Posterior Amalgam Posterior Amalgam Replacement using Replacement using

Esthet-XEsthet-X®® and Xeno and Xeno®® IV IV

Case completed by Case completed by Martin B. Goldstein, DMDMartin B. Goldstein, DMD

Presented by Dentsply/CaulkPresented by Dentsply/Caulk

Figure 1: The case presented is a replacement of four Figure 1: The case presented is a replacement of four amalgam restorations, #28 to #31, per the patient’s request. amalgam restorations, #28 to #31, per the patient’s request. Before removing the alloy, a rubber dam was applied, using Before removing the alloy, a rubber dam was applied, using #31 as the anchor tooth. #31 as the anchor tooth.

Figure 2: All alloy was quickly removed and evacuated using Figure 2: All alloy was quickly removed and evacuated using a 245 carbide bur. Cavo-surface margins were then planed a 245 carbide bur. Cavo-surface margins were then planed back with a wide, conical, flat end fine diamond so as to back with a wide, conical, flat end fine diamond so as to create an even bonding surface. create an even bonding surface.

Figure 3: The gingival cavo-surface margins were planed back Figure 3: The gingival cavo-surface margins were planed back using a fine, mosquito tipped diamond. using a fine, mosquito tipped diamond.

Figure 4: The full thickness of a Hu-Friedy Flexi-thin plastic Figure 4: The full thickness of a Hu-Friedy Flexi-thin plastic instrument can be freely moved in and out, buccal to lingual. instrument can be freely moved in and out, buccal to lingual. This small step ensures easy sectional matrix and wedge This small step ensures easy sectional matrix and wedge placement as well as easy “free hand” sculpting of proximal placement as well as easy “free hand” sculpting of proximal walls.walls.

Figure 5: In this case, dentin, while deeply stained, was Figure 5: In this case, dentin, while deeply stained, was resistant to hand excavation. Areas of deep dentinal exposure resistant to hand excavation. Areas of deep dentinal exposure in the completed preps were coated with a light cured glass in the completed preps were coated with a light cured glass ionomer liner. ionomer liner.

Figure 6: Marginal, uninstrumented enamel requires more Figure 6: Marginal, uninstrumented enamel requires more aggressive etching when applying a self-etching adhesive. aggressive etching when applying a self-etching adhesive. Therefore, Caulk Tooth Conditioner Gel (34% phosphoric Therefore, Caulk Tooth Conditioner Gel (34% phosphoric acid) was applied to the enamel for 10 to 15 seconds. acid) was applied to the enamel for 10 to 15 seconds.

Figure 7: Following rinsing and drying, XenoFigure 7: Following rinsing and drying, Xeno®® IV Light Cured IV Light Cured Self-Etching Dental Adhesive was placed. The above steps Self-Etching Dental Adhesive was placed. The above steps were performed on all teeth, simultaneously, in an effort to were performed on all teeth, simultaneously, in an effort to reduce the amount of time to complete the restoration.reduce the amount of time to complete the restoration.

Figure 8: Finally, before beginning placement of the final Figure 8: Finally, before beginning placement of the final restorative material, Esthet-Xrestorative material, Esthet-X®® Flow Liquid Micro Hybrid Flow Liquid Micro Hybrid Restorative was placed in deeper areas of the preparations Restorative was placed in deeper areas of the preparations and light cured for 20 seconds. and light cured for 20 seconds.

Figure 9: In this case, tooth #31 was restored first, as no proximal Figure 9: In this case, tooth #31 was restored first, as no proximal walls were involved. The cavity was restored using Esthet-Xwalls were involved. The cavity was restored using Esthet-X®® Micro-matrix Restorative, shown here being sculpted with a Micro-matrix Restorative, shown here being sculpted with a plastic placement instrument. plastic placement instrument.

Figure 10: The second restoration placed takes advantage of the Figure 10: The second restoration placed takes advantage of the Esthet-XEsthet-X®®’s highly sculptable nature. The DO on #28 was restored ’s highly sculptable nature. The DO on #28 was restored free hand in two increments, even though an open proximal wall free hand in two increments, even though an open proximal wall was present. Esthet-Xwas present. Esthet-X®®’s non-slumping, stay-put handling, allowed ’s non-slumping, stay-put handling, allowed for intimate contact with the walls of the distal box. for intimate contact with the walls of the distal box.

Figure 11: The PalodentFigure 11: The Palodent®® Sectional Matrix System Sectional Matrix System ring and matrix ring and matrix system was employed to form the distal wall of #30. The plastic system was employed to form the distal wall of #30. The plastic instrument was seated against the matrix and angled towards the instrument was seated against the matrix and angled towards the center of the tooth so as to assist in creating proper anatomic form center of the tooth so as to assist in creating proper anatomic form of the marginal ridge. of the marginal ridge.

Figure 12: The PalodentFigure 12: The Palodent®® Sectional Matrix System was used Sectional Matrix System was used to create the distal wall of #29 first and then the mesial wall. to create the distal wall of #29 first and then the mesial wall. One ring at a time is placed to allow for better access. One ring at a time is placed to allow for better access.

Figure 13: After curing the restorations, a #12 disposable Figure 13: After curing the restorations, a #12 disposable scalpel may be used to trim the interproximal flash. scalpel may be used to trim the interproximal flash.

Figure 14: The rubber dam was removed and the occlusion Figure 14: The rubber dam was removed and the occlusion was checked with articulating paper. Finishing diamonds or was checked with articulating paper. Finishing diamonds or carbide burs were used to refine occlusal anatomy. carbide burs were used to refine occlusal anatomy.

Figure 15: The Dentsply/Caulk EnhanceFigure 15: The Dentsply/Caulk Enhance®® Finishing System Finishing System instruments were used for final contouring and smoothing. instruments were used for final contouring and smoothing. The resulting surface is acceptable to complete the case.The resulting surface is acceptable to complete the case.

Figure 16: A glossy surface may be obtained with polishing Figure 16: A glossy surface may be obtained with polishing pastes or with a composite sealant, such as Lasting Touchpastes or with a composite sealant, such as Lasting Touch™™ Nano-Technology Liquid Polish,Nano-Technology Liquid Polish, as shown here. as shown here.

Figure 17: The completed case.Figure 17: The completed case.