Simplified Hypoplastic Enamel Restoration with a Dental Nanocomposite

Friday, November 15, 2013

Multiple Class IV bonded restorations present a special challenge to restore both functionally and esthetically. This is especially true when hypoplastic enamel is present involving the entire incisal edge of the affected teeth. Malformed enamel, dentin, and stains are commonly seen complications. These challenges can be met easily with proper yet simplified preparation and finishing techniques using one of the newer composite resins.

These finishing techniques can be simplified even further as 3M ESPE has recently introduced the Sof-Lex™ Spiral Finishing and Polishing Wheel system.  These unique, abrasive impregnated wheels have flexible “fingers” that adapt to irregular, convex or concave tooth surfaces, making intra- and extraoral finishing and polishing easier.

The wheels have abrasive particles embedded throughout, so all surfaces of the spiral wheel can be used, and as a result, they are effective from any angle, making it easier to work intraorally while also reducing the need to change to different disk grades and sizes. In this case the Sof-Lex Spiral Finishing and Polishing Wheels were used to produce an exceptional esthetic and functional restorative result with far fewer steps than before.

Case Study:

A fifteen-year-old boy with a history of rickets since age three presented with the incisal third of his six anterior teeth (#6-#11) affected by hypoplastic enamel (Fig. 1). Old bonding material and stain were present, and he was quite self-conscious about his appearance.

Fig. 1 The patient presents with hypoplastic enamel

Fig. 1 The patient presented with hypoplastic enamel on teeth #6-#11.

Ideal treatment would be restoration with a newer variant of composite resin to provide both a highly esthetic final result as well as ease in placement, handling and finishing. The following case presentation describes a simplified technique for the restoration of the patient’s six anterior teeth using 3M ESPE Filtek Supreme Ultra Universal Restorative, a highly polishable, high strength nanocomposite. The rationale for treatment included the removal of the old bonding material as well as excavation of all carious and stained enamel and dentin.

Fig. 2 Preparation was completed to remove caries and stain

Fig. 2 Preparation was completed to remove caries and stain.

Initial preparation was done with a medium football diamond to remove caries and stain, followed by a medium flare diamond for a long cavosurface bevel (Fig. 2). Starting with the central incisors, the prepared teeth were etched for 15 seconds with gel etchant followed by a 10 second rinse, and placement of two 15-20 second scrubbed on coats of 3M ESPE Scotchbond Universal Adhesive, gently blown dry for 5 seconds between coats, and light cured for 10 seconds (Fig. 3).

Fig. 3 Scotchbond Universal Adhesive is applied to the prepared teeth after etching

Fig. 3 Scotchbond Universal Adhesive is applied to the prepared teeth after etching.

Again, starting with the central incisors, and working outward two teeth at a time, incremental additions of Filtek Supreme Ultra Universal Restorative in a single body shade were made using an unblemished steel instrument—in this case Hu-Friedy’s Tarno FP-3- PFIW-3—and light cured for 10-15 seconds. A lingual matrix was created with the first addition, and then added on to the facial, slightly overbuilding the teeth with resin to allow for finishing.

Initial reduction of the bonding material is made with a medium flame diamond used for preparation, followed by the flame and carbide finishing burs.

Fig. 4 Finishing and polishing are completed using the Sof-Lex Spiral Wheels

Fig. 4 Finishing and polishing are completed using the Sof-Lex Spiral Wheels.

Then, finishing and polishing was completed with the newly introduced 3M ESPE Sof-Lex Spiral Finishing and Polishing Wheels (Fig. 4), which create a high natural luster, and seem to be easier and faster to use than discs when working on multiple teeth. The final result was highly esthetic and pleasing to the patient (Fig. 5).

Fig. 5 The completed case

Fig. 5 The completed case.

Sof-Lex™ Spiral wheels may be used on all composite resin restorative materials including materials such as Filtek Supreme Ultra as used in this case, and 3M™ ESPE™ Paradigm™ Nano Hybrid Restorative or 3M™ ESPE™ Lava™ Ultimate indirect restorative nano engineered ceramic/composite materials.

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