Armamentarium
(1) rubber dam/contoured matrix strips (Vivadent);
(2) round and fissure diamond burs;
(3) enamel/dentine bonding kit;
(4) new generation, highly polishable, hybrid composite resin;
(5) Soflex discs (3M) and interproximal polishing strips.
Technique
- Take preoperative photographs and select the shade (535HFig. 10.6 (a)).
- Apply rubber dam or contoured matrix strips.
- Remove demarcated lesion with a round diamond bur down to the amelodentinal
junction (ADJ). - Chamfer the enamel margins with a diamond fissure bur to increase the surface
area available for retention. - Etch the enamel margins⎯wash and dry.
- Apply the dentine primer to dentine and dry.
- Apply the enamel- and dentine-bonding agent and light-cure.
- Apply the chosen shade of composite using a brush lubricated with the bonding
agent to smooth and shape, and light-cure for the recommended time. - Remove the matrix strip/rubber dam.
- Polish with graded Soflex discs (3M), finishing burs, and interproximal strips if
required. Add characterization to the surface of the composite. - Take postoperative photographs (536HFig. 10.6 (b)).
The localized restoration is quick and easy to complete. Despite the removal of
defective enamel down to the ADJ there is often no significant sensitivity and
therefore no need for local anaesthesia. If the hypoplastic enamel has become carious
and this extends into dentine then a liner of glass ionomer cement (correct shade)
prior to placement of the composite resin will be necessary. Local anaesthesia will
probably be required in these cases. Advances in bonding and resin technology make
these restorations simple and obviate the need for a full labial veneer. Disadvantages
are marginal staining, accurate colour match, and reduced composite translucency
when lined by a glass ionomer cement.