Large composite buildup tooth #13

Initial presentation:

The buccal cusp fractured off tooth #13 and the existing 20 year old MOD composite became dislodged. There are evident caries which should be very manageable. This will be an easy one to achieve tight contacts since the mesial and distal embrasures are a manageable width.

Buccal view

Caries removed

Remaining lingual cusp has ample thickness and will be preserved as is.

Contact openings

Mesial and distal contact openings made in the Greater Curve matrix. Contact openings size dictated by matching the available contact surface of the contiguous teeth. The operator has the ability to create a contact with width and depth. No active wedging needed. The tooth will be built in a neutral position. Able to eliminate expensive sectional hardware. Everything much simpler.

Mesial contact opening

Bonding agent

Bonding agent - Prelude SE (Danville), Activa (Pulpdent) base placed mesial, distal and buccal. I like Activa for its' bioactive properities. Base was light cured for 5 seconds. 5 seconds is all that is needed to provide a hard base. Activa is a dual cure.

Snow plow

One increment of A2 Filtek Supreme Ultra (3M) is snow plowed against a thin layer of Activa. Light cured and ready for shaping.

Matrix removal

Matrix severed into a mesial and a distal segment.

Matrix removal

Mesial matrix segment removed with hemostats. Bonded contact broken with a mixing spatula and then matrix grasped with a hemostat.

Matrix removal

Hemostat is slightly rotated moving the matrix laterally. You can see the slight kink in the matrix where the rotation occurred. Matrix then easily removed occlusally. Mesial contact opening evident.

Matrix removal

Distal contact opening in matrix segment.

Ready for shaping

Ready for shaping

Final restoration - buccal view

Final restoration - occlusal view

Contacts

Tight contacts with width and depth.

Conclusion

I have many of these conservative restorations lasting 10 years and more. Now that we have Activa in our restorative arsenal I expect large buildups to last even longer.