Adjusting Occlusion And Contours To Idealize Your Case

Introduction: 

This is my 40 yo ex-Coke Zero addict so we're dealing with erosion and compensatory supraeruption. I'm replacing crummy composites at 30 DO/31 MO with Apex Dental Materials products. Look at your case before you start. If there is supraeruption that's worn down the tooth you're restoring, don't be afraid to level that out. There is absolutely nothing sacred about a little enamel, and if you go thru it remember this is restorative dentistry, not fill and bill. If you don't correct the "mistake", you'll only enhance it.

Thomas W. Mitchell, DDS, FAGD
Crummy old composites at 30 DO and 31 MO with tons of erosion from living on Coke Zero. With that deep erosion comes compensatory supraeruption (not super eruption!)
Thomas W. Mitchell, DDS, FAGD
So check out 3 DL cusp and 2 ML cusps.
Thomas W. Mitchell, DDS, FAGD
It's obvious 3 DL cusp is tipped down into 30 central fossa and that 2 ML cusp has worn deeply into 31 DL cusp. I know I'm going to shorten those, but I don't know how much yet. So I'll finish the composites and then shorten them.
Thomas W. Mitchell, DDS, FAGD
Now you can clearly see the wear facets. First thing I did was shorten down 30 DL cusp and 31 Dl cusp to move them out of harms way.
Thomas W. Mitchell, DDS, FAGD
31 prep is nothing special. Just standard prepping.
Thomas W. Mitchell, DDS, FAGD
For 30 prep I want all the margins in bonded enamel.
Thomas W. Mitchell, DDS, FAGD
I filled 31 first with a contour band in a Toffelmeyer retainer. I think this photo is after Clean and Boost, Surpass 1,2,3 and co-cured Titan A2 Flowable on the gingival margin and pulpal floor. Then I filled the proximal contact. I'm curing for 3 seconds with my Valo light set on "plasma mode".
Thomas W. Mitchell, DDS, FAGD
After the proximal's filled I get the retainer out of the way so I have more room to work. I filled the lingual half first with Exquisite, cured that and filled the buccal.
Thomas W. Mitchell, DDS, FAGD
Quickly polished the proximal surface to an ideal contour
Thomas W. Mitchell, DDS, FAGD
Triodent matrix on 30, Clean and Boost, Surpass 1,2,3 and co-cured Titan A2 Flowable.
Thomas W. Mitchell, DDS, FAGD
Proximal filled and Triodent ring removed. Now we're just filling a Class 1 composite.
Thomas W. Mitchell, DDS, FAGD
I filled the lingual half first with Exquisite, then the buccal. I'm curing with the Valo Light on XTRA POWER. A little polishing and the dam comes off.
Thomas W. Mitchell, DDS, FAGD
Then we check the occlusion and it's high right where we knew it would be. So I just shortened #3 DL cusp and the distal 1/2 of #2 ML cusp, plus a little adjustment on the fillings at the high marks.
Thomas W. Mitchell, DDS, FAGD
And we're looking good.
Thomas W. Mitchell, DDS, FAGD
Just a final glaze with Surpass 1,2,3 and we're done
Thomas W. Mitchell, DDS, FAGD
Final xray.

Conclusion: 

The idea in restorative dentistry is to recreate the ideal as close as possible so we don't enhance the complications we're presented with. There's nothing sacred about a little enamel, and if we don't correct the environment, we just make it worse.

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

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