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The current president-elect of the Philippine Academy of Esthetic Dentistry, a society which he also co-founded in 1996, takes special interest in the field of Cosmetic Dentistry. His practice largely involves indirect composite restorations and bleaching. A nature lover his hobbies usually involve outdoor activities such as biking, mountain climbing and snorkeling to name a few. Dr. Magantino shares his work with us.
Using Composite Resin as a Long-Term Interim Restoration For Increasing Crown Length of Extensively Abraded Anterior Mandibular Teeth.
Abrasion due to poor occlusion with opposing ceramic restorations can be so extensive that vertical height almost diminished. After proper therapy for regaining the lost height the restoration of the abraded teeth can be best accomplished with resin-bonded fiber-reinforced composite resin splint. This serves as a reliable and very esthetic long term interim restoration. If the opposing ceramic restorations are corrected accordingly the composite splint may well be a permanent solution.
Click on the image to enlarge An incisal view of the manibular anteriors showing extensive abrasion caused by opposing ceramic crowns. Note that almost only the gingival third of the crown.
Click on the image to enlarge Conservative crown preparation was performed was performed on teeth 33-43. At labial, margins were placed equigingivally and gradually became subgingiva at the lingual. Sharp edges were smoothed and rounded.
Click on the image to enlarge Stone model was constructed surfaces of prepared teeth were applied with a rubber separating medium. A coping was then fabricated covering all the teeth from 33 to 43. It was formed by adapting a twofold length of connect reinforcement fiber (earlier soaked in unfilled resin) to the lingual and labial surfaces of the prepared teeth. Uncured composite was placed under the ribbon to tack it in place. Once in position the whole coping was cured for 40 sec. each tooth.
Click on the image to enlarge Each tooth was built-up and shaped into correct anatomy reproducing the interdental spaces and interproximal contacts. Stratification technique was utilized to achieve realistic shade using A-3 shade composite for the body and coating it with shade A-2. A transparent shade was placed at the incisal and blended to the body. The new crown height was dictated by the vertical clearance based on the articulated upper and lower models. Veneers for teeth 34 and 44 were likewise fabricated.
Click on the image to enlarge The anterior splint and veneers (34 and 44) were well polished using polishing disc. Notice the high polish composite and the lifelike effect brought about by stratification technique.
Click on the image to enlarge Prior to cementation, the bonding surfaces of the composite restorations were applied with copious amount of ceramic primer. It was set aside to dry while the prepared teeth are made ready for the bonding procedure.
Click on the image to enlarge Etch for 15 sec. Total technique insures maximum area for bonding. Celluloid strips were used to protect adjacent teeth from etching.
Click on the image to enlarge Two coats of adhesives were applied on the etched surfaces and lightly air blown into an even thickness all throughout.
Click on the image to enlarge A resin cement were mixed and placed onto the restoration. The prepared teeth are likewise lightly brushed with the cement.
Click on the image to enlarge The composite splint was seated gently but firmly and held in place for 3 minutes until cement becomes "rubbery" in consistency. At this point it is easy to just flick off the excess cement that flowed out at the margins.
Click on the image to enlarge The restorations were then thoroughly cured for at least 40 sec. each surface of every tooth. Under curing was avoided at all cost so as not to compromise bond strength.
Click on the image to enlarge The patient was asked to bite on articulating paper and premature contacts were noted. Final adjustments were done making use of a carbide but. Polishing was done again to smoothen areas of adjustment maintaining the shine earlier achieved.
Before
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After
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Dr.
Roy Magantino
