hello and welcome to chairside live I'm your host Megan strong I'm back from
maternity leave and excited to jump into this interesting case from doctor cheese in this
episode doctor cheese place in camouflage nano hybrid composite on tooth number 8
and 2 through 9 watch as he adds a layer of this powerful composite on tooth number 8 to
corrupt some surface pitting and roughness in the enamel camouflage is a versatile solution
formulated to be an affordable option for any composite based restoration but
without sacrificing quality so let's take a look at it in action take it away dr. Qi
for this case we have a young female patient that presents with a leaking unaesthetic class
5 composite restoration on the labial surface of number 9 the plan is to remove the old resin and
any secondary decay that might be lurking beneath the labial surface of number 8 exhibits some
pitting and irregularity so I'm also planning to fill those areas as well I'll show you how
to best avoid staining and micro leakage when restoring smooth surface lesions with composite
while we're at it the patient's edge to edge bite has led to some incisal attrition so I'll also
bond some resin along these areas to improve their appearance we are starting here with a little bit
of preoperative shade selection the key here is to apply the resin early on when the teeth are still
hydrated to get the closest match possible we cure camouflage a-1 and a-2 enamel onto unaged enamel
to allow for easy removal using a scaler these dollops pop right off with a coarse grit round
and a tapered diamond bur I begin the removal of the existing restoration along the periphery first
and slowly work my way towards the center I create an irregular bevel along the defect and feather it
out along the labial surface to try and make the interface as invisible as possible when removing
the composite it's always a challenge because they can blend in so well with two structure
drying the area really well can help expose the more matte surface of the composite and using
a slow-speed round bur facilitates its removal with a minimal impact to the enamel and dentin
now we begin the bonding procedure I'm using ultra dense 37% phosphoric acid to the surfaces I plan
on restoring it's important to etch beyond the plan restorative margins so we can ensure we have
a good seal along the edges of the restoration especially on these type of cases since we bevel
the margin and we'll intentionally have some resin overlapping the enamel along the edges we want to
create the chemical and micromechanical retention along the entire composite restoration this will
help avoid micro leakage in the future as we know when we cure resin onto unnatural it'll
stick but not very well since we are mostly in enamel I allow the acid to sit for about
20 seconds after a thorough wash we dry the area and check for the ideal bonding surface
the frosty white enamel next I apply kurz octi bonds so low adhesive I scrub the bonding agent
in really well so it will infiltrate into all the surface irregularities and then air thin
and ensure the solvents have evaporated for this case I prefer using camouflage flowable on these
smooth surface restorations because they adapt so well to the cavity here I'm applying the a1
enamel to both number 8 and number 9 and I like to use an explorer and probe to carefully push
the resin to the correct position on the incisal edges I use camouflage Universal since it has 12
mega Pascal's of additional flex show strength over the flowable which should be more resilient
against wear from the opposing and obsidian ceramic or even a brookster anterior veneer
would be ideal for a situation where a lot of additional length is desired but the edge to edge
position for this case limits how long I can make this without undergoing ortho treatment which the
patient is not really willing to do so I'm simply adding a layer to help with some of the chipping
that has occurred so along the incisal edges once I apply the resin I use a composite spatula
to help shape and try to establish the edges to a more aesthetic position lengthening them but again
the edge to edge position on number 9 limits how long I can make the especially along the distal
half so I'll use a Explorer to help remove some of the excess material on the lingual and ensure that
the surfaces are as smooth as possible and then we'll cure this for 20 seconds once the resin
is cured then I'll start finishing the surface to blend it in here I'm using a flame shaped diamond
bur and I like the length of this bird because I'm able to cover the entire length of these anterior
teeth to help smooth those surfaces out as much as possible once I use the diamond and finish
the surface and most of the roughness is removed then I'll move on to composite polishers these
rubber wheels and after we begin polishing the surface sometimes will notice concavities on the
restoration and in this case I have a little bit of a concavity on the center of number
nine and it's sometimes hard to tell especially whenever we're working under such dim lighting
when we're applying the composite especially if you have an overhead light and you use a filter
so here for this concavity I'm going to go back and apply a little bit of bonding agent and add
some resin directly to the center of number nine to repair this area to bring the contour
of that out to match the surrounding surface so we'll go through our bonding process cure
the bonding agent and apply a little bit more of the a1 enamel flowable right into that concavity
adapting it and blending it in with an explorer and then we'll cure that again for 20 seconds to
help blend that area into the surrounding tooth I'll use a fine grit round in a tapered diamond a
little bit of a larger burr to help blend more of that surface in and once I notice most of
the surface roughness has been taken down then we'll move back to our composite polishers to
help smooth and blend in the resin to the natural tooth surface so again we'll start off with the
coarse Composite polisher again here we're using the show food kit course composite polisher and
removing those surface irregularities to a nice smooth area on the lingual surface here I'm gonna
remove some excess composite with a slow speed handpiece and a round in this case I'm using a
ceramic burr it can be a round slow speed carbide or ceramic burr using a setting of about 3,000 rpm
and the round slow speed Berger helps to remove excess composite without having much effect on
the enamel whenever you apply composite resin to these smooth surfaces are really any situation you
want to really check the edges with an explorer to ensure the interface is as smooth as possible
and that will help ensure that the areas are more resistant to staining and especially
along the gingival margins that any overhangs are removed because any sort of overhang can certainly
allow for plaque accumulation and lead to tissue irritation after running through the polishing kit
from shofu will finish everything off with an aqua brush biker and this bristle brush helps
to bring the composite resin to a nice high shine running it along in a circular motion with light
pressure and that will help really bring luster to the surfaces of these restorations often times
these simple and more straightforward cases can be equally as rewarding as complex ones where we can
improve our patient self-esteem and help restore their teeth to a natural and aesthetic appearance
for these minimally invasive treatments I enjoy utilizing camouflage composite as it blends in
really well with the surrounding tooth structure with great handling and optical properties thank
you for tuning in for this week's chairside live we look forward to having you back for
the next one back to you Megan thank you for that dr. Chi and on behalf of everyone here at
gladware Laboratory we thank you for watching and I'll meet you right back here next time
you