Hi guys, here is the case I did last Wednesday just to show my composite technique. The case is a 32 year old female who had caries in 25 distally well into dentine. Here are the shots of the case from start to finish.
Starting point 25d caries – it seems a definite shame to drill this tooth!!
Caries removal 25d and along the occlusal fissure (not a retentive key). Placement of rubber dam with clamp on 27, slit dam 26 to 23 with floss ligature.
Acid etch and rehydration of dentine. Wedgewand placed and sectional matrix strip followed by Compositight 3D-ring.
Flowable composite lining and proximal contact built up in an enamel shade of composite after burnishing of thhe sectional matrix.
Placement of composite in incrementally built up layers up to the cusp slopes starting with a dentine shade first and finishing with an enamel shade.
Finishing and polishing of the restorations. Pleasing contact point and the patient was very happy.
Feel free to comment! I’ll put an MOD case up illustrating the use of two rings as soon as I can.
#1 by Cara at April 25th, 2010
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beautiful work
#2 by Jon Moulding at April 25th, 2010
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Great work again. Still persevering with the dam I see.
I must be bored though, I’m reading dental blogs whilst in Florida, but it is 6am here and I can’t sleep.
#3 by Jason at April 26th, 2010
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good work
#4 by Pete Buchan at April 26th, 2010
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Great photos. Great work!
Good use of split dam and sectional matrix.
Bit of mist on mirror on first and last picts. (helps to pre warm mirror under warm running water)
Ideally the pre op and post op picts have exactly the same point of view, but I am being really picky.
Pete
#5 by ChrisO'C at April 28th, 2010
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Hi Jon, wish I could say it was my work but this is from Neal the newest greatest contributer!
I use pretty much the same technique Though I prefer the look of that system to mine.
It’s just lovely to learn from someone elses workand have them in the firing line for once!
#6 by Jason at April 29th, 2010
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i think it is always a good idea to stock a variety of banding system and bands in the practice. once in a while i will run into a subgingival cavity with wide contact space that my routine banding system just won’t cut it. I saw a sectional matrix with gingival apron in a presentation by Dr Jason Smithon (UK). Been wanting to try it for a while.
#7 by Dentist MD at April 29th, 2010
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Neal is pretty good, especially as a newest greatest contributor!
Dentist MD´s last blog ..Teeth Bleaching vs. Whitening
#8 by Neal at April 29th, 2010
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Oh it’s great to be in the firing line Chris!
Jason, with this system there are an assortment of different bands depending on the cavity and anatomical tooth form soo you can pick the best fitting. I used a boomerang shaped bicuspid matrix for this case but the subgingival bands that come with it are very good.
#9 by ChrisO'C at April 29th, 2010
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Yeah but I’m still the oldest greatest contributer so I don’t mind
#10 by Jim Lafferty at May 4th, 2010
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I’m intrigued as to why the split dam technique – since I switched to Roeko Flexi Dam I have hardly done any split dams. For my two-pennorth, I’d have punched holes for 654 and not split it; wedjet between the 3 and 4 if it’s not a tight contact; if you stretch the dam so it goes really thin interproximally, you can get the wedge/matrix in subgingivally without having to split it; though I always question my diagnosis and treatment planning if I’m doing a posterior direct composite subgingivally – is this the correct technique given what we know about bonding? Should we/ would we be better be placing an indirect restoration?
#11 by Gilbert Dentists at May 6th, 2010
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Very good work. How did you get such good shots by the way?
#12 by Neal at May 7th, 2010
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Thanks for your feedback!
They were fairly quick shots to be honest. It was commented on that there was some mist on the mirror and that I had not got the angulation on pre-op and post-ops the same. They are very fair comments but these photos were just for illustration purposes. And also I went through enough sets of gloves taking them and was really only concerned with having even illumination and focus.
For aesthetic cases it’s best to take full mouth shots as per BACD guidelines in jpeg and RAW format. RAW is unnecessary for general shots though. With RAW format you store all digital data in the format for later manipulation – however if you plan on doing anything official with your photos they shouldn’t be altered anyway.
I think decent photos are down to the equipment used more than anything. I used to manage in the early days doing smile shots with a compact but capturing single teeth was very hard and often focusing was poor.
To get good close-ups you need a good macro lens, a digital SLR, ring or dual source flash, cheek retractors and mouth mirrors.
I have a Canon 1000D 10MP camera (all set to aperture priority with a high F-number and hence greater depth of field in order to get most of the subject in focus)
A Marumi (cheapest but does a great job) Ring flash for even illumination and no shadows. It can although flatten images a little.
A 105mm macro lens – you can get smaller macros but with a 105mm you can get further from the patient and so breath steaming up the lens isn’t a problem. It also means you aren’t likely to hit the patient in the face with your camera when trying to focus! Mine is a generic Sigma lens which has easy to see markers to allow you to keep the scale of photos e.g. 1:1, 1:2, 1:3 etc…
I used an occlusal mouth mirror which was pre-warmed and dried with a 3 in 1. Unfortunately patients cough and still steam things up or spit on the mirror.
Anything else is just practice and of course there will be a lot of apologising to patients as you look like a fool trying to get your camera to work.
If you want any more info on the kit I bought just give me a shout.
#13 by Dentist at May 13th, 2010
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Great work and skill you have. The pictures are very well-taken. Bravo!
#14 by Farydon at May 27th, 2010
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It is a good job, Do we realy need a rubber dam in this case?
#15 by San Marcos Dentist at June 20th, 2010
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Nice blog and good job with these photos. Interesting to see the rubber dam in use, I haven’t used the dam as I am old school but it is making me think…Thanks
#16 by Simon Templeman at June 28th, 2010
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Hi Neil, hope you are well – good to see your cases up here. Out of interest which composite system do you use for posteriors and is there any reason for this choice? I’m currently using 3m ESPE Filtek though not 100% happy with the handling characteristics.
Cheers
Simon
#17 by Toronto Dentist Blog at June 29th, 2010
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Nice work Neal, great photos.
Good thing it’s just dentists here though. Patients might freak looking at that blood-tinged cotton roll in the last shot.
Joe
Toronto Dentist Blog´s last blog ..Dentists are Tooth Carpenters -amp Dental Hygienists are Gum Gardeners
#18 by Partha Dental Hospital at September 2nd, 2010
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Nice blog and good job with these photos. Great work and skill you have.
Thanks