CLINICAL CASE REPORT

FULL MOUTH ORAL REHABILITATION WITH DIRECT ADHESIVE RESTORATIONS, APPLYING THE ADDITIVE PHILOSOPHY.

AUTHOR: Dr. Mónica Lucía González Montero, M.D.

Reason for Consultation: 55 year old female patient, who comes to consultation asking for a second concept because her rheumatologist doctor indicates her to perform exodontia of all her teeth, as part of the treatment of all her systemic problems, which include Lupus, hemolytic anemia, Sjögren’s Syndrome, thyroid problems and herpes zoster of recent appearance.

Clinical Evaluation: The patient wishes to keep most of her teeth, knowing the oral problems that have been generated by her systemic condition, which has allowed the development of carious cervical lesions due to decreased salivary flow and continued medication intake. A complete evaluation of her oral health was performed, determining that a maximum preservation treatment could be performed, avoiding endodontic treatments, with an exhaustive follow-up of her oral hygiene and the preservation of the 12, with endodontics and fiberglass post and the planning of a full mouth rehabilitation with composite resin, including the crown of the 12 with polymeric material. All the necessary treatment is carried out without generating costs to the patient, with academic objectives and to support her in the process of restoring her health, which has been very satisfactory.

Objective of the Clinical Case: The biological, esthetic and functional objectives are met, using adhesive restorations in direct technique, with layering technique with opacifier, dentines and enamels of Zafira resin from New Stetic Company, including the crown of tooth 12 by indirect technique, with the same material.

Step by Step:

Advances in composite resin technology, the optimization of its properties and the development of new adhesive techniques have made its use increasingly reliable and of greater longevity.

1, Initial situation: Multiple carious lesions caused by xerostomia and difficulty in oral hygiene management. Presence of composite resin restorations with microleakage and coronal fracture of tooth 12 with pulp exposure but without presence of symptomatology.

2. In the initial radiographic analysis there was an absence of apical lesions and the need for endodontic treatment of 12. The endodontist performed the treatment of the exposed canal which was obliterated, which generated great difficulty and initial deviation of the instruments, direction that was retaken and could be performed satisfactorily without perforation of the canal (See in the radiography of the periapical set).

3. A fiberglass post was made in die # 12, which was cemented and reconstructed with Coltene’s Paracore system. The crown was made by indirect method by means of analogous impression, using Zafira resin, placing Dentin A3 in the bottom and enamel A2 and A1 in the external area. The adhesive used was Zafira Bond, rubbed for 20 seconds, aerated for 20 seconds and polymerized for 20 seconds.

4. The other resins were made with B-OP Opacifier in the background, A2 Dentin and A2 and A1 Enamel according to the color intensity of the restored area.

5. Palatal and lingual areas of the restored teeth. Tooth 41, which had a large amount of caries, was treated with glass ionomer as a cavity base and placed under observation.

6. Before and after the restorations performed.

7. Upper and lower arch finished with direct restorations. Polishing with the 3M Soflex and Soflex spiral disc system.

8. Case Completed. polished restorations and occlusion control.

FINAL RESULT : Mimic restorations with different opacities to mask the pigmentations of the substrate, creation of functional morphology and marginal sealing of the cervical areas and polymeric reconstruction with prefabricated post of tooth #12.

DRA. MÓNICA LUCÍA GONZÁLEZ M.

Odontóloga USTA Bucaramanga – Colombia, especialista en Biomateriales, Operatoria Dental y Estética UNICIEO Bogotá – Colombia. Docente Postgrados de Rehabilitación Oral, Biomateriales y Operatoria Dental Estética, UNICIEO – Bogotá, y Universidad Santo Tomás de Aquino – Bucaramanga.

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Guarne, Antioquia, Colombia.

