Tony Rotondo is a registered specialist in Prosthodontics, he completed his undergraduate degree at the University of Queensland in 1984 and a postgraduate residency in Prosthodontics in 1996 at the University of California, Los Angles (UCLA). He currently practices in Brisbane. Tony has specific interests in dental aesthetics, dental implants and ceramic materials. He has and continues to teach undergraduates and postgraduates at the University of Queensland. He has been a visiting lecturer to the postgraduate program in prosthodontics at the University of Sydney and a visiting lecturer to Griffith University, School of Dentistry in Southport and the University of Queensland.
In the past Tony has been the president of the Australian Society of Aesthetic Dentistry (QLD Branch), secretary of ANZAP (Australian and New Zealand Academy of Prosthodontists), treasurer and founding member of AOS (Australasian Osseointegration Society, QLD branch), he is part of the DSD scientific board and a member of many other professional associations. Tony is a product evaluator for dental companies and presents numerous continuing educational programs nationally and internationally.
Restoration of worn teeth with composite resin additions
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She was aware of the localised wear on her maxillary anterior teeth, and the wear, although less so, of her mandibular anterior teeth. She was presented with a number of treatment solutions, these included ceramic veneers or composite resin additions, with or with out the inclusion of orthodontic treatment. She chose the later, with an understanding that the treatment may have long term limitations.
Her treatment plan involved orthodontics to align her moderately crowded anterior dentition, improve the maxillary arch form, align gingival levels and create space for restorative material, to be placed on the maxillary anterior teeth.
The diagnostic wax-up will define the palatal surface and the incisal edge of the definitive resin restorations and to that end must be accurate. It is important that the palatal inter-proximal regions are well defined, this will prevent excess resin finding its way to the proximal regions.
In the same way, the lab putty key will also need to be accurate, this can be achieved either by ensuring it cures under pressure (in a laboratory pressure pot) or by relining the key with light body silicone impression material.
The key was trimmed so that it would not interfere with the rubber dam isolation, so it extended distally to the 2nd premolars and material was removed form the palate.
The key was the sectioned through the incisal edge.
The key is positioned on the teeth and time is taken to further thin the enamel shaded material and ensure there is little material in the proximal areas. Some dentine composite can be pushed in between the enamel shaded material and tooth on the palatal while the material is still un-set to ensure there is no porosity in this region. The composite can now be completely cured completely and the putty key removed.
It is my preference to add the dentine mass prior to the proximal wall build -up, so that nothing is interfering with the placement and positioning of the dentine mass.
Taking photographs of the restorations at the end of the build-up appointment provide the operator with an opportunity to objectively evaluate the restorations and contemplate what alterations may improve the final result.
After listening to the patients feedback final gross alterations may be made. These might include refining the patients occlusion and checking excursive occlusal contacts, adjustments of form that relate to the views of the patient and the clinician.
Composite resin can provide an aesthetic and functional solution for managing worn teeth, however in a bruxing patient fracture and wear can present as problems and a night guard should be recommended for this type of patient.
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