Class IV Composite with Greater Curve

Introduction:  

Patient had obvious decay in teeth #'s 7, 8 and 10. Immediate objective is to manage the more serious cavities, and then address periodontal issues.

Restoration of 7 & 8 complicated by the overlap of  7 & 8.

All caries removed. Enamel tapered on both preps. Enamel taper includes the entire labial of tooth #7.  Many call this an apple core prep.

Apple core prep isolated with the Greater Curve tofflemire band. Matrix secured with Mega Bite (Discus Dental).  A portion of the matrix has been cut away intra-orally with a diamond or carbide to provide access.  The distal contact will be established by smoothing away the matrix with a football finishing bur down to the level of the base of the contact.

Brush and Bond. Pentron's Artiste Flowable. Kerr's Premise opacious shade A2 snowplowed into the Flowable. Kerr's Premise Body shades A2 at the cervical 1/3 and A1 incisal 2/'3's to complete the restoration.   (This photo was taken prior to adding the Body shades.)

As mentioned above Kerr’s Premise Body shades A2 & A1 provide the final layers of composite.

Appearance of tooth before shaping.

#7 completed.

Set up for #8.  As done previously matrix is cut back intra-orally.  Distal contact “smoothed in” with football finishing bur.

#’s 7 & 8 completed.  Arrow shows a distal area which needs to be shaped better.  When patient returns I will improve on the contour with a #15 blade.

Lingual view of completed restorations. Note how #7 is lingual #8. With the Greater Curve Matrix overlapped anterior teeth do not present a challenge.

Completed restorations.

Conclusion:

The Greater Curve tofflemire band simplifies the placement of large anterior composites. These restorations would be impossible to do properly with the traditional mylar strip and wedge

Utilizing the Greater Curve the dentist can create excellent composite restorations with rounded contours.  Long tight contacts peculiar to anterior teeth can be easily created.

Case B

Introduction:

Tooth #7 is vital. Crown would require root canal and post for retention. Unfortunately, there is no ferrule for a crown.

Pre-opt incisal view.

PA #7

Greater Curve set up. Matrix trimmed labially. Contact openings made.  Wood wedges are lightly placed to secure the matrix only.  The wood wedges are not used to force the teeth apart.  Wedging in the traditional sense is not necessary, since the contacts will be a direct build against the adjacent teeth.  In lieu of using a retainer Triad Gel holds the matrix in the proper position.

Note, the gap between the band and the mesial of #6 (see arrow). This will be addressed on the next slide.

Matrix held against the mesial of #6 while the first increment of flowable was placed. This procedure locks the matrix against the mesial of #6.

Premise A3.5 Opacious and Premise A3.5 Body complete the Build Up.

Do not be in a hurry to remove the matrix. Do much of the initial trimming with the matrix left in place. The stainless matrix guides the long fluted finishing bur along the cervical and prevents gouging.  You will be cutting matrix and composite simultaneously.

Contact is broken with the blade end of a composite placing instrument. Matrix severed in the middle, and each segment lifted through the contact.  Distal matrix segment can be seen being lifted through the contact (see arrow). 

Completed #7 composite Build Up.

Incisal view #7.

Conclusion:
Fun to do. One hour and done. Patient appreciative.

This photograph is the tooth prior to cut back.

Sequence of the buildup:

1. Pentron fiber post cemented with Panavia.

2. Bottom 2/3 rd’s of the buildup DenMat’s A3 True Vitality.

3. Incisal 1/3 rd Kerr’s A2 Premise.

Patient has limited finances.  She has many other dental concerns, but for now she “wanted the gap in her smile fixed”.

Isolation provided by rubber dam with Greater Curve band held in place with Clear Triad gel.  Over grown labial gingiva removed with Soft Tissue Trimmer by Axis Dental.  Post space prepared.  Contact areas have been “smoothed in” with football finishing bur.

Metal spatula breaking bonded contact.  Sequence of buildup:

1. Pentron fiber post cemented with Panavia. 

2. DenMat's A2 True Vitality provided the the bulk of the core.   True Vitality is a Dual Cure, and works like a Core Paste.  It is malleable but stiff enough not to slump.

3. Kerr's A2 Premise veneered the labial surface.

       Final Buildup         Final Buildup
                                   1 Month Later