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Special Issues
September 2020
Volume 41, Issue 1

A Practical, Flowable Technique for Restoring a Worn Dentition

Giancarlo Romero, DDS, MS

The restoration of a worn dentition can be a complicated, lengthy procedure. Often, patients present with collapsed vertical dimension of occlusion (VDO) and/or minimal tooth structure, leading clinicians to prescribe root canal treatment on multiple canals to gain resistance form prior to restoring. This case demonstrates a flowable technique, in which a laboratory wax-up was transferred at the estimated VDO with the use of translucent silicon matrices fabricated from the cast. Each tooth was restored with flowable composite; the patient can be fully treated in one or two sessions. This technique, featuring the use of various BISCO products (, allows the clinician to reestablish the proper VDO, occlusion, and esthetics before completing the case with final ceramic materials. The key advantage is not having acrylic temporaries in the mouth for months when the case requires temporomandibular disorder resolution. Another advantage is the use of segmental impression-taking versus a full-arch impression due to the occlusion being dialed in and there being no need for full-mouth temporaries. This approach also eases the financial burden for the patient over time. Finally, this protocol preserves marginal peripheral enamel for excellent bond strength in these areas when compared to adhesion to dentin.

Key Takeaways

Adhesive dentistry using a range of products from BISCO is an alternative to conventional, full-mouth rehabilitation involving root canal treatment for
restorative indications.

The use of selective etching and a universal bonding agent can eliminate post-cementation sensitivity, a common problem in restorative dentistry.

Reducing the provisional service period minimizes complications with
recurrent caries, fractures, and loose temporaries.

About the Author

Giancarlo Romero, DDS, MS
Clinical Assistant Professor, Graduate Prosthodontics, University of Texas Health Science Center, Houston, Texas; Private Practice, Houston, Texas
Center, San Antonio, Texas

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