How to do class two composties that finish on cementum?


Usually two surface composite restorations don't work terribly well if there is no enamel on the gingival finish line. The restorations seem more prone to recurrent decay when this occurs.  One alternative technique is to use a "sandwich" technique . This is a two step process, where a modified glass ionomer is syringed into the gingival portion of the restoration and set. Then a portion of this is removed and shaped in order to leave the gingival mm or two in place.This becomes the floor of the preparation and a stronger bonded composite restoration is placed over it to complete the restoration.

Although this procedure definitely take additional time (probably an additional 5 to 10 minutes) the resulting restoration maybe more predictable and last longer than a one step conventional composite. It does take a little practice to perfect this technique but it is a good technique for a general dentist to master and keep in his or her toolbox.

For me the hardest part is cleaning the cavosurface margins up after placing my resin modified composite (Vitremer in my case) since it can stick to the tooth enamel. I use fine diamonds and diamond finishing strips to clean off my enamel finishing lines prior to placing my final composite in the preparation.  I use a Centrix needle tube to introduce the Vitremer into the gingival portion of the box and try not to be messy when applying it. After my restoration is complete I use a fine diamond coated Proflin tip in a manual handle to finish my gingival margin.

from Ask Dr. Spindel - http://ift.tt/2k9lMEy - http://ift.tt/1SpPbm6

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