July Clinician's Choice Onsert - 11

bevel progressed from being deeper at the fracture line to more superficial
and fading into the enamel. In addition to providing more surface area for
increased bond strength and retention, the starburst design allows light
to diffuse and refract in a way that hides the junction between tooth and
restoration better than a flat, traditional bevel.
shaped ARTE spatula (LM-Dental) and adapted to form the lingual
layer against a gloved finger. The lingual layer was kept relatively thin,
being brought just into the deepest aspect of the bevel. (FIG. 4) At this
stage, the ENC was blended into the base of the starburst bevel and was
FIG. 3
A kidney-shaped, stainless steel sectional matrix
band was placed vertically between teeth #s 8 and 9.
The contour of this matrix band established a natural
looking proximal surface that required little finishing.
A kidney bean-shaped metal bicuspid sectional matrix, oriented vertically,
was placed between teeth #8 and 9. (FIG. 3) This isolates #8 while the etch
and adhesive bond is placed as well as providing a better convex initial
proximal contour compared to a mylar strip.
Max Etch (Clinician's Choice) was placed over the preparation, slightly
beyond the starburst bevel, for 15 seconds. Max Etch is a viscous 35%
phosphoric acid that holds firm vertically for the duration of the etch. Once
the etch is thoroughly rinsed off the tooth, Peak Universal was scrubbed
into the enamel and dentin for 20 seconds. Peak Universal is easily applied
due to its applicator syringe and brush combination and provides a high
strength bond to both enamel and dentin. The air-thinned adhesive was then
light-cured using a Valo for 10 seconds. I prefer the Valo X, however it
is essential that your choice of curing light has broad-wavelength curing
capabilities, a large surface area and a consistent strength, ideally 1000mW/
cm2, over the entire surface of this area.
FIG. 5
Vit-l-escence Opaque Snow was layered over the
lingual layer and onto the enamel layer. The addition
of this very bright and very opaque composite
effectively masked the fracture line.
Evanesce A1U (Clinician's Choice) was placed as the final, or body layer.
This composite was chosen for its chameleon-like shade blending, and its
ability to finish quickly and polish to a super high shine. Once placed and
spread onto the tooth with the ARTE spatula, a composite brush lightly
wetted with ResinBlend LV (Clinician's Choice) was used to further blend
and smooth the facial layer of composite into the uncut enamel. (FIG. 6)
The use of ResinBlend LV produces a very smooth final surface that
significantly reduces finishing time. At this point, the restoration was lightcured
from the facial and lingual for 10 seconds.
" chopped " using the ARTE spatula to create a variegated appearance and
interface with the subsequent layer of composite. The Evanesce ENC was
then light-cured for 10 seconds from the facial and 10 seconds from the
lingual. This organic interface, compared to one that is flat, allows light
to better reflect and absorb in a way that mimics natural tooth structure,
helping the restoration disappear. In the case of a larger Class IV, I would
build the entire proximal wall against the metal sectional matrix band
first then establish the lingual layer using a gloved finger as a lingual
matrix. The next layer required a more opaque and brighter composite to
hide the tooth-restoration junction. The brightness and higher opacity of
Vit-l-escence Opaque Snow is very effective for the purpose of hiding the
fracture line. Opaque Snow was adapted onto the preparation using the
ARTE spatula and " chopped " into the ridges straddling the translucent
lingual layer and the enamel bevel. (FIG. 5) This opaque layer was lightcured
for 10 seconds each from the facial and lingual.
FIG. 4
The translucent lingual enamel layer of Evanesce
Enamel Clear (Clinician's Choice) was placed into the
preparation. Through successive " chopping " motions
with a composite instrument, this layer was blended
into the deepest aspect of the bevel and left with
a variegated appearance, forming a more organic
junction with the next layer of composite.
The starburst bevel is the first step in helping the restoration disappear. The
next step was the careful placement of a translucent lingual enamel layer
using Evanesce Enamel Clear (Clinician's Choice). I favor a syringe over
a compule in the anterior, not only to reduce waste, as you dispense only
what is needed, but also to eliminate folds or voids when dispensing the
composite. Evanesce ENC was carried to the preparation with a paddleFIG.
6
The final layer of composite, Evanesce A1U (Clinician's
Choice), was placed into the preparation, then
smoothed and blended into the facial surface using a
#3 composite brush lightly coated with ResinBlend LV
(Clinician's Choice).
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CLINICAL LIFE
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SUMMER 2023
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July Clinician's Choice Onsert

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