

style italiano styleitaliano using lm arte fissura for layering of class V restoration

Fig.7
Finally, the composite is polymerized, leaving the most cervical part unfilled. This area is then filled with Venus Bulk Flow One (Kulzer GmbH) using the “closing gap” technique by Jordi Manauta. For the “closing layer,” we opted for a flowable composite. This choice is made to facilitate the clinician during the polishing phase, especially in the area closest to the gum line. Using a stable flowable composite in this area helps to achieve optimal finishing and polishing results.

style italiano styleitaliano lucida star felt polishing composite restorations

Fig.8
The two restorations are then polished using the Lucida by DiaShine, ensuring a smooth and glossy finish that enhances the overall aesthetics and longevity of the restorations.

style italiano styleitaliano finished composite class V restorations

Fig.9
The final result showcases the impeccable morphological and chromatic integrity thanks to the usage of the Venus Bulk Flow One (Kulzer GmbH) and the Venus Pearl One (Kulzer GmbH). This outcome reflects the meticulous attention to detail in the restoration process, resulting in natural-looking and durable restorations that seamlessly blend with the surrounding dentition.

Conclusions

Cervical lesions pose a frequent challenge for dentists. The primary obstacle is achieving effective isolation to work in a dry field. Secondly, when these lesions affect anterior teeth like premolars, canines, and incisors, they are deemed aesthetic restorations. The use of composites that are easily moldable and possess high chromatic adaptability simplifies this challenge.

Bibliography

  1. Kubo S, Yokota H, Yokota H, Hayashi Y. Three-year clinical evaluation of a flowable and a hybrid resin composite in non-carious cervical lesions.
  2. Yazici AR, Baseren M, Dayangaç B. The effect of flowable resin composite on microleakage in class V cavities. Oper Dent. 2003 Jan-Feb;28(1):42-6.
  3. McDonald NJ. Microleakage of Class 5 composite resin restorations: a comparison between in vivo and in vitro. Oper Dent. 1993 Nov-Dec;18(6):237-45.
  4. Krejci I, Lutz F. Marginal adaptation of Class V restorations using different restorative techniques. J Dent. 1991 Feb;19(1):24-32.
  5. Manauta J. The Closing Gap Technique. The perfect seal in Class 5 restorations. StyleItaliano.

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