Phone:
(+604) 550 0000

E-mail:
infocolombia@newstetic.com

INSTRUCTIONS FOR USE

Preparation:

Remove the cap from the etchant syringe.
Firmly twist a disposable dispensing tip onto the application end of the syringe.
Check the dispensing tip installation and etchant flow prior to intraoral application.

Application:

Clean: Prepare the cavity or area to be etched by cleaning and drying it, if necessary, apply a pulp cap.
Isolate: A clean and dry working field is essential for the acid etching procedure and avoids contamination of the working area.
Etching: Gently apply the etchant gel directly on the surface to be etched. The gel should be applied for 15 seconds, either on enamel or dentin. The indicated time control avoids injury to the dentin.
Rinse: After the 15 seconds of application, the tooth should be washed with abundant water until the acid is completely removed from the dental surface.
Drying: Remove the excess of water with oil free air or cotton balls. The dentin should be dry but not dehydrated (keep the dentin moist).
Proceed immediately with the application of the Bonding agent according to the instructions for use of the Bonding agent.

Instructions for use

Cleaning: Clean the prepared cavity with water or with a rubber cup and pumice or fluoride-free prophylactic paste. Rinse thoroughly with water and dry with air or micro suction (do not desiccate).
Isolation: Isolate to ensure a dry operative field, may be using a rubber dam or a cotton roll and a saliva ejector.

Pulp protection: In very deep cavities, the areas close to the pulp can be covered with calcium hydroxide or glass ionomer as a pulp protective base.

Application of Zafira Bond: Shake the bottle of Zafira Bond briefly before use.

Note: The first time you use it, shake the bottle of Zafira Bond adhesive vigorously for 10 seconds.

4.1 Procedure for direct and indirect restorations with light-curing composite resins and compomers, desensitization of cervical areas with tooth hypersensitivity, sealing of cavities prior to amalgam restorations, sealing of core build-up preparations, prior to fixation of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam.

before the fixation of indirect restorations.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto a disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the disposable brush or micro applicator on the tooth surface. Rub the surface for 20 seconds.

– Aerate the adhesive for at least 5 seconds with a gentle stream of air, until no more movement is observed, and the solvent has completely evaporated. The surface should have a glossy and uniform appearance.

– Light cure for 20 seconds using a lamp with a light intensity ≥ 500 mW/cm2.

– For the rest of the procedure, follow the instructions for use of the restorative and luting materials.

4.2. Procedure for intraoral repair of fractured resin and light-curing compomer restorations.

– Roughen the surface to be repaired with a diamond bur, clean with water and dry with compressed air free of oil and moisture.

– The following working steps are the same as for the application of Zafira Bond direct/indirect restorations (section 4.1.).

4.3. Procedure for use as a protective glaze for glass ionomer restorations

– Place the glass ionomer-based cement/restoration according to the manufacturer’s instructions.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto the disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the disposable brush or micro applicator on the tooth surface.

Instructions for use

Cleaning: Clean the prepared cavity with water or with a rubber cup and pumice or fluoride-free prophylactic paste. Rinse thoroughly with water and dry with air or micro suction (do not desiccate).

Isolation: Isolate to ensure a dry operative field, may be using a rubber dam or a cotton roll and a saliva ejector.

Pulp protection: In very deep cavities, the areas close to the pulp can be covered with calcium hydroxide or glass ionomer as pulp protective base.

Selective Etching. Etch the enamel margins of the cavity with Zafira Etchant Gel (37% phosphoric acid) for 15 to 30 seconds, then rinse thoroughly with water ensuring that all traces of etchant are removed.

Drying: Dry lightly with water and oil free air or micro suction, do not desiccate.

6. Application of Zafira Bond: Briefly shake the bottle of Zafira Bond prior to use.

Note: The first time you use it, shake the bottle of Zafira Bond adhesive vigorously for 10 seconds.

adhesive for 10 seconds.

