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Posterior Amalgam Replacement using Esthet-X ® and Xeno ® IV. Case completed by Martin B. Goldstein, DMD Presented by Dentsply/Caulk.
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Posterior Amalgam Replacement using Esthet-X® and Xeno® IV Case completed by Martin B. Goldstein, DMD Presented by Dentsply/Caulk
Figure 1: The case presented is a replacement of four amalgam restorations, #28 to #31, per the patient’s request. Before removing the alloy, a rubber dam was applied, using #31 as the anchor tooth.
Figure 2: All alloy was quickly removed and evacuated using a 245 carbide bur. Cavo-surface margins were then planed back with a wide, conical, flat end fine diamond so as to create an even bonding surface.
Figure 3: The gingival cavo-surface margins were planed back using a fine, mosquito tipped diamond.
Figure 4: The full thickness of a Hu-Friedy Flexi-thin plastic instrument can be freely moved in and out, buccal to lingual. This small step ensures easy sectional matrix and wedge placement as well as easy “free hand” sculpting of proximal walls.
Figure 5: In this case, dentin, while deeply stained, was resistant to hand excavation. Areas of deep dentinal exposure in the completed preps were coated with a light cured glass ionomer liner.
Figure 6: Marginal, uninstrumented enamel requires more aggressive etching when applying a self-etching adhesive. Therefore, Caulk Tooth Conditioner Gel (34% phosphoric acid) was applied to the enamel for 10 to 15 seconds.
Figure 7: Following rinsing and drying, Xeno® IV Light Cured Self-Etching Dental Adhesive was placed. The above steps were performed on all teeth, simultaneously, in an effort to reduce the amount of time to complete the restoration.
Figure 8: Finally, before beginning placement of the final restorative material, Esthet-X® Flow Liquid Micro Hybrid Restorative was placed in deeper areas of the preparations and light cured for 20 seconds.
Figure 9: In this case, tooth #31 was restored first, as no proximal walls were involved. The cavity was restored using Esthet-X® Micro-matrix Restorative, shown here being sculpted with a plastic placement instrument.
Figure 10: The second restoration placed takes advantage of the Esthet-X®’s highly sculptable nature. The DO on #28 was restored free hand in two increments, even though an open proximal wall was present. Esthet-X®’s non-slumping, stay-put handling, allowed for intimate contact with the walls of the distal box.
Figure 11: The Palodent® Sectional Matrix Systemring and matrix system was employed to form the distal wall of #30. The plastic instrument was seated against the matrix and angled towards the center of the tooth so as to assist in creating proper anatomic form of the marginal ridge.
Figure 12: The Palodent® Sectional Matrix System was used to create the distal wall of #29 first and then the mesial wall. One ring at a time is placed to allow for better access.
Figure 13: After curing the restorations, a #12 disposable scalpel may be used to trim the interproximal flash.
Figure 14: The rubber dam was removed and the occlusion was checked with articulating paper. Finishing diamonds or carbide burs were used to refine occlusal anatomy.
Figure 15: The Dentsply/Caulk Enhance® Finishing System instruments were used for final contouring and smoothing. The resulting surface is acceptable to complete the case.
Figure 16: A glossy surface may be obtained with polishing pastes or with a composite sealant, such as Lasting Touch™ Nano-Technology Liquid Polish, as shown here.
