July Clinician's Choice Onsert - 6

FEATURE
CLINICAL EXCELLENCE
that reflects the desired restorative result and accurately transferring this
information directly to the preparation ensures that the lingual contours
and incisal edge location and thickness are already established. Taking
the time to place, shape and blend the remaining composite prior to
light-curing can limit the need for further adjustments. Regardless of the
amount of finishing anticipated, a methodical finishing protocol keeps this
step predictable and time efficient.
FIG. 8
Very thin layers of Evanesce
Enamel White were placed
in the incisal area of teeth #8
and 9 within lingual matrix and
this matrix was replaced on
the teeth. This layer was then
attached to the preparation
using a combination of an
REJ #4 composite instrument
(Clinician's Choice) and a #3
composite brush lightly coated
with ResinBlend LV (Clinician's
Choice). These lingual shells
were light-cured in place.
FIG. 9
With a mylar strip separating
tooth #9 from the adjacent teeth,
Evanesce A1U was adapted
to the mesial surface using an
REJ #4 composite instrument.
The pull-through technique was
utilized to ensure an ideal proximal
contour, natural contact area and
emergence profile.
In this case, the finishing protocol involved the placement of a wedge
prior to adjusting. This initiated tooth separation that would increase the
access and accuracy to adjust the emergence profiles later in the protocol.
Once the length and inciso-facial line angles were confirmed, the facial
planes and proximal line angles were surveyed. The side of a pencil lead
was used to outline the proximal line angles on both the restorations and
adjacent teeth and compared. A coarse Contours Finishing and Polishing
Disc (Clinician's Choice) was used to correct the proximal line angles
to better reflect those on the lateral incisors. (FIG. 11) Axial inclination
was assessed through visualizing from various cervical, incisal and
proximal angles and adjusted accordingly with the same coarse disc. The
sequence of medium, fine and super-fine discs was followed to prepare the
restorations for polishing. (FIG. 12)
uniform proximal surface and contact while maintaining an overhang-free
emergence profile. A #3 composite brush with ResinBlend LV smoothed
and blended the Evanesce A1U into the facial tooth structure after the
pull-through, producing a surface that required minimal finishing. The
restoration was light-cured from the facial and lingual. The identical
sequence of Evanesce A1U composite placement was repeated on tooth
#8. (FIG. 10)
FIG. 11
Pencil lines drawn on the restored and adjacent teeth provide a visual
guide to the placement of the proximal line angles. A coarse Contours
Finishing and Polishing Disc (Clinician's Choice) was used to " move "
these line angles into their natural positions.
FIG. 10
The exact technique for placement and adaptation of Evanesce A1U
composite was repeated on tooth #8 in order to close the midline
diastema.
By utilizing the pull-through technique and creating the desired contours
and surface smoothness prior to polymerizing,
it was possible to
immediately proceed to completing the incisal portion of the restorations.
The relative translucency of the Evanesce Enamel White was not
sufficient to replicate the existing incisal translucency of the adjacent
teeth; therefore, a grey tint was added in this area. A thin increment of
Evanesce A1U was placed over the Enamel White layer and light-cured. A
small amount of grey tint was placed onto the A1U of both teeth #8 and 9
with a CompoSculpt #1/2 (Hu-Friedy). Any excess tint was blotted using a
microbrush. Once this application of tint was light-cured and assessed, the
final layer of Evanesce A1U was placed over this and adapted to the facial
surface of each tooth. Once again, a #3 composite brush lightly coated
with ResinBlend LV was used to smooth and blend the A1U over the tooth
surface and composite from the diastema closure.
If a well-organized approach to the restorative phase is followed, there is
need for minimal finishing prior to polishing. A wax-up on mounted models
FIG. 12
Once the adjustments of the axial inclination, incisal length and location
and proximal line angles have been made, the sequence of Contours
Discs was followed from medium to fine to super-fine to prepare the
restorative surfaces for the polishing steps.
This patient did not display any significant facial lobes, depressions or
surface texture. Should this have been necessary to establish, a F8888
(Brasseler) fine flame-shaped diamond is ideal. A sweeping motion at low
speed is effective for texturizing the smooth surface as well as developing
lobes prior to polishing.
A.S.A.P. Polishers (Clinician's Choice) were used to obtain a high luster
that was present on the adjacent teeth. The purple Pre-polisher initiated
6 SUMMER 2023 | CLINICAL LIFE | clinicianschoice.com
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July Clinician's Choice Onsert

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