6.1. Procedure for direct and indirect restorations with light-curing composite resins and compomers, desensitization of cervical areas with tooth hypersensitivity, sealing of cavities prior to amalgam restorations, sealing of core build-up preparations, prior to fixation of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam, sealing of restorations with amalgam.before the fixation of indirect restorations.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto a disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the disposable brush or micro applicator on the tooth surface. Rub the surface for 20 seconds.

– Aerate the adhesive for at least 5 seconds with a gentle stream of air, until no more movement is observed, and the solvent has completely evaporated. The surface should have a glossy and uniform appearance.

– Light cure for 20 seconds using a lamp with a light intensity ≥ 500 mW/cm2.

– For the rest of the procedure, follow the instructions for use of the restorative and luting materials.

6.2. Procedure for intraoral repair of fractured resin and light-curing compomer restorations.

– Roughen the surface to be repaired with a diamond bur, clean with water and dry with compressed air free of oil and moisture.

– The following working steps are the same as for the application of Zafira Bond direct/indirect restorations (section 6.1) including acid conditioning (step 4).

6.3. Procedure for use as a protective glaze for glass ionomer restorations

– Place the glass ionomer-based cement/restoration according to the manufacturer’s instructions.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto the disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the brush or disposable micro applicator on the tooth surface.

Instructions for use

Instructions for use
1. Cleaning: Clean the prepared cavity with water or with a rubber cup and pumice or fluoride-free prophylactic paste. Rinse thoroughly with water and dry with air or micro suction (do not desiccate).
2. Isolation: Isolate to ensure a dry operative field, may be using a rubber dam or cotton roll and saliva ejector.
3. Pulp protection: In very deep cavities, the areas close to the pulp can be covered with calcium hydroxide or glass ionomer as a pulp protective base.
4. Total Etching: Apply Zafira Etchant Gel (37% phosphoric acid) with applicator tip on enamel and dentin for 15”, then rinse abundantly with water for twice the etching time, making sure that all the acid remains are removed.
5. Drying: Dry lightly with water and oil free air or micro suction, do not desiccate.
6. Application of Zafira Bond: Briefly shake the bottle of Zafira Bond before use.
Note: The first time you use it, shake the bottle of Zafira Bond adhesive vigorously for 10 seconds.

6.1. Procedure for direct and indirect restorations with light-curing composite resins and compomers, desensitization of cervical areas with dental hypersensitivity, sealing of cavities prior to amalgam restorations, sealing of core build-up preparations prior to fixation of indirect restorations before the fixation of indirect restorations.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto a disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the disposable brush or micro applicator on the tooth surface. Rub the surface for 20 seconds.

– Aerate the adhesive for at least 5 seconds with a gentle stream of air, until no more movement is observed, and the solvent has completely evaporated. The surface should have a glossy and uniform appearance.

– Light cure for 20 seconds using a lamp with a light intensity ≥ 500 mW/cm2.

– For the rest of the procedure, follow the instructions for use of the restorative and luting materials.

6.2. Procedure for intraoral repair of fractured resin and light-curing copolymer restorations.

– Roughen the surface to be repaired with a diamond bur, clean with water and dry with compressed air free of oil and moisture.

– The following working steps are the same as for the application of Zafira Bond direct/indirect restorations (section 6.1) including acid conditioning (step 4).

6.3. Procedure for use as a protective glaze for glass ionomer restorations

– Place the glass ionomer-based cement/restoration according to the manufacturer’s instructions.

– Dispense 1 or 2 drops of Zafira Bond into a clean container or if preferred directly onto the disposable brush or micro applicator. Protect the adhesive from light. Replace the cap on the bottle immediately after dispensing so that the solvent does not evaporate.

– Apply the adhesive with the disposable brush or micro applicator on the tooth surface.

INSTRUCCIONES DE USO

Preparación:

1.Retire el tapón de la jeringa de ácido grabador.

