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Fig 19: Margins look better Fig 20: It’ll take him a while to smile but that’s a start!

agent (hydrophobic). The acidic monomers lose their potency when Cervical Overhangs: A great tool to ensure no overhangs are
they come into contact with the dentinal tissue hence scrubbing the left behind causing gingival inflammation is #12 surgical blade.
bond into the cavity will let new monomer come into contact with the Interproximal polishing should be carried out with strips sequentially
tissue making sure the dentin is etched and primed well before bonding in a S shaped pattern starting from coarse to fine.
protocols. I scrub the bonding agent into the tissue for 20 seconds, air
dry with oil free air and cure for another 10 seconds. (Gluma, Kulzer) Follow ups: Follow ups are carried out 5-7 days later for final polishing
Layering protocols: We used 3 different opacities to restore the teeth. and patient is recalled after a month again.
In teeth where the palatal wall was intact, dentin was used only 0.5
mm thickness to mask the discoloration and universal was layered to ConCluSion
balance opacity followed by enamel shade again not more than 0.5 mm This case will always remain as one of my career highlights, not because
in thickness. it was challenging but because it helped me appreciate the undying
In teeth lacking the palatal wall, the palatal build up was first human spirit. This young patient has taught me how the human spirit
done with dentin to block the darkness of the oral cavity followed by even if bent cannot be broken.
universal and enamel. Both optical efficiency and refractive index are proving to be the
Though Composite button technique gives us the desired path to follow for developing better restorative materials that can
ingredients for a restoration, the thickness of individual layers would effectively mimic natural teeth.
greatly vary depending on the age, chromaticity, translucency and With modern composites already mimicking fluorescence and
bucco lingual width of a particular tooth and must be decided by the opalescence, appreciated in natural dentition it is only a matter of
dentist mindfully. Every layer in placed not more than 2 mm and cured time that more advancements in the field make Composites a viable
for 20 seconds. Opaque or darker shades should be cured longer. solution for smile designing and caries control in the most predictable
manner.
Surface texture, blending and moulding the composite: A great tool
to help mould the composite is a flat or pointed brush (GC) dipped
in unfilled resin