Dentaltown March 2020 - 30

Fig. 6

(Brasseler), and then polished with silicone
brushes (Alpen Polishers, Coltene, Fig. 6).
Both the patient and I were very pleased
with the outcome (Fig. 7).

Fig. 7

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30

But having discussed the treatment
for so long, I really wanted the patient to
be pleased with the result; I didn't want to
just be "close." I had been experimenting
with a new material from Tokuyama Dental
called Omnichroma, a composite resin that's
said to have the ability to match all tooth
shades. Rather than using filler particles
dyed to match a variety of shades, it derives
its shade-matching quality by reflecting the
color of the surrounding tooth structure.
I isolated the tooth with a rubber dam,
then proceeded to prep away the discoloration. This was conservatively performed
with a thin tapering diamond bur. I was
surprised that, in some areas, the depth
approached 0.75mm (Fig. 3, p. 29). I also
roughened the linguo-incisal area, where
much of the enamel had worn away.
Then, using a selective-etch approach,
I etched the enamel around the prep with
phosphoric acid (UltraEtch, Ultradent
Products, Fig. 4, p. 29). This was followed
by a two-step self-etch adhesive (Clearfil
SE Protect, Kuraray America).
As shown in Fig. 5 (p. 29), uncured
Omnichroma is opaque white. It requires
a certain leap of faith to imagine that, once
cured, this will blend seamlessly with its
surroundings. After placement, the material
was polymerized with a Valo cordless curing
light (Ultradent Products). I trimmed the
restoration with Esthetic Trimming burs

Case #2
A-61-year-old patient was found to have
mesial decay on tooth #5. His imperfect
home care was responsible for a history of
decay (Fig. 8). Evaluation of the patient's
tooth color revealed that the closest shade
was Vita A-4 (Fig. 9).
After administration of local anesthetic,
I proceeded to prepare the tooth for a
mesio-occlusal composite resin restoration
with a 330 carbide bur (Fig. 10). Using a
sectional band, wedge and separating ring
(ComposiTite 3D, Garrison Dental), I
isolated the area for restoration (Fig. 11).
This would ensure excellent contour and
contact with the adjacent tooth.
I then selectively etched the peripheral
enamel, rinsed with water, removed most
water, leaving a moist dentin surface, and
applied a self-etch two-step adhesive (Clearfil
SE Protect). I decided once again to employ
Omnichroma composite resin, which, as
usual, was layered in 2mm increments, and
light cured (Valo).
After initial shaping, the occlusion was
checked and adjusted as necessary. The
restoration was then polished with a silicone
point (Enhance, Dentsply-Sirona), followed
by a polishing brush (Groovy Diamonds,
Clinician's Choice). The restoration was a
very acceptable match to its surroundings
(Fig.12).

MARCH 2020 // dentaltown.com

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