Meet expectations with BRILLIANT EverGlow® -Dr Charles Brandon

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Posted by: Dental Design 7th January 2019

Dr Charles Brandon is a dentist at S3 Dental. Since graduating from King’s College London in 2016 he has striven to develop his cosmetic skills and deliver the highest standards of dentistry. Here, he presents a case using BRILLIANT EverGlow®by COLTENE.

Working in restorative dentistry you tend to see the whole spectrum of patient expectations, from those who are satisfied with a restoration as long as it’s functional, to those who demand a high level of aesthetics. In recent years the latter of the two outcomes seems to be the most popular choice, with a number of patients opting for white composite fillings over amalgam and visiting the practice to replace existing restorations. This was the case recently with a patient of mine, who presented to the practice for a routine check-up.

His examination revealed advanced dental caries in several teeth that had been previously restored, and early decay on others as a result of poor oral hygiene and high sugar intake. Upon hearing that he would need restorations on UR4 and UR5 he requested composite, as he felt that amalgam would not fulfil his aesthetic demands. Before treatment commenced, the patient was given some toothpaste to aid with his oral hygiene and fluoride was applied as a preventive measure. He was also informed that improvement would be required to his oral health and diet to prevent any further restorations in the future.

Treatment pathway

To carry out the treatment a rubber dam was placed and lidocaine was administered bucally before the site was opened. All caries was gently removed down to the hard aseptic dentine over the floor of the cavity but no further as it was in close proximity to the nerve. Taking it down to entirely clean dentine would have been too risky endodontically. Air abrasion with sandblasters was then carried out over the base of the cavity just to ensure everything was as clean as possible without encroaching on the pulp. To prepare the enamel, the teeth were selectively etched using phosphoric acid for 20 seconds on the enamel and 15 seconds on the dentine, before applying ONE COAT 7 UNIVERSAL (COLTENE) adhesive.

On the UR5 there was also some proximal decay distally, which was restored, and the upper right bicuspid was treated with an all-ceramic crown, zirconia core and an E-max jacket as the tooth was very discoloured as a result of previous endodontic therapy. The patient was not interested in internal or external bleaching. During placement there were several contact points to restore as well as some deep cavities in both pre-molars from secondary decay underneath the amalgam.

To ensure optimal results I used BRILLIANT EverGlow^®universal composite from COLTENE in shades A2/B2 and A3/D3, which is exceptionally easy to handle and manipulate – especially when carrying out a proximal adaptation of buccal walls. The restorations were built up free hand beginning with the buccal walls. From there the distal cavities were restored followed by infill of the cavities stepwise in 2-3mm increments, building up the occlusal surfaces. Polishing was completed with a polishing kit after wetting resin and glycerine gel had been applied to the teeth, increasing the fineness as I went before applying some composite diamond impregnated polishing paste.

Appraisal

Altogether, both the patient and I are very happy with the results. The aesthetic and versatile VITA based Duo Shade system of BRILLIANT EverGlow^®meant I was able to achieve an exceptional colour balance that blends in well with the surrounding natural dentition, satisfying both mine and the patient’s expectations. Using BRILLIANT EverGlow^®also ensured exceptional polishability and a high gloss once the restorations had undergone the finishing touches. As such, the patient is happy to undergo any further restorations that might be required later on down the line, though he understands that the best outcome would be a preventive approach.