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Inside Dentistry
December 2016
Volume 12, Issue 12
Peer-Reviewed

One laboratory composite, Sinfony™ (3M, www.3m.com), has great flowability, physical properties, and esthetics. The manufacturer cites very high-density cross-linking, resulting in high compressive, flexural, and impact strengths and abrasion resistance.8 However, it lacks dual-cure capability and is designed to be used for indirect restorations, which also entail impressions, provisionals, return appointments, and additional laboratory costs that are not feasible in a low-fee environment. An “off-label” direct application of Sinfony is described in Case 1.

A relatively new “bioactive” direct resin restorative material, ACTIVA™ (Pulpdent, www.pulpdent.com), is, in the author’s opinion, the most ideal material to employ for this technique and is demonstrated in Case 2. The manufacturer reports that this material possesses the previously mentioned desired properties to act as a suitable injectable direct restorative.9-11

Curing and Finishing

Once the matrix is filled, it is held stable for extended intraoral light-curing. A concern with curing through the matrix is the inherent reduction in polymerization energy that reaches the hybrid layer. The matrix is translucent, not clear, filtering out some of the polymerization energy. More importantly, the light source is at an increased distance from the deeper hybridized surfaces, and light energy is reduced proportionally as the inverse of the distance squared.12

To offset this diminished energy, dual chairside LED light sources of approximately 1,500 mW/cm2 were bench tested for extended cure times of approximately 90 seconds per surface, curing from all accessible angles through the matrix. A hardness test on the intaglio surface of the restorative materials yielded sufficiently positive results to support innovative application with the matrix technique.

After maximal curing, the resin sprues from the injection and vent holes are ground down to facilitate matrix removal. The outer carrier tray is removed first, followed by the flexible inner PVS liner.

Initial gross finishing and separation of adjacent restorations is accomplished with an interproximal separator (Figure 5), various burs, disks and strips, according to personal preferences. The esthetics are refined and occlusion is adjusted as with any restorative technique.

Case Report 1

This is a case study of a severely damaged, worn occlusion that was restored on a limited budget with direct resin overlays and economy acrylic partial dentures. The restorative approach used matrix-driven direct resin overlays to a predetermined increased occlusal vertical dimension.

Patient History and Complaints

A 58-year-old Caucasian man presented with a chief complaint of “pus and tooth pain on the lower right.” He was very self-conscious about the appearance of his teeth and wanted them to look better and to improve his ability to chew. He stated that he knew his teeth were “jacked up” and wondered if he should just get complete dentures (Figure 6).

He reported that he had not seen a dentist in more than 30 years. He was on disability from chronic back pain, managed by the Veterans Administration Hospital, and had a limited budget, relying on Medicaid coverage to help with his treatment. Although his health history was significant, consultation with his physician indicated no contraindications to routine dental treatment.

Clinical Findings

The initial oral and radiographic examination revealed localized periodontal disease, caries, several missing teeth with resultant drifting and three impacted third molars. There was evidence of prior endodontic treatment with poor prognosis, a symptomatic apical abscess on tooth No. 31, occlusal trauma, and severe occlusal mutilation resulting in a collapsed vertical dimension. He was an acknowledged bruxer. The mutilation and loss of vertical support presented a challenge to restore normal form and function (Figure 7).

Treatment Plan and Clinical Procedures

The ultimate decision was to treat the periodontal disease and restore the caries in teeth with favorable pulpal and biomechanical prognosis. Less-critical abutment teeth and those with endodontic or severe compromise (teeth Nos. 7, 23 through 25, and 31) were removed and would be replaced with economy acrylic partial dentures. Informed consent was obtained for the innovative application of a laboratory resin to restore his form and function with direct overlay procedures, and he would follow his treatment with an occlusal guard.

After this initial urgent phase of extractions and nonsurgical periodontal treatment had been completed, occlusal modifications and tooth preparations were accomplished with reference to preparation guides made from the diagnostic wax-up.

Total-etch bonding was completed with Ultra-Etch® (Ultradent, www.ultradent.com) and OptiBond™ Solo Plus (Kerr, www.kerrdental.com), and the restorative matrix was held securely while the restorative resin (Sinfony) was introduced into the injection hole until the excess was visualized from the vent hole. Prolonged light-curing from all angles, as previously discussed, was accomplished. After matrix removal, additional light-curing was completed to achieve the maximum polymerization.

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