Full Contour Buildup prior to ortho

Introduction: 

Patient is a lovely Romanian educated at a French law school now working in computer science (a typical new Bellevue resident!) who wants to get into ortho asap. Tooth #14 was prepped for a crown in France, but not completed. She's headed for ortho soon so our plan is to do big buildups now with final restorations done after ortho.
This case demonstrates using multiple materials and techniques to get these teeth stable and ortho ready as easily as possible.

Thomas W. Mitchell, DDS, FAGD
Typical Romania endos with composite buildups and an incomplete prep on 14. We'll have to address the PARL on 13 later.
Thomas W. Mitchell, DDS, FAGD
14 was "prepped" for some kind of onlay, but that was quite a while ago and 15 has shifted forward. Today's goal is to do a full contour composite buildup on 14 and restore 13 DO.
Thomas W. Mitchell, DDS, FAGD
I removed all the old dentistry, leaving the existing endo fills intact. This is a Getz Dixieland Band with a Toffelmeyer retainer and enough wedging to seal the gingivals.
Thomas W. Mitchell, DDS, FAGD
The first layer is Surpass 1,2,3 and White Opaque Titan Flowable over all the dentin and co-cured. I like using white opaque flow under any buildup so when I do the final prep it's easy to be sure the margin is on tooth. I don't do the "elevated margin technique", as I've discussed many times.
Thomas W. Mitchell, DDS, FAGD
Next layer is Injectafil by Apex Dental Materials. This is a bulk fill material that reaches it's gel stage (when all the shrinkage stress is released) very quickly. Once there I give it a couple of seconds of light to harden it.
Thomas W. Mitchell, DDS, FAGD
Bulk fill materials expressed thru syringes are not filled enough to withstand occlusal force, so you must layer a traditional composite on top. This is Exquisite and I spread it all over the occlusal surface and quickly did basic shaping. Nothing fancy here.
Thomas W. Mitchell, DDS, FAGD
After contour 14 I prepped the distal of 13 and used Triodent sectional matrix to get a good contact.
Thomas W. Mitchell, DDS, FAGD
Of course the distal contact of 14 was slightly open so I had to reform that as well.
Thomas W. Mitchell, DDS, FAGD
And a quick final polish and these are ortho ready.

Conclusion: 

So a nice technique using several different materials to get these teeth stable enough to withstand ortho. Obviously more procedures are in the future. But now it's off to ortho. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD

Email: 

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