#16 Large composite by Dr. Ahmad Fayad

Posted on February 24 2018

The below case was completed and documented by our guest presenter, Dr. Ahmad Fayad.   This is a great example of a Greater Curve band and technique at work! 

Introduction:

In the economy down turn I am being faced with more and more of these larger restorations... Most of these people can't afford crowns... So what do you do? Crown or bullet in the tooth? How would you like to be treated if faced with a scenario similar to this? There should be an alternative other than letting it fail slowly! I think these large monster composites have a place in Dentistry today.

 

Before

Step 1

16 Large composite with asymptomatic RCT - Reccurent caries. Recommended crown, Patient denied.

Prep

Step 2

After caries and composite removal, had to cut down the palatal cusps… Ready for the greater curve matrix band.

Greater Curve Band in place

Step 3

Greater curve in place and window holes drilled by a finishing round diamond (Thanks Karim for that tip it makes the window much smoother!)

Band removal

Step 4

Composite in place - doesn't look good yet… No attention to occlusal anatomy or detail yet... (Xtra base U- Filtek supreme A2)

Band cut back

Step 5

I get asked these questions a lot: Doesn't the composite bond to the adjacent tooth? And how do you remove the matrix band?

Q1: Yes the composite does bond to the adjacent tooth ... Big deal? No.

Q2: I place my matrix forceps on the band and force the band laterally on the tooth in a upward motion, you here a SNAP, that is when you have broken the bond in the window that you created and now you have a nice tight contact.. It is very simple to do.

Occlusal anatomy

Step 6

Occlusal anatomy by 557 burs, shoufo white dura stone, soflex disc are essential.

Palatal cusps reduced

Step 7

 

Intraorally

Step 8

 

Nice tight contacts

Step 9

 

Post op Radiograph

Step 10

 I dont like the RCT, but it doesn't bother her...

 

7 comments

  • Dennis Brown: March 14, 2018

    I use a round diamond to rough out anatomy and occlusion. I then do refinements with the egg shaped finishing carbide (7404). I refine the interproximals with a flame shaped finishing carbide (7901
    Dennis Brown, DDS

    I took this quote from Ahmad Fayad, DDS

    Start with 557 burs to create cusp inclines. Then with the white stone from shofou to help make the grooves look better .
    Then the dark soflex disc to make the embrasures buccally , lingually and occlusal .
    The soflex helps make the cusp tips I built in composite rounded .
    So a combination of : 557 and white tip stone from shoufo ( both in high speed ) Then the soflex is all I use for the anatomy.

  • Dennis Brown: March 12, 2018

    Prior to making the hole burnish the band against the adjacent contact. Burnishing gives you an outline of where the contact is. Keep the hole within that outline. It doesn’t have to be very big. Should not be a gap around the periphery. The transition around the edge of the matrix opening should be imperceptible to an explorer tip.

  • Annie Sohn: March 09, 2018

    Beautiful! I do big composites all the time! Predictable with GC bands

  • David Barr: March 08, 2018

    I struggle with creating the hole in the band. I often get a step or overhang. I believe it is from trying to create a contact that is to large?

  • Dario: March 02, 2018

    Great as usual. I use this matrix system every single day and I’m quite satisfied.

  • Francis samuel: March 02, 2018

    Great work I am particularly impressed with the tigh contacts .

  • Hal rider: March 02, 2018

    Fantastic anatomy…what is your technique and step with the burs and finish/polishing…looks awesome…nice job…

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