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Inside Dentistry

August 2013, Volume 9, Issue 8
Published by AEGIS Communications


Streamlined Tools for Chairside Restorations

Efficiency and excellent esthetics with the Trifecta Method

Peter Gardell, DDS

Compatibility of materials is an important concern for dentists during any procedure, as is working with maximum efficiency. By using tools that are designed to work together, dentists can optimize productivity and feel confident that they are delivering the best care to patients.

To that end, 3M™ ESPE™ has recently begun marketing its “Trifecta Method” for indirect-composite restorations. The Trifecta Method consists of Lava™ Ultimate Restorative, Scotchbond™ Universal Adhesive, and RelyX™ Ultimate Adhesive Resin Cement (all 3M ESPE, www.3m.com). These three products are designed to be used together and therefore enable dentists to use the most streamlined restorative process possible.

Lava Ultimate Restorative can be milled in-office with CEREC® (Sirona, www.sirona.com) or E4D® (D4D Technologies, www.e4d.
com) systems, and can also be ordered through laboratories. This resin nanoceramic mills nicely and requires no firing. Because it is less brittle than many other milling materials, its edge quality is excellent. The material is available in low and high translucencies, and, because of its unique makeup, can be adjusted with composite, just like natural tooth structure. Only a few minutes of polishing are required to achieve a natural-looking luster.

Restorations performed with Lava Ul­ti­mate restorative must be bonded with adhesive, a process that is simplified with the use of Scotchbond Universal adhesive and RelyX Ultimate Adhesive Resin cement. Scotchbond Universal adhesive works with total- and selective-etch applications, and requires just one technique for performing direct- and indirect-composite restorations. It bonds to a wide range of materials, including enamel, dentin, glass ceramic, zirconia, noble and non-precious alloys, and composites, and does not require an additional primer. Its versatility and ease of use facilitates the simplest adhesive process possible, making it a standby for any procedure. Restorations performed with Scotchbond Universal adhesive are made even easier when RelyX Ultimate Adhesive Resin cement is used, which has an integrated dark-cure activator for the adhesive, eliminating the need for an additional activator component. The cement covers the entire spectrum of indirect indications, making it another versatile tool in this system.

Case Presentation

The patient presented with margins on existing restorations that were breaking down and interproximal decay on teeth No. 12 through No. 15 (Figure 1 through Figure 3). It was determined that instead of performing large, direct-composite restorations, which would require time-consuming placement of matrix bands and building up of the composite layer by layer, the quadrant would be restored with partial-coverage restorations made using the CEREC system (Figure 4).

The patient was anesthetized and an Isolite® mouthpiece (Isolite Systems, www.isolitesystems.com) was placed to keep the area dry. The existing restorations and decay were removed, which required that the embrasures be opened. In a few areas, the decay extended subgingivally; these areas were excavated down to sound tooth structure and a retraction cord was placed to separate the gingival tissue from the margin. Areas in which the gingival tissue overlaid the margin were recontoured with a diode laser. The 3M™ ESPE™ Retraction Capsule was used to help control bleeding to avoid interference with the capture of a clean margin.

Care was taken to create paths of draw to allow seating of the restorations. With the CEREC software, each restoration may have its own path of draw. Because the whole quadrant was being restored, the opposing arch was imaged and the arches were articulated by use of the “Buccal Bite” feature.

The restorations were milled from blocks of Lava Ultimate restorative in high translucency and fit was evaluated (Figure 5). The restorations were then polished to a high luster following 3M ESPE’s recommendations. The intaglios of the restorations were air-abraded, after which Scotchbond Universal adhesive was applied as a primer. Enamel margins of the preparations were selectively etched with Scotchbond™ Universal Etchant (3M ESPE) (Figure 6), which was allowed to react for 15 seconds, then rinsed and dried, with care taken to not over-dry.

The adhesive was then applied to the tooth structure for 20 seconds and air-dried for 5 seconds. A translucent shade of RelyX Ultimate Adhesive Resin cement was applied to the restorations and they were seated. The cemented areas were light-cured for 2 seconds to reach the cement’s gel stage, after which excess was cleaned away with an explorer. The interproximal areas were cleaned with floss and final polishing was completed.

The polished, high-translucency material and the transparent cement allow the final restorations to blend in with the patient’s natural teeth (Figure 7 and Figure 8).

Conclusion

The Trifecta Method and the CEREC system allow dentists to perform efficient restorations using a simple workflow. The outstanding interproximal contours and esthetics seen in this case highlight the capabilities of the Lava Ultimate restorative and RelyX Ultimate Adhesive Resin cement products when used together. These tools, used with Scotchbond Universal adhesive, permitted the quickest, most effective adhesion process in this case.

About the Author

Peter Gardell, DDS
Private Practice
Stamford, Connecticut


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Image Gallery

Figure 1 and Figure 2 Patient presented with margins that were breaking down and interproximal decay.

Figure 1

Figure 1 and Figure 2 Patient presented with margins that were breaking down and interproximal decay.

Figure 2

Figure 3 Preoperative radiograph.

Figure 3

Figure 4 Restoration design.

Figure 4

Figure 5 Try-in of milled restorations.

Figure 5

Figure 6 Selective etching.

Figure 6

Figure 7 Final result.

Figure 7

Figure 8 Postoperative radiograph.

Figure 8