18/11/2024

Transforming an unsatisfactory restoration with Vittra APS Unique

Clinical case of restoration with Vittra APS Unique and Opus Bulk Fill Flow APS.

Author: Prof. Dr. Alex Sandro Olivaldo

MALE PATIENT, 43 YEARS OLD

He complained of loose restoration, sensitivity to cold, heat, and sweet food, in addition to the threading floss

Initial evaluation

When performing a clinical and radiographic evaluation on tooth 46, a composite resin restoration with signs of marginal infiltration, with maladapted edges, was observed. Upon examination with the explorer probe, it was found that the restoration was loose.

This condition was associated with threading floss during hygiene and sensitivity to cold and hot when chewing.

Treatment performed

The inferior alveolar nerve block technique was performed. Then, absolute isolation involving teeth 44, 45, 46, and 47 was performed for better visualization of the operative field and visual reference of the occlusal plane. The restorative material selected for the case was the Vittra APS Unique composite resin, so the color selection step was unnecessary.

During the restoration removal, it was noticed that the rubber dam was not well adapted due to the margin depth. For this reason, an accessory clamp was used to adapt the sheet better and achieve an effective inversion of the rubber dam in the distal region. With the dam properly adapted, a piece of Teflon tape was inserted into the site to obtain better exposure of the distal margin.

The enamel selective acid etching technique was performed for 15 seconds with Condac 37 for the acid attack. After etching, acid removal was performed with water and air blasting for the same application time. The chosen adhesive system was Ambar Universal APS in self-etching mode with the application of one drop actively for 10 seconds, volatilization with the blasting of air for 10 seconds, application of the second drop actively for 10 seconds, volatilization for 10 seconds, removal of excess adhesive with endodontic cannula and photoactivation for 10 seconds.

Opus Bulk Fill Flow APS resin in color A2 was used in a very thin layer and photoactivated for 20 seconds as a second step of the adhesive system. The restoration was performed using the incremental technique using the Vittra APS Unique resin.

To reconstruct the distal face, a partial metal matrix was adapted. Opus Bulk Fill Flow APS color A2 resin was applied at the tooth-matrix interface, and then Vittra APS resin was used to lift the cavity margin.

Next, a plastic wedge was inserted to promote sufficient dental clearance to compensate for the thickness of the metal matrix, achieving optimal contact between the faces. The same composite resin was used throughout the restorative procedure, both for simplifying the cavity – reconstruction of the distal face – and for the other stratifications

Next, the resin was used at the bottom of the cavity to regularize the pulp wall, complementing the final layer by building cusp-to- -cusp occlusal morphology

The brown pigment was applied in the grooves, and the finishing and polishing were conducted still under absolute isolation. After the removal of absolute isolation, occlusal adjustment was performed with spherical carbide drill