CLINICAL CASE REPORT

INCISAL EDGE RECONSTRUCTION IN SAPPHIRE RESIN IN ANTERIOR TEETH

AUTHOR: FEDERICO LATORRE C

Reason for Consultation: Fracture of teeth 11 and 12.

Clinical Evaluation: Odontologist patient, who manifests due to an illness, to be taking a medicine with high acidity, also with dental clenching, which generated fracture and wear of the incisal edges in 11 and 12. Irregular fracture is observed, caused by the weakening of the structure due to acidity and favored by the clenching, irregular edges.

Description of the Problem: Irregular and fractured edges, with weakened enamel and in the 11 affected dentin in the palatal area, with span superficial pigmentation.

Objective of the Clinical Case: To recover lost enamel and dentin structure and to achieve adequate function and esthetics by repairing the edges, achieving a bright and polished surface.

Proposed Treatment Information:

Initial impression for evaluation of contours and anterior plane, placement of Nic tone rubber dam medium thickness blue color, placed with Wed jet in distal of 12 and distal of 21, cleaning of enamel and dentin with electric piezo equipment Satelec Newtron tip P1 NSK, placement of Teflon in mesial and distal of 11, attention under vision with Omni Pico Zeiss microscope, total etching on 11 and on 12 total etching, enamel etching time 15 seconds, orange filter is put on the microscope to avoid adhesive polymerization, use of New Stetic universal adhesive with microbrush, two layers, polymerizing only the second one, leaving each layer to act for more than 20 seconds and aerating until the adhesive does not move, polymerization with Blue phase N Ivoclar lamp in soft mode for 30 seconds , then use of Zafira incisal layer in palatal area, preheated to 39 degrees in Heat Micerium heater , using Ivoclar Optrasculpt spatula , polymerization with Blue phase N lamp in soft mode for 30 seconds , then an intermediate layer of A1 Zafira dentin was placed with Ivoclar Optrasculpt spatula, preheated to 39 degrees in Heat Micerium heater and polymerization with blue phase N lamp in soft mode for 30 seconds and finished with another layer of Incisal Zafira, using Ivoclar Optrasculpt spatula, resin preheated to 39 degrees in Heat Micerium heater and polymerization with blue phase N lamp in soft mode for 30 seconds. The color is checked and we proceed to the finishing, polishing and shining procedure, with a 0.12 yellow grain diamond bur, grain size between 10 to 36 microns, then we proceed to use Shape Guard Diatech discs, first a pink disc for finishing and polishing, 10 seconds between 6000 to 10000 revolutions, washed with water, the same disc is passed again for another 10 seconds at the same revolutions, wash the surface again with the water syringe, and proceed with the blue polishing and shining disc, 10 seconds for each surface, between 6000 and 10000 revolutions and washing between each step of 10 seconds, confirming that a smooth and shiny surface has been achieved, check with a thin Hu Friedy scanner and proceed to do the same steps in the 12, in the 12 total engraving is done.

Step by Step:

1. Isolation of Nic tone medium thickness rubber dam, blue color, held with Wed Jet elastics and metallic arch.
2. Cleaning of dentin and enamel with Satelec Newtron P1 tip piezoelectric equipment.
3. Under vision with Omni Pico Zeiss microscope, at 0.4 to 1 X magnification, we proceed to selective etching on 11.
4. Use of New Stetic phosphoric acid for 15 seconds in the enamel.
5. Cleaning for more than 30 seconds with acid water.
6. Drying and priming with two coats of New Stetic Universal adhesive and airing until the adhesive does not move.
7. Placement of Incisal resin on palatal 11, then A1 dentin and then incisal enamel in vestibular area.
8. Finishing, polishing and brightening procedures with a yellow band diamond bur with a grain size between 10 to 36 microns and then Shape Guard discs, using each disc twice for 10 seconds each and washing in between.
9. Check color and final result on 11 and proceed to put Teflon on mesial of 12 and distal of 12 and do selective etching on 12.
10. Apply New Stetic acid on enamel for 15 seconds and wash for more than 30 seconds.
11. Apply New Stetic universal adhesive for more than 20 seconds each layer without polymerizing between the two layers, aerate very well until the layer does not move and polymerize with Blue Phase N lamp for 30 seconds.
12. Apply the same as 11, three layers, one incisal palatal, one intermediate dentin and one final vestibular Enamel.
13. Finishing, polishing and shining procedures with yellow band diamond bur. Astropol Ivoclar F, P and HP discs, corresponding to gray finishing discs, green polishing discs and pink polishing and brightening discs, each disc was used for 10 seconds, washed with water with the syringe, then another 10 seconds and finish the procedure by removing the dam and evaluating the final result.

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Guarne, Antioquia, Colombia.

Phone:
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E-mail:
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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.