Large MODL Class II restoration with ceram.x® SphereTEC one, Palodent® V3 and SDR® Plus
A 43 year old female came to my practice with a history of non-attendance. She was concerned about generalised sensitivity with her heavily-restored dentition, many teeth of which featured extensive composite restorations with recurrent caries detectable both clinically and radiographically. Certain teeth with extreme structural compromise were planned for bonded porcelain restorations, however, restorations like this large MOD were planned to be restored with direct composite due to financial constraints.
Conclusion and references
Following the total etch bonding technique, Dentsply Sirona’s SDR® Plus was placed against the base of the proximal box floor as liner in very thin layers and cured, in an effort to ensure hybridisation and marginal integrity in this sensitive area before building the marginal ridge.
The body composite chosen, Dentsply Sirona’s ceram.x® SphereTEC™ one, features SphereTEC™ technology using spray granulation to produce spheres with a mean size of 15 µm out of primary submicron filler glass. These spheres minimise frictional forces when under stress. On the other side, the irregularly shaped primary particles ensure high slump resistance, thus leading to excellent sculptability. The Cloud Shading Concept adopted by Dentsply Sirona’s ceram.x® SphereTEC™ one allows a single shade to umbrella a cluster of shades, by its distinct chameleon effect, permitting a minimalised armamentarium.
The Palodent® V3 matrix permitted efficient reconstruction and placement of initial layers in the extended proximal box situation, obviating the need to free-hand sculpt line angles prior to placement of the sectional matrix assembly.
All in all, the Class II Solution™ offered by Dentsply Sirona is elegant, efficient and precise; three features I strive to achieve in every restoration.
Before - Intraoperative situation showing extent of large MODL Class II restoration. Resin-modified calcium silicate liner placed against area of deeper dentin with near-carious pulp exposure. Wedgeguards will protect against accidental adjacent tooth grazing during preparation, and also double as the wedge for the Palodent® V3 sectional matrix assembly.
Palodent® V3 sectional matrix set-up showing a re-creation of an ideal line angle anatomy all in one solution.
Zoomed out view showing diametrically-opposing Palodent® V3 rings with Palodent® V3 matrices overlapping each other in a one-step solution driving the rebuilding of proximal and axial contours predictably.
Marginal ridge formation using A2 ceram.x® SphereTEC™ one. Removal of sectional matrix assembly after this stage. Finish like a Class I restoration.
After - Final result after placement of lingual lobe and characterisation. This result demonstrates the superb handling, sculptability and chameleon effect of the universal, cloud-shaded ceram.x® SphereTEC™ one composite featuring spherical fillers for ultimate control of placement. Note the precision of line angle and bucco-lingual embrasure formation with Palodent® V3.
Buccal lobe placement using A2 ceram.x® SphereTEC™ one. Fissure stain placed in interlobar position.