Injectafil with co-cured Titan Flowable for sub-gingival filling- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is a great use of Injectafil. Patient from China with very crowded Class 2 div 2 and uneven occlusal planes. She's finally going to ortho next week. 15 is supraerupted and has contact with 18 on the mesial side of the mesial marginal ridge, pushing 15 distally for a very efficient food trap. Of course that means decay at the CEJ. I'm using Injectafil here because I can bulk fill it and since it's dual cure I don't have to worry about too little or too much light curing.

Thomas W. Mitchell, DDS, FAGD
Supraerupted #15 with decay at the CEJ
Thomas W. Mitchell, DDS, FAGD
My plan is to cut straight down from the top of the mesial marginal ridge like a "slot prep"
Thomas W. Mitchell, DDS, FAGD
Just at the top of the decay. I used a 330 bur and a long tapered prepping diamond to get this far.
Thomas W. Mitchell, DDS, FAGD
This is after decay removal. I struggled to get separation from 14 at the gingival, and of course I had nicks in the distal surface of 14 which I polished smooth. I used a needle point diamond to get the separation from 14, then flattened the gingival a bit with a beveling diamond to reduce the steepness of the now beveled margin.
Thomas W. Mitchell, DDS, FAGD
I changed to a smaller rubber dam clamp and was able to get an extended triodent matrix to sit right down at the margin I did not place a wedge as that would have dented the matrix just above the margin.
Thomas W. Mitchell, DDS, FAGD
This is after Clean and Boost, Surpass 1,2,3 and co-cured white opaque Titan flowable with my Valo light on Standard Power. Because the flowable is so opaque and the light is pretty far away from the composite, I cured it for 20 seconds. I use white opaque flowable on the deep gingival margins (and on other deep areas) so that if this needs to be redone it's easy to find the flowable and the margin.
Thomas W. Mitchell, DDS, FAGD
Next I squirted Injectafil into the prep almost to the top of the matrix and pulse cured it for 3 seconds. I added a thin layer of Exquisite on the top and cured again for 10 secs. Then removed the matrix and cured for 10 seconds from each direction.
Thomas W. Mitchell, DDS, FAGD
After finishing/polishing
Thomas W. Mitchell, DDS, FAGD
From the buccal you can clearly see where the gingival margin is. That's a bit of an overhang there. I eventually polished that off with a finishing strip.
Thomas W. Mitchell, DDS, FAGD
From the lingual the margin can be clearly seen.
Thomas W. Mitchell, DDS, FAGD
After adjusting the occlusion, and the contact was on the mesial side of the mesial marginal ridge, pushing 15 distally so the contact is open. Oh well, she's off to ortho next week.
Thomas W. Mitchell, DDS, FAGD
From the buccal
Thomas W. Mitchell, DDS, FAGD
From the lingual
Thomas W. Mitchell, DDS, FAGD
And the final film.

Conclusion: 

Using Injectafil made this case relatively easy as I didn't have to worry about layering and curing. I could have gone back and placed a second Triodent matrix, adding more composite to close that contact (did that yesterday for another tough one). But she's off to ortho next week so there's no need.

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

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