Simplifying a large overlay case, without compromising a beautiful final result – Dr Charles BrandonFeatured Products Promotional Features
Posted by: The Probe 5th December 2019
Dr Charles Brandon is a dentist at S3 Dental. Here, he presents a case where an elderly patient wanted an efficient, aesthetic solution to a failed restoration with the minimal amount of time spent at the dentist.
Initial presentation and medical background
The patient presented for a routine examination with a complaint of a broken tooth
in the lower-right side of the jaw. The tooth had been asymptomatic but broke while the patient was chewing. The tooth was catching the tongue when eating and was temporised during the examination visit.
My patient was an older gentleman, with a medical history of high blood pressure.
He was also taking ranitidine (for decreasing stomach acid production), atorvastatin (statin), clopidogrel (for blood thinning) and propranolol (beta blocker). He is a type-II diabetic, who is medicated with gliclazide, sitagliptin and metformin. The patient was also taking ferrous fumarate (for iron-deficiency anaemia) and dapagliflozin. He had suffered a stroke in 2016 and there was also a history of epilepsy.
Dental examination and diagnosis
The patient had good oral hygiene and healthy gums. He had multiple worn amalgam restorations, which were not currently requiring any intervention. The lower-right second molar was in apposition to the upper-right second molar, without first molar occlusion. This heavy occlusion was likely the aetiology of the fractured tooth. No other problems were identified.
The LR7 was non-TTP and gave a normal short, sharp response to ROEKO Endo-Frost™ (available from COLTENE). Pockets were no greater than 2mm.
The enamel that was supporting the amalgam restoration was weakened from years of use and had failed. A non-carious enamel/dentine fracture had occurred, which had resulted in the loosening of the amalgam restoration and exposed the core of the tooth (see Figure 1).
In these cases, the ideal treatment pathway would normally have been ceramic restoration of the tooth for longevity, because of resilience of the ceramic to occlusal forces. However, because of his age, my patient was keen to minimise visits to the surgery and to reduce chair time where possible. As a result, we discussed a direct resin overlay of the tooth, with the understanding that the lifespan of the restoration would not match that of a ceramic overlay and that there would be a higher risk of fracture of the restoration.
The patient was happy with this information and keen to proceed with the restoration of the tooth in one visit as a direct resin overlay.
Anesthesia was achieved with intraligamentary Articaine 4%, to minimise the risk of adrenaline in the anesthetic reaching a vein following an ID block. The tooth was isolated using a HYGENIC® Fiesta® Color Coded Winged Clamp 9 for a lower molar and corresponding rubber dam (available from COLTENE) (see Figure 2). The tooth was prepared with the removal of the old restoration and a uniform 2mm reduction of all tooth tissue to allow for thickness of composite to overlay the site and prevent further fracture/damage to the underlying tooth.
The tooth surface was air-abraded with 27um aluminium oxide, sandblasted and then selectively enamel-etched with 37% orthophosphoric acid. COLTENE ONE COAT 7 UNIVERSAL bonding agent was applied and allowed to rest on the tooth for 30 seconds, followed by a 10-second gentle air-drying and a 20-second light cure.
The composition of COLTENE BRILLIANT EverGlow™ – which was used in shades A3 and D3 – enable free-hand placement. We built each individual cusp in turn, starting with the mesial and working around to the fifth distal cusp. Once completed, COLTENE Miris2™ in gold effect was used in the occlusal fissures to characterise the tooth and the whole restoration was then set for 40 seconds under glycerine gel (see Figure 3).
The rubber dam was removed and a DIATECH™ Universal Polishing Kit from COLTENE was used to give the restoration its final polish and lustre after adjusting for occlusion (see Figure 4).
The outcome was a highly cosmetic, functional overlay that fully protected the underlying tooth and met with the patient’s requirements of minimal time spent in the dental chair with as few visits as possible. The patient reported no post-operative sensitivity due to the incremental build-up of the restoration.
COLTENE products allow for a very repeatable restorative framework from tooth preparation, to bonding and polishing. The range provides an easily shade-matched set of restorative materials with natural staining to match. The products are extremely malleable for placement and using the DIATECH™ Universal Polishing Kit will finish with an easily achievable lustre and smoothness. COLTENE restorative tools and materials allow me to simplify even large overlay cases such as this one and achieve reliable, effective result and beautiful results with few stages.
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