Page 33 - CEREC Q2 | 2014

QUARTER 2 | 2014 | CERECDOCTORS.COM | 31
filled with Tetric EvoCeram Bulk Fill to
be light-cured in a single step. Thanks to
the shortened tip after the bend of the
light guide, even posterior teeth of pedi-
atric patients or patients with restricted
mouth opening can be easily reached.
CASE STUDY
A 28-year-old female patient came to our
office because she was concerned about
the fast deteriorationof her composite fill-
ings in teeth #19 (#36) and #18 (#37). The
clinical examination showed marginal
discoloration and excessive translucency
of the existing composite (Fig. 1).
After composite removal, it was clear
that a zinc-eugenol-based material was
used as a base (Fig. 2). This is one of the
beliefs we discussed at the beginning of
the article. The idea behind this technique
is to reduce the amount and thickness of
the composite in order to apply a bulk fill
or, if not desired, at least to decrease the
stress. Zinc-eugenol-based materials are
clearly not a first choice due to the adverse
effect of eugenol on the polymerization.
A rubber dam (Optradam) was placed.
After final excavation and caries removal
(Fig. 3), the margins of the cavities were
finished with a slow-speed round bur
(Fig. 4).Aself-etchingbondingagentwas
applied (Fig. 5), the solvent evaporated
and cured with light. Next, a flowable
composite (Tetric EvoFlow) was placed
as a liner (Fig. 6). Then, TetricEvoCeram
Bulk Fill was applied in a single step
(Fig. 7), adapted to the cavity walls
following the cusp’s slope, and cured
Fig. 1: Preoperative
situation. Unsightly
discoloration underneath
the composite can be seen.
Fig. 2: Zinc-eugenol-based
material exposed after
composite removal
Figs. 3-4: Excavation
(coarse burs) and
finishing of the cavities
( fine burs)
Fig. 5: Bonding with a
self-etching system
Fig. 6: Placement of a
flowable composite
Fig. 7: Bulk filling: one-layer,
one-stage curing with
Tetric EvoCeram BulkFill
Figs. 8-9: Curing:
disadvantageous
positioning of the light
due to the long light probe
Figs. 10-11: Easy handling
with a shorter light probe;
bluephase style
Fig. 12: Final result at the
three-month check-up
3
5 6
8
10 12
9
11
4
7
1 2
for 10 seconds (Fig. 8).
The advantages of using a light probe
with a shortened neck after the angled
bend can be clearly seen. Figures 8 and
9 show the conventional light probes
used by many curing units; figures 10
and 11 show the new 10-mm light guide
provided with the new ergonomic blue-
phase style from Ivoclar Vivadent.
Tooth #18 (#37) is easier to reach
and the patient does not need to open
her mouth to the maximum and cause
unnecessary stress to the TMJ.
Figure 12 shows the final result after
three months at a follow-up visit.
For questions and more information,
Dr. Mahn can be reached at
edomahn@gmail.com.