Product Profile: A Better Way to Treat Class V Restorations by Dr Sanzio Marques

Voco’s Admira Fusion excels at both strength and aesthetics

by Dr Sanzio Marques

Introduction
Day-in, day-out, we are seeing an increasing demand for the restoration of noncarious cervical defects at our dental practice. The reasons for this include increasing expectations on the part of the patients with respect to their appearance and their teeth, as well as continuing changes in eating habits.

These defects are associated with the loss of mineralised tooth substance and have a number of causes; the most common are erosion, abrasion and abfraction.

In addition to the common phenomenon of sensitive tooth necks, these defects result in concave areas in the immediate vicinity of the periodontal tissues. It is easy for a microbiotic biofilm to develop in these very susceptible regions. This may lead to gingivitis, with all its harmful consequences for oral health and the patient’s general health.

These cases are a classic indication for composite restorations, because without treatment, noncarious defects tend to expand progressively. The success and longevity of these restorations are directly linked to the restorative technique employed and selection of the correct materials. In such cases, it is imperative to select a material that has good physical properties and is resistant to the oral environment. In addition, it is particularly important that the material is easy to polish, allowing the dentist to achieve a smooth surface.

The Admira Fusion restorative material (Voco) from the “Ormocer” (organically modified ceramic) range satisfies all of these requirements. With its aesthetic shade and good polishability, the material was employed in a clinical case with Class?V restorations of cervical defects caused by abfraction.

Description of the clinical case
A patient presented in our practice complaining of hypersensitivity in teeth 34 and 35 (lower left premolars). Both teeth had previously been restored twice, although the restorations had been lost after only a short period of time. In addition, #34 had been repaired with an inadequate composite restoration.

A detailed clinical examination revealed occlusal interferences during lateral movements, which were resolved before new restorations were placed.

Because of the lower risk of damage to the remaining tooth substance, an ultrasonic instrument was selected for removal of the old restoration and preparation of the cavity (Figs. 2–4). The restorations were placed with the assistance of two suction devices for relative moisture control in the operating site.

After complete conditioning with 37% phosphoric acid (Fig. 5), the Admira Bond adhesive system was applied (Fig. 6) and light-cured for 20 seconds (Fig. 7). Following the incremental technique, using increments of not more than 2mm, the restoration of the cavities was begun with care (Fig. 8).

The dentist’s finesse ensures restorations with a good marginal seal and correct contouring. Appropriate spatulas and brushes are essential tools in this respect.

The complete finishing and polishing of a restoration is rendered much simpler if the dentist takes time and care when smoothing the layers individually with good brushes, especially the final layer (Figs. 9 and 10).

Once the final increment was applied, each restoration was cured for 40 seconds, with a water-soluble gel being used for the final curing to prevent the formation of an oxygen inhibition layer on the surface of the composite and thereby enhance its physical properties (Fig. 11).

A #12 scalpel blade was used to remove the proximal and cervical excesses, thus beginning the finishing and polishing.

A medium-grit polishing wheel was used for the fine contouring and for initial surface smoothing (Fig. 12). The surface polishing was performed with diamond-coated rubber polishers with flexible polishing lamellae in two different grit sizes (Eve Diacomp Plus Twist) (Figs. 13 and 14).

The final polish was achieved with goat’s hair brushes and felt polishers in combination with diamond pastes and aluminium oxide. The final result was both aesthetically pleasing and functionally very satisfactory (Fig. 15). In addition, thanks to the complete resolution of the hypersensitivity, it contributed to the preserving the patient’s general health and well-being.

Conclusion
Admira Fusion proved an excellent option for the restoration of noncarious cervical defects. All of the requirements associated with optimal restorations were satisfied.

The long-term success of this restorative treatment depends on the after-care with precise monitoring of the causative factors, the patient’s own efforts and regular visits to the practice for check-ups and preventive care.

 

Fig. 1: Teeth 34 and 35 with the indication for adequate composite restorations.

 

Figs. 2 and 3: Removal of existing composite restoration and cavity preparation with ultrasonic tip.

 

Figs. 2 and 3: Removal of existing composite restoration and cavity preparation with ultrasonic tip.

 

Fig. 4: Fully prepared cavities.

 

Fig. 5: Total etch technique with phosphoric acid.

 

Figs. 6 and 7: Application of adhesive system and subsequent light-curing for 20 seconds.

 

Figs. 6 and 7: Application of adhesive system and subsequent light-curing for 20 seconds.

 

Figs. 8–10: Introduction of increment (Admira Fusion), sculpting with a spatula and smoothing with the help of a brush.

 

Figs. 8–10: Introduction of increment (Admira Fusion), sculpting with a spatula and smoothing with the help of a brush.

 

Figs. 8–10: Introduction of increment (Admira Fusion), sculpting with a spatula and smoothing with the help of a brush.

 

Fig. 11: Curing of increment.

 

Figs. 12–14: Finishing and polishing the restorations with polishing wheels and diamond-coated rubber polishers.

 

Figs. 12–14: Finishing and polishing the restorations with polishing wheels and diamond-coated rubber polishers.

 

Figs. 12–14: Finishing and polishing the restorations with polishing wheels and diamond-coated rubber polishers.

 

Fig. 15: The final result displays good shade matching and outstanding polishing of the cervical restoration.

Dr Sanzio Marques is a practicing dentist with special interests in conservative dentistry and prosthodontics in Belo Horizonte, Brazil. Marques also lectures at the Federal University of Minas Gerais and at the University of São Paulo. He is the author of various reference books and is a course instructor at several institutions.

Admira Fusion: The purely ceramic-based restorative material

With Admira Fusion, Voco presents a purely ceramic-based universal restorative material. This is made possible by the innovation of combining nanohybrid technology with that of “Ormocers” (organically modified ceramics) developed in cooperation with the Fraunhofer Institute for Silicate Research ISC.

Silicon oxide forms the chemical base for Admira Fusion, not only for the fillers but also for the resin matrix.

This unique “Pure Silicate Technology” offers several advantages: For example, Admira Fusion shows the lowest level of polymerisation shrinkage (1.25% by volume) and extremely low shrinkage stress.

The Ormocers in Admira Fusion make it highly biocompatible, because there is no content of classic monomers, some of which might otherwise escape after polymerisation.

Admira Fusion’s particularly high colour stability gives it an additional edge and allows its absolutely universal use, for highest demands in both the anterior and posterior regions.

This very homogeneous material offers outstanding handling and is compatible with all conventional bonding materials. The restoration system also comprises fast-track version Admira Fusion X-tra, which allows increment thicknesses of up to 4mm, as well as the flowable bulk-fill material Admira Fusion X-Base and the flowable variant Admira Fusion Flow.