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Special Issues
July/August 2024
Volume 45, Issue 1
Peer-Reviewed

Workflow for Bonded Partial Ceramic Restorations Treating Subgingival Caries

A 51-year-old patient presented to hygiene recall revealing a fractured amalgam restoration and deep secondary caries on tooth No. 14 exhibiting signs of reversible pulpitis. Selective caries removal using caries dye was performed, and the preparation was cleaned using air-particle abrasion with 29-µm aluminum oxide and Sylc® Bioglass. A bonded full-coverage onlay or "overlay" was then prescribed. A modified circumferential wide band was placed and sealed with sterile teflon tape. Immediate dentin sealing was performed using G2-BOND Universal (GC America, gc.dental/america). Deep margin elevation (DME) technique was used to move the deep mesial margin coronally with a highly filled injectable composite (G-ænial™ Universal Injectable, GC America). This approach enables bonding under absolute isolation, a conservative preparation, and ease of impression/digital scanning. Subsequently, a short-fiber-reinforced composite (everX Flow™, GC America) was used for the remainder of the restorative foundation. A fully crystallized lithium-disilicate CAD/CAM block (GC Initial® LiSi Block, GC America) requiring no firing was selected as enamel replacement. The restoration was luted with a universal resin cement (G-CEM ONE™/Adhesive Enhancing Primer, GC America). At recall, the restored tooth tested vital with resolution of symptoms and a pleasing esthetic integration.

KEY TAKEAWAYS

Strong, well-sealed restorative foundations coupled with immediate dentin sealing simplify indirect ceramic work while enabling lasting, durable results. Modern flowable/injectable materials have highly desirable esthetic and physical properties for these indications.

Isolation techniques, most notably rubber dam, allow clinicians to perform modern adhesive dentistry effectively while simultaneously increasing efficiency and patient comfort during restorative procedures.

Contemporary materials such as fully crystallized lithium disilicate blocks and high bond strength universal cements can be used to achieve high-level adhesion in an efficient workflow without sacrificing quality.

Kevin Anderson, DMD
Private Practice, Saint Paul, Minnesota

Fig 1. Tooth No. 14 at initial patient visit prior to caries and symptom development. With dental anxiety and a tight schedule, the patient desired a single-visit solution.

Figure 1

Fig 2. Bitewing radiograph taken at hygiene recall depicting caries extent on tooth No. 14 several weeks before restorative procedure. Pulp testing elicited a non-lingering hyper-response to cold.

Figure 2

Fig 3. Rubber dam isolation prior to caries removal.

Figure 3

Fig 4. Selective caries removal was performed using a caries indicator (Sable™ Seek™, Ultradent). A small area of affected dentin was left surrounded by a ≥2 mm periphery of sound dentin.

Figure 4

Fig 5. A circumferential wide band (Greater Curve) was modified with crownand- bridge scissors to capture and seal the deep mesial margin (matrix side profile shown). A sealed margin is paramount for this technique to maintain isolation, minimize finishing, and limit plaque accumulation from overhangs or under-contoured emergence. technique to maintain isolation, minimize finishing, and limit plaque accumulation from overhangs or under-contoured emergence.b

Figure 5

Fig 6. G-ænial Universal Injectable A1 shade was selected for DME because of its ease of placement, stackability, and high degree of polish retention/wear resistance.

Figure 6

Fig 7. everX Flow dentin shade was used for the remaining dentin replacement. This short-fiber-reinforced material provides high fracture resistance, block-out ability, and shrinkage stress mitigation.

Figure 7

Fig 8. Delivery isolation was easily achieved with the aid of the relocated margin. The preparation was cleaned with 29-μm aluminum oxide and primed with G-CEM ONE Adhesive Enhancing Primer.

Figure 8

Fig 9. Initial LiSi block was milled with CEREC MC XL (Dentsply Sirona). After fitting and polishing, the intaglio was treated with 20-second hydrofluoric acid, 30-second phosphoric acid, and primed with G-Multi PRIMER™ (GC America).

Figure 9

Fig 10. Postoperative radiograph showing restoration after cementation with G-CEM ONE. Isolation techniques employed allowed for seamless transitions between all substrates involved.

Figure 10

Fig 11. Mesial/buccal view, immediate postoperative. Favorable margin adaptation was obtained with both the composite margin elevation and the milled LiSi block.

Figure 11

Fig 12. Final restoration at several months’ recall. Satisfactory esthetics were achieved using fine diamond burs and rubber ceramic polishing wheels. No glaze, stain, or crystallization cycle was used.

Figure 12

Fig 13. At recall, good buccal shade integration after tooth rehydration was evident. The beveled enamel margin allowed for seamless blending of translucent monolithic materials while conserving tooth structure.

Figure 13

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