NewsletterThe modern composite resin material blends into the surrounding dentition without the need for additional shades or resin tints/color modifiers.
By Todd Snyder, DDS
Restoring teeth can often necessitate using numerous layers and stains to make a composite-based filling blend into the dentition. Composites are time-consuming and challenging to place because of all the concerns of handling the tooth structure, achieving quality adhesion, and properly placing the restorative material itself. The ability to eliminate or simplify just one of the many steps in placing a posterior composite would certainly help in an already challenging process, as well as cut down on inventory and overhead for the practice. Furthermore, a single composite material that can handle the stress and wear of the posterior dentition while also imparting excellent color-matching properties in either the posterior or anterior is very desirable.
This case highlights the simplicity offered by the ability of a single shade of a composite resin material (Estelite® Sigma Quick, Tokuyama, www.tokuyama-us.com) to blend into the surrounding dentition without the need for additional shades or resin tints/color modifiers.
The patient presented with an interproximal cavity on the distal of tooth No. 28 (Figure 1). The bite was evaluated with articulating paper to determine where the current functional stops were in centric occlusion—ie, the areas not to be removed in order to maintain the same bite position. The patient was anesthetized using a single carpule of carbocaine. A wedge guard (WedgeGuard, Triodent, www.triodent.com) was placed interproximally between teeth Nos. 28 and 29 to avoid causing iatrogenic damage to the adjacent mesial tooth structure of tooth No. 29 when working interproximally.
The tooth was prepared with an electric handpiece using a coarse-grit cylinder diamond bur at 20,000 rpm. After removing the gross decay, a slow-speed electric handpiece with a Smart Bur II polymer bur (SS White Burs,www.sswhiteburs.com) was used at 2,000 rpm so that additional decay could be removed without damaging healthy tooth structure. A caries indicator was used to evaluate the caries removal process. The wedge guard was removed and the preparation was re-evaluated (Figure 2). A contoured sectional matrix, along with a V3 sectional ring (Triodent), was placed (Figure 3). The enamel was then etched first, followed by the dentin, using 32% phosphoric acid and benzalkonium chloride (UNI-ETCH®, BISCO, Inc., www.bisco.com) for 15 seconds to modify the dentin and enamel for adhesion while at the same time potentially minimizing the risks of matrix metalloproteinases.1,2
The tooth was then rinsed for 10 seconds and air-dried for 3 seconds with a warm-air tooth dryer. Next, the OptiBond FL® (Kerr Corporation, www.kerrdental.com) primer was lightly brushed onto the enamel and dentin for 15 seconds, and air-dried 5 seconds. Then OptiBond FL adhesive was brushed lightly onto the enamel and dentin for 15 seconds, followed again by 3 seconds of air-drying. The tooth was light-cured for 20 seconds at 600 mW/cm2. Next a 2-mm increment of Estelite Sigma Quick shade A3 was injected into the preparation using a composite gun and lightly agitated to create a flat appearance while also adapting the material against the axial walls of the preparation. This layer was cured for 40 seconds, followed by a second and final increment of the same A3 composite. This increment was also lightly agitated, applying minor pressure pulpally and axially to finalize adaptation. An egg burnisher was then used to create the primary anatomy followed by a Peter K. Thomas #3 to create secondary anatomy. A dry microbrush was then used around the margins to relieve any small amounts of flash. The composite was light-cured for 40 seconds. The V3 ring, the sectional matrix, and wedge were removed as well. Additional light-curing from the buccal and lingual was performed for 20 seconds each to ensure complete curing in the proximal box area.
If care was taken to not remove the functional stops when preparing the tooth structure, and the composite placement was placed to mimic the natural anatomy of the tooth structure without being over-filled, the tooth should still be in occlusion with no alteration to the existing bite pattern in centric occlusion. Articulating paper was used to evaluate the bite again. However, this time, a different color was used so that new marks were created on top of the original occlusal markings to evaluate whether the bite was actually still in the same position prior to starting the dental procedure.
If occlusal adjustments are necessary, various shapes of 12-fluted carbide burs can be used to remove gross excess. The same shapes in 30-fluted carbide burs can be used if only fine adjustment is necessary. Various points, cusps, or discs can be used to polish the restoration. In this case, the author used the Jazz Polishers (SS White) at 7,000 rpm in a slow-speed electric handpiece (Figure 4).
Estelite Sigma Quick was chosen for this case because of its unique ability to diffuse light, which helps the composite material to blend into the dentition easily with a single shade. One shade of Estelite Sigma Quick can span through multiple shades, resulting in easier shade matching. The excellent wear properties and unique characteristics that allow for its ability to blend into the dentition have been attributed to Tokuyama’s unique new filler particles. The spherical filler particles resist long-term wear and plucking, while quickly creating a high shine that can last for years. The unique supra-nano monodispersing spherical particles are uniform in diameter and are defined as being within the range of smaller than a micron yet larger than a nanometer. The average size of a filler particle in Estelite Sigma Quick is 200 nm, making it a supra-nano-fill composite. Most traditional and modern composites use polydispersed particle technology. Estelite Sigma Quick imparts heightened compressive strength due to its ability to achieve 82% filler loading by weight. Marginal leakage and stress on the restoration–tooth complex is reduced because of the low 1.3% volumetric shrinkage.
1. Türkün M, Türkün LS, Ergücü Z, Ateş. Is an antibacterial adhesive system more effective than cavity disinfectants? Am J Dent. 2006;19(3):166-170.
2. Pashley DH, Tay FR, Imazato S. How to increase the durability of resin-dentin bonds. Compend Contin Educ Dent. 2011;32(7):60-66.
Todd Snyder, DDS
Private Practice
Laguna Niguel, California
Figure 3 The V3 ring system was placed.
Figure 4 Postoperative photograph of the imperceptible final composite restoration.
