Achieving Optimal Esthetics with Premise
Today’s general dentists are faced with myriad challenges to meet patient expectations. One fundamental challenge is restorations. Posterior restorative dentistry is our bread and butter, and with so many changes in dentistry over the last few years, it has become extremely important to meet all of those challenges.
The first obstacle is tooth sensitivity in the adhesive arena, especially with posterior teeth. Other concerns are ease of placement and longevity of the restoration. Last, but not least, is the ability to meet the esthetic demands of patients.
Kerr Corporation (Orange, CA) has simplified the process with their new improved Premise™ formula. The new formula maintains the original patented trimodal filler with an amazing 84% filler load that decreases shrinkage. The particle size consists of prepolymerized filler, patented Point 4 filler, and 0.02-µm filler. This approach gives Premise consistent durability, polishability, and strength and provides low polymerization shrinkage—one of the lowest in the industry. With Premise and a quick, simple clinical technique, an esthetic direct composite can be placed within a matter of minutes.
There are two major issues with placing posterior direct composites. The first is in creating a direct composite with minimal occlusal adjustments. Spending valuable chair time adjusting the occlusion on a posterior composite is not only time consuming but can also ruin the esthetic appearance and make the composite more difficult to polish. The second issue is in creating a restoration that appears anatomically natural and needs only a minimal amount of adjustment and polishing.
The illustrated clinical case demonstrates a method of placement that will virtually eliminate occlusal adjustments and create a natural restoration efficiently.
A 35-year-old female patient had two posterior amalgams with recurrent decay on the buccal of tooth No. 18 and occlusal of tooth No. 19 (Figure 1). After the patient was given anesthesia, the teeth were isolated with a rubber dam so the amalgams and decay could be removed (Figure 2). Once the amalgams and decay were re-moved, the preparations were scrubbed with 2% chlorhexidine for 15 seconds and then thoroughly rinsed (Figure 3).
In this circumstance, clinicians can use a total-etch or self-etch adhesive technique. Kerr's OptiBond® All-In-One self-etch system was chosen for its simplicity and dependability. A generous application of the adhesive was applied to the enamel and dentin of teeth Nos. 18 and 19 for 15 seconds and then the excess solvent was evaporated off. The application was repeated and both teeth were light-cured for 10 seconds each (Figure 4).
A thin 1-mm layer of Premise Flowable A-2 was placed to cover the pulpal floor, making sure to cover the undercuts created when the amalgam was placed (Figure 5), and then the layer was light-cured for 10 seconds.
The new optimized Premise body shade was placed on the mesiobuccal and distobuccal cusps and then carefully contoured to recreate the anatomical shape of the tooth, virtually eliminating the need for occlusal adjustments (Figure 6 and Figure 7). The composite was then cured for 10 seconds. These steps were repeated on the mesiolingual and distolingual cusps.
Occlusal pit stain characterization was added with a small amount of Kerr Kolor + Plus®. In this case, ochre stain was chosen (Figure 8A). A fluted carbide bur, No. 7404, was used to remove excess composite at the occlusal margins (Figure 8B). Kerr Hawe polishing points and brushes were used to create a natural polish (Figure 9 and Figure 10 ; Figure 11).
This article was written by Stephen Poss, DDS. Dr. Poss is in private practice in Brentwood, Tennessee.
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|Figure 1 Preoperative view of two posterior amalgams with recurrent decay on the buccal of tooth No. 18 and occlusal of tooth No. 19.||Figure 2 The teeth were isolated with a rubber dam.|
|Figure 3 The preparations were scrubbed with 2% chlorhexidine for 15 seconds and thoroughly rinsed.||Figure 4 The application was repeated and both teeth were light-cured for 10 seconds each.|
|Figure 5 A thin 1-mm layer of Premise Flowable A-2 was placed.|
|Figure 6 and Figure 7 The new optimized Premise body shade was placed on the mesiobuccal and distobuccal cusps and then carefully contoured to recreate the anatomical shape of the tooth.|
|Figure 8A Ochre stain was applied.||Figure 8B A fluted carbide bur No. 7404 was used to remove excess composite at the occlusal margins.|
|Figure 9 and Figure 10 Kerr Hawe polishing points and brushes were used to create a natural polish.|
|Figure 11 Final postoperative view.|