No-Prep Class V Abfractions- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

I get a lot of inquiries about this procedure, so here is my protocol. This is for the classic Non-Carious Cervical Lesion (NCCL). If there's caries then obviously we have to prep.

Thomas W. Mitchell, DDS, FAGD
The gingival margin is below tissue so first I packed the tissue with 00 silk suture to retract it vertically about 1/2 mm and to prevent the composite from drifting subgingivally. If the gingival margin is at the top of the tissue or above it I don't pack cord.
Thomas W. Mitchell, DDS, FAGD
The next step is to clean the salivary pellicle off the abfraction with pumice.
Thomas W. Mitchell, DDS, FAGD
Then we etch the abfraction with Clean and Boost dentin and enamel cleanser, leaving it on the prep for 10-20 seconds. (Clean and Boost is acidic, so it not only cleans and disinfects but also etches the tooth surface)
Thomas W. Mitchell, DDS, FAGD
Etched, rinsed and dried.
Thomas W. Mitchell, DDS, FAGD
Then re-wet the dentin with Bondsaver D. (This is a very important step. Bond Saver D contains fluoride, a collagen stiffener, an antimicrobial agent, a desensitizer and a component to prevent bond degradation) Remember we're doing "wet bonding" . The dentin must be wet so the solvent in the "dentin primer" can chase the water down the tubules, dragging resin with it. That's how we get "dentin bonding".
Thomas W. Mitchell, DDS, FAGD
This surface is wet with Bondsaver D.
Thomas W. Mitchell, DDS, FAGD
Superb Universal Adhesive is a one bottle bonding system. As with all of the one bottle systems we need to etch the enamel more, and that's why we leave the Clean and Boost on for a few seconds longer (15-20 seconds).
Thomas W. Mitchell, DDS, FAGD
Titan is a highly radio opaque flowable that is very tough.
Thomas W. Mitchell, DDS, FAGD
Here's the Superb/Titan Flowable step. I co-cure these simultaneously for 3 seconds with the Valo light on Xtra Power (3200 mW/cm2)
Thomas W. Mitchell, DDS, FAGD
Then force in composite. This is Exquisite Restoration nano composite shaped with lots of Seamfree wetting resin, finger pressure and a composite instrument. With Exquisite we can cure it with the Valo light on Xtra Power (3200 mW/cm2) for only 3 seconds due to its extremely low shrinkage, with no resulting white lines.
Thomas W. Mitchell, DDS, FAGD
Then polished with Softflex discs and a Jiffy cup. At that point I add another layer of Superb Universal Adhesive to seal the prep and the gingival dentin. Remember we remove the cementum layer when we polish these restorations. If you don't seal the tubules they're wide open and will leak junk into the tooth.
Thomas W. Mitchell, DDS, FAGD
The last step is to check the occlusion. If there's a sliding interference of course you want to eliminate that, but just narrowing the heavy contact areas should be sufficient.
Thomas W. Mitchell, DDS, FAGD
So I just narrowed those occlusal contact areas, not taking any tooth out of occlusion. He could not tell I'd done any reduction at all.

Conclusion: 

I have been doing these NCCL's for a few years without doing any beveling/prepping. I've had almost no de-bonds. These steps I’ve shown are very logical The key is to start with a very clean NCCL and finish with a very light "touch up" occlusal reduction. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

[email protected]