Volume 9 • 2022 • Issue 4

© 2022 Garrison Dental Solutions, LLC Mention Code ADCACDA822 150 DeWitt Lane Spring Lake, MI USA 49456 To order: Contact your authorized Garrison Dealer or call toll free 888.437.0032 or online at www.garrisondental.com ORDER TODAY! 888.437.0032 or contact your authorized Garrison dealer. Clinical Case with Dr. Clarence Tam Figure 1. Figure 2. ANK02 Contains: 25 short bands 25 tall bands 10 extra small wedges 10 small wedges 10 medium wedges 10 large wedges Case courtesy of: Dr. Clarence Tam (Auckland, New Zealand) demonstrates her technique for efficient Class III restorations while bonding to multiple substrates. To see the full article, go to the Learning Center at garrisondental.com/learning Efficient Class III restorations bonded to multiple substrates using a prefabricated anterior sectional matrix with curved wedges. The patient was anesthetized with 1 carpule of 2% Lignocaine w/ 1:100,000 epi and a rubber dam placed with individual floss ties for ultimate isolation (Fig 001), the old restorations in the anterior first quadrant were resected as well as the recurrent caries noted on tooth 12M cervicoproximally. Indeed, the final preparation form involved a substrate of both feldspathic porcelain/leucite-reinforced glass ceramic as well as dentin and cementum (Fig 002). The cavosurface margins were lightly bevelled, as bonding to the ends of enamel rods is more effective than to the sides of enamel rods. The entire preparation and its peripheries were treated with micro air abrasion (27-micron aluminum oxide) (Prep Start, Danville Engineering). The silica-based porcelain intaglio was treated using a 5% hydrofluoric acid solution for 45 seconds prior to rinsing, drying and application of a 33% orthophosphoric acid. The preparations were dried and a MDP-based silane coupling agent was applied only to the porcelain surfaces (G-MultiPrimer, GC America) for 1 minute without disturbance. The surfaces were dried with oil-free air and a 2% chlorhexidine solution (Vista Products) applied to the dentin for 30 seconds before controlled puff drying to a moist dentin state. G-Premio Bond (GC America) was agitated and applied to the preparations and air dried forcefully as per the IFU. Microlayers of composite (Majesty Esthetic flowable, A2, Kuraray Noritake) were placed in 0.25mm increments as part of an immediate dentin sealing protocol used for direct and indirect restorations against the pulpoaxial wall (minimizing C-Factor influences) building up progressively but not exceeding a 1.5mm total thickness within the first 5 minutes (2). This microincremental restorative period is critical for the hybrid layer to mature and decouple with time (3) and to generate microtensile bond strengths 400% that of control (1). The distal aspect of 11 was isolated with a sectional anterior matrix (Fusion Anterior, Garrison Dental Solutions, TX) and a curved orange wedge secured to ensure linguoproximal adaptation and thus a minimal of flash or overhangs of restorative material (Fig 003) The restorative material used was a single shade of A2 G-Aenial A’Chord (GC America) used incrementally to minimize C-Factor influences. The mesial of 11 was restored next (Fig 004), followed by the MP of 12 (Fig 005). Cingulum anatomy was placed in 12 for a truly biomimetic finish, and tinted with brown tint (Final Touch, Voco America) (Fig 006) Pre-and-postoperative radiographs show excellent marginal adaptation as well as adhesive adaptation of the material to the internal aspects of the preparations (Fig 007, Fig 008). Figure 3. Figure 4. Figure 5. Figure 6. Figure 7. Figure 8. Fusion ™ Anterior Matrix System