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Special Issues
September 2020
Volume 41, Issue 1
Peer-Reviewed

A Practical, Flowable Technique for Restoring a Worn Dentition

Giancarlo Romero, DDS, MS

The restoration of a worn dentition can be a complicated, lengthy procedure. Often, patients present with collapsed vertical dimension of occlusion (VDO) and/or minimal tooth structure, leading clinicians to prescribe root canal treatment on multiple canals to gain resistance form prior to restoring. This case demonstrates a flowable technique, in which a laboratory wax-up was transferred at the estimated VDO with the use of translucent silicon matrices fabricated from the cast. Each tooth was restored with flowable composite; the patient can be fully treated in one or two sessions. This technique, featuring the use of various BISCO products (bisco.com), allows the clinician to reestablish the proper VDO, occlusion, and esthetics before completing the case with final ceramic materials. The key advantage is not having acrylic temporaries in the mouth for months when the case requires temporomandibular disorder resolution. Another advantage is the use of segmental impression-taking versus a full-arch impression due to the occlusion being dialed in and there being no need for full-mouth temporaries. This approach also eases the financial burden for the patient over time. Finally, this protocol preserves marginal peripheral enamel for excellent bond strength in these areas when compared to adhesion to dentin.

Key Takeaways

Adhesive dentistry using a range of products from BISCO is an alternative to conventional, full-mouth rehabilitation involving root canal treatment for
restorative indications.

The use of selective etching and a universal bonding agent can eliminate post-cementation sensitivity, a common problem in restorative dentistry.

Reducing the provisional service period minimizes complications with
recurrent caries, fractures, and loose temporaries.

About the Author

Giancarlo Romero, DDS, MS
Clinical Assistant Professor, Graduate Prosthodontics, University of Texas Health Science Center, Houston, Texas; Private Practice, Houston, Texas
Center, San Antonio, Texas

BEFORE. Initial presentation illustrating excessive wear and reduced VDO.

BEFORE

Fig 1. Occlusal and lingual erosive lesions were present in the maxillary arch. The patient reported being a heavy soda drinker.

Figure 1

Fig 2. Occlusal and facial erosive lesions were present in the mandibular arch. The bicuspids showed transparency to the pulp chamber. The patient was not symptomatic to cold or hot.

Figure 2

Fig 3. After fabrication of a diagnostic wax-up on an articulator at the estimated VDO following the principles of phonetics and esthetics, the technique treats one tooth at time or alternating teeth, as shown. Adjacent teeth were isolated with Teflon tape. Selective etch with phosphoric acid (Select HV® Etch, BISCO), if required, and bonding agent (All-Bond Universal®, BISCO) were applied and cured.

Figure 3

Fig 4. With the aid of a clear silicon matrix fabricated from the wax-up, flowable composite (Aeliteflo™, BISCO) was applied. The composite will fill all empty space occupied by the wax-up and then be light-cured through a clear matrix

Figure 4

Fig 5. Build-up with flowable composite on teeth Nos. 22 through 27, transferring wax-up to the clinical situation.

Figure 5

Fig 6. In one or two appointments the full wax-up is transferred in a reversible fashion. The VDO then gets restored, and no temporaries are needed. Final occlusion can now be dialed in.

Figure 6

Fig 7. Occlusal view illustrating the ideal transfer of the proposed wax-up.

Figure 7

Fig 8. After the patient adjusted to the new VDO and final preparations were done with the flowable mock-up acting as a prep guide since it was the final contour of the final restorations, lithium-disilicate restorations (e.max®, Ivoclar Vivadent, ivoclarvivadent.com) were fabricated, as shown. The restorations were treated with hydrofluoric acid etch (Porcelain Etchant, BISCO), ultrasound in alcohol for 5 minutes, and application of silane (Porcelain Primer, BISCO).

Figure 8

Fig 9. A segmental impression was done in the mandibular arch. This is less challenging than trying to do a full-mouth impression with an active tongue. Note the preservation of marginal peripheral enamel. Final mandibular anterior veneer preparations and a final impression would follow (not shown).

Figure 9

Fig 10. Final maxillary full-coverage all-ceramic crowns bonded in place using selective etching, universal bond, and dual-cure resin cement (eCEMENT® dual-cured, BISCO).

Figure 10

Fig 11. Final mandibular veneers bonded in place using selective etching, universal bond, and light-cured resin cement (eCEMENT® light-cured, BISCO).

Figure 11

Fig 12. Final restorations bonded and final rehabilitation.

Figure 12

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