Youssef Dahbi Skali

Community - Direct anteriors
2015-11-11

The Time Frame
Let’s talk about time !

Time is the « sinews of war » in the everyday practice.

Praising one technique over another, is irrelevant without correlating it to time consumption or time efficiency !
What is worth a handiness demanding composite technique with an outstanding outcome, if performed in 3 hours ?
The controlled body thickness is a simplified technique that allows us to finally bring simplicity in anterior composite layering, and within a reasonable amount of time to perform esthetically satisfying restorations with a reliable protocol in everyday work.

The purpose of this case report is to follow the time frame of the application of the CBT technique. In 1 to 1,5 hour, we can achieve, every time, with this technique a well integrated restoration.
The main advantage of the CBT technique is that the simplicity and reliability of the protocol, from color matching to enamel layering, enable us to save time in the composite build-up, so we can focus on time-consuming and non-negotiable procedures such as dental dam application, preparation, bonding and finishing, without any shortcuts that may jeopardise our biological and functional longterm outcome.
We don’t have to choose anymore between aesthetics, function, biology and time efficiency !

First appointment: diagnosis, teeth scaling if needed or just polishing.
3 options for the defect reconstruction:
alginate impressions are taken and sent to the lab for wax-up.
Direct composite build up and silicone impression
BRB technique

Color matching is performed at the beginning of the first appointment or till the next appointment before starting the procedure. The reason is that dehydration starts within first minutes of mouth opening, when the teeth are no longer in direct contacts with saliva.

The silicone stent is prepared for palate wall layering before the second appointment.

Fig. 1

Second appointment, 18-08-2015 at 11h39nnpatient receivingncolor matching and initial photonanaesthesia nsilicone stent try-in and adjustingnIsolation by dental damnDuration: 10 to 15 minutes

Fig. 2

Dam placed. 11h54nnCavity preparation: carie detector application and rinsing, carie and infected-dentin removal, assessing the defect and margins, finishing the cavity, bevel and margins polishing if needed, disinfection (chlorhexidine 1 min), nBonding procedure: etching, rinsing, bonding, polymerisationnnDuration: 10 to 20 minutes. large variation, depending of the amount of the decayed tissues and the ease of access to the cavity.

Fig. 3

11h55

Fig. 4

Palatal wall placed. 12h13

Fig. 5

Palatal wall placed. 12h13

Fig. 6

Dentin (1 layer) layering. 12h16nnnTip: The best and simplest way to layer the dentin with leaving the right thickness of the enamel mass, is to use the Missura spatula.nYou can also use the tip of a periodontal probe of 0,5 diameter to do same, but it’s less efficient.

Fig. 7

12h16

Fig. 8

Transparent mass layering. 12h18nnnTip: Use a small or medium size microbrush, to push the transparent into dentin concavities, for a better blending of the effects.

Fig. 9

12h19

Fig. 10

Enamel (1 layer) placement. 12h24nnfinal polymerisation with glycerin.nexcess removalnfinishing (first, secondary, tertiary anatomy)npolishing stepsnnDuration: 10 to 20 minutes.

Fig. 11

Evaluation of the result must wait until complete rehydration, where final color can be assessed and adjustments can be made, if needed.

Fig. 12

Tip: The occlusal view (on a photo mirror) is very useful for assessing the shapes and contours in a glance. it make it easy to see the defects or overcountours and to correct them quickly before polymerisation.

Fig. 13

Start: 11h39. Finish: 12h57ntotal duration: 1 hour 18 minutes.

Fig. 14

Finishing performed.12h40

Fig. 15

Secondary anatomynnUse a coarse burs at very low speed with red contra-angle to shape the texture.

Fig. 16

Tertiary anatomy. Polishing finished.

Fig. 17

dam removal, nassessing the margins and excess, nchecking occlusion, nocclusal adjustments if needed, nrepolishing the adjusted areas.nnEnd of procedure. 12h57

Fig. 18

Dehydration.nWe can see it clearly from each side of the dam situation line.

Fig. 19

12h59 (2 minutes after)nRehydration starts immediately after dam removal. It takes up 24 to 48 hours for complete rehydration

Fig. 20

21-08-2015 at 11h50. (72 hours after)

Fig. 21

different flash configuration to see better the secondary anatomy

Fig. 22

different flash configuration to see better the tertiary anatomy