How to perform the sandwich technique for performing Class 2 composites that finish on cementum?

Sandwich fillings on distal of #4 & #29

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.  One alternative recommended 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 portion still 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.

I start by placing a sectional matrix the same way I ordinarily do for a regular compostie.   I use a Centrix syringe to introduce the Vitremer into the gingival portion of the box and try not to be messy when applying it. After I place my modified glass ionomer restoration and allowing it to set, I remove the sectional matrix and I use fine diamonds and diamond finishing strips to clean off my enamel finishing lines prior to reapplying my sectional matrix again and placing my  composite.  After my restoration is complete, I use a fine diamond coated Profin tip in a manual handle to finish my gingival margin.



from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2017/02/how-to-do-class-two-composties-that.html - http://lspindelnycdds.blogspot.com/

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