Gire firmemente una punta dispensadora desechable sobre el extremo de aplicación de la jeringa.
3. Compruebe la instalación de la punta dispensadora y el flujo del grabador antes de la aplicación intraoral.

Aplicación:

Limpiar: Preparar la cavidad o área a ser grabada, limpiándola y secándola, si es necesario aplicar un protector pulpar. 5. Aislar: Un campo de trabajo limpio y seco es esencial para el procedimiento de grabado ácido y evita la contaminación del área de trabajo.
Grabado: Aplicar suavemente el gel grabador directamente sobre la superficie a grabar. El gel deberá ser aplicado por 15 segundos, ya sea en esmalte o en dentina. El control del tiempo indicado evita una lesión a la dentina.
Enjuague: Después de los 15 segundos de aplicación, el diente debe ser lavado con abundante agua hasta remover totalmente el ácido de la superficie dental.
Secado: Eliminar el exceso de agua con aire libre de aceite o motas de algodón. La dentina deberá estar seca pero no deshidratada (mantener la dentina humedecida).
Proceder de inmediato con la aplicación del agente adhesivo, conforme a las instrucciones de uso del mismo.

Instrucciones de uso

Limpieza: Limpie la cavidad preparada con agua o con una copa de caucho y piedra pómez o pasta profiláctica libre de flúor. Enjuague abundantemente con agua y seque con aire o micro succión (no desecar).
Aislamiento: Aislar para garantizar un campo operatorio seco, puede ser utilizando un

dique de goma o un rollo de algodón y un eyector de saliva.

Protección pulpar: En cavidades muy profundas, las áreas cercanas a la pulpa pueden cubrirse con hidróxido de calcio o ionómero de vidrio como base protectora pulpar.
4. Aplicación de Zafira Bond: Agite brevemente el frasco de Zafira Bond previo a su uso.

Nota: La primera vez que lo use, agite enérgicamente el frasco de adhesivo Zafira Bond

durante 10 segundos.

4.1. Procedimiento para restauraciones directas e indirectas con resinas compuestas y compómeros fotopolimerizables, desensibilización de zonas cervicales con hipersensibilidad dental, sellado de cavidades antes de las restauraciones con amalgama, sellado de preparaciones de muñones

antes de la fijación de restauraciones indirectas.

– Dispense 1 o 2 gotas de Zafira Bond en un recipiente limpio o si se prefiere directamente sobre un pincel o micro aplicador desechable. Proteger el adhesivo de la luz. Vuelva a tapar el frasco inmediatamente después de dispensar para que el solvente no se evapore.

– Aplicar el adhesivo con el pincel o micro aplicador desechable sobre la superficie del diente. Frotar la superficie durante 20 segundos.

– Airear el adhesivo durante al menos 5 segundos con una suave corriente de aire, hasta que ya no se observe movimiento y el solvente se haya evaporado por completo. La superficie debe tener una apariencia brillante y uniforme.

– Fotopolimerice durante 20 segundos usando una lámpara con una intensidad de luz ≥ 500 mW/cm2.

– Para el resto del procedimiento, se deben seguir las instrucciones de uso de los materiales de restauración y cementación.

4.2. Procedimiento para reparación intraoral de las restauraciones fracturadas de resina y compómero fotopolimerizable.

– Crear rugosidades en la superficie a reparar con una fresa de diamante, limpiar con agua y secar con aire comprimido libre de aceite y humedad.

– Los siguientes pasos de trabajo son los mismos que para la aplicación en restauraciones directas/indirectas de Zafira Bond (sección 4.1.)

4.3. Procedimiento para usar como barniz protector para restauraciones de ionómero de vidrio

– Coloque el cemento/restauración con base de ionómero de vidrio de acuerdo con las instrucciones del fabricante.

– Dispense 1 o 2 gotas de Zafira Bond en un recipiente limpio o si se prefiere directamente sobre el pincel o micro aplicador desechable. Proteger el adhesivo de la luz. Vuelva a tapar el frasco inmediatamente después de dispensar para que el solvente no se evapore.

