32 | DENTAL PRODUCT SHOPPER www.dentalproductshopper.com

JAMES CHAE, DDSDr. James Chae graduated from

the University of California San

Francisco School of Dentistry in 2000. He currently owns

a private practice in Diamond Bar, CA,

called Diamond Bar Dental Group, where he practices general

and cosmetic dentistry. A member

of the American Academy of

Cosmetic Dentistry, California Dental Association, and American Dental

Association, Dr. Chae has published cases

in various dental publications. He

shares his work and answers questions

on Facebook and Instagram

using the handle @ diamondbar

dentalgroup.

NEW PRODUCTS | PRODUCT SPOTLIGHT | TRIED & TRUE CLINICAL PRACTICEPRODUCT

focus

A 28-year-old woman presented with an old, failing amalgam restoration on the occlusal surface and a missing filling on the buccal sur-

face of tooth No. 19 (Figure 1). Bitewing and periapi-cal x-rays were taken to ensure that no interproximal caries or periapical lesions were present (SuniRay, Suni). Then, an intraoral photo was taken to present and confirm the caries (CS 1200, Carestream).

After distributing 2% Lidocaine with 1:100,000 epinephrine on the inferior alveolar block, a rubber dam was placed (Figure 2). The existing amalgam was then removed using an inverted cone diamond bur (Figure 3) and all soft caries were removed using carbide round burs with a slow-speed handpiece (Midwest Shorty, Dentsply Sirona).

To ensure a clean, neat cavity preparation, the superficial caries and stains were removed conservatively with a small round diamond bur. Intraoral photos were taken to confirm no caries were left behind (Figures 4-5). To ensure absolute isolation, a liquid dam was placed around the tooth (Figure 6).

Creating a Durable RestorationTheraCal LC (BISCO) was placed on the cavity

surface to decrease sensitivity and mask the dark amalgam stain that could potentially show through the planned translucent composite restoration (Figure 7). TheraCal LC is a resin-based calcium silicate containing material that is ideal to use as a protective liner in deep cavity preparations; it can be easily placed through its syringe delivery system. It also is highly durable and allows for immediate placement. In this case, I placed TheraCal LC on the deep cavity surface and light-cured it for 20 seconds.

A wide bevel was placed on the occlusal and buccal surfaces and a selective enamel etching technique was performed using 37% phosphoric

acid (Figure 8). The area was rinsed and dried and a bonding agent was placed and then lightly air dried.

Using a condenser, composite shades A2 and A3 (Estelite Sigma Quick, Tokuyama Dental) were placed on the occlusal and buccal surfaces, respectively. Before light curing, some occlusal anatomy was created using several hand instruments (21B Burnisher, Hu-Friedy; Blue Titanium CIB3, Pioneer Solution; CEEX3A, Nordent). Then, occlusal adjustments were made and more detailed anatomy was created using football- and needle-shaped diamond burs (Brasseler USA).

Polishing and Final OutcomePolishing was completed using a large coarse

polishing disc (Sof-Lex, 3M), a fine needle-shaped diamond bur, and a White Arkansas Stone (Dedeco). The final restoration blended nicely to the tooth after occlusal adjustments and polishing (Figures 9-10).

My patients never leave the office without a clear view of the final outcome, and this patient was completely relieved and happy to see such a healthy, natural-looking restoration before she left the chair.

CASE PRESENTATION

Protecting the Deep Cavity Surface

Figure 1—Preoperative view of failing amalgam restoration and missing filling on the buccal surface of tooth No. 19

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GO-TO PRODUCT USED IN THIS CASEFigure 8—Selective enamel etching technique performed using 37% phosphoric acid

Figure 5—Buccal view after soft caries removal Figure 6—Liquid dam placed around the tooth to ensure absolute isolation

Figure 7—TheraCal LC (BISCO) is placed on the deep cavity surface

Figure 2—Rubber dam placement Figure 3—Existing amalgam is removed using an inverted cone diamond bur

Figure 4—Occlusal view after soft caries removal

GO-TO PRODUCT USED IN THIS CASETHERACAL LC

A light-cured, resin-modified calcium silicate filled liner, TheraCal LC is indicated for direct and indirect pulp capping and as a protective liner under composites, amalgams, cements, and other base materials. The proprietary hydrophilic resin formulation creates a durable liner, while its light-cured set permits immediate placement.

BISCO800.247.3368www.bisco.com

Figure 9—Final restoration blends nicely after occlusal adjustments and polishing

Figure 10—Postop view of the final restoration; patient was very happy with the result