– Aplicar el adhesivo con el pincel o micro aplicador desechable sobre la superficie del diente.

Instrucciones de uso

Limpieza: Limpie la cavidad preparada con agua o con una copa de caucho y piedra pómez o pasta profiláctica libre de flúor. Enjuague abundantemente con agua y seque con aire o micro succión (no desecar).
Aislamiento: Aislar para garantizar un campo operatorio seco, puede ser utilizando un

dique de goma o un rollo de algodón y un eyector de saliva.

Protección pulpar: En cavidades muy profundas, las áreas cercanas a la pulpa pueden cubrirse con hidróxido de calcio o ionómero de vidrio como base protectora pulpar.
Grabado Selectivo. Grabe los márgenes del esmalte de la cavidad con Zafira Etchant Gel (ácido fosfórico al 37%) durante 15 a 30 segundos, luego enjuague abundantemente con agua asegurando que se hayan eliminado todos los restos del agente grabador.
Secado: Secar ligeramente con aire libre de agua y aceite o micro aspiración, no desecar.
6. Aplicación de Zafira Bond: Agite brevemente el frasco de Zafira Bond previo a su uso.

Nota: La primera vez que lo use, agite enérgicamente el frasco de adhesivo Zafira Bond

durante 10 segundos.

6.1. Procedimiento para restauraciones directas e indirectas con resinas compuestas y compómeros fotopolimerizables, desensibilización de zonas cervicales con hipersensibilidad dental, sellado de cavidades antes de las restauraciones con amalgama, sellado de preparaciones de muñones

antes de la fijación de restauraciones indirectas.

– Aplicar el adhesivo con el pincel o micro aplicador desechable sobre la superficie del diente. Frotar la superficie durante 20 segundos.

– Fotopolimerice durante 20 segundos usando una lámpara con una intensidad de luz ≥ 500 mW/cm2.

– Para el resto del procedimiento, se deben seguir las instrucciones de uso de los materiales de restauración y cementación.

6.2. Procedimiento para reparación intraoral de las restauraciones fracturadas de resina y compómero fotopolimerizable.

– Crear rugosidades en la superficie a reparar con una fresa de diamante, limpiar con agua y secar con aire comprimido libre de aceite y humedad.

– Los siguientes pasos de trabajo son los mismos que para la aplicación en restauraciones directas/indirectas de Zafira Bond (sección 6.1) incluyendo el acondicionamiento ácido (paso 4).

6.3. Procedimiento para usar como barniz protector para restauraciones de ionómero de vidrio

– Coloque el cemento/restauración con base de ionómero de vidrio de acuerdo con las instrucciones del fabricante.

– Aplicar el adhesivo con el pincel o micro aplicador desechable sobre la superficie del diente.

Instrucciones de uso

Limpieza: Limpie la cavidad preparada con agua o con una copa de caucho y piedra pómez o pasta profiláctica libre de flúor. Enjuague abundantemente con agua y seque con aire o micro succión (no desecar).
Aislamiento: Aislar para garantizar un campo operatorio seco, puede ser utilizando un

dique de goma o un rollo de algodón y un eyector de saliva.

Protección pulpar: En cavidades muy profundas, las áreas cercanas a la pulpa pueden cubrirse con hidróxido de calcio o ionómero de vidrio como base protectora pulpar.
Grabado Total: Aplicar Zafira Etchant Gel (ácido fosfórico al 37%) con punta aplicadora sobre esmalte y dentina durante 15’’, luego enjuage abundantemente con agua, por el doble del tiempo de grabado, asegurando que se hayan eliminado todos los restos del agente grabador.
Secado: Secar ligeramente con aire libre de agua y aceite o micro aspiración, no desecar.
6. Aplicación de Zafira Bond: Agite brevemente el frasco de Zafira Bond previo a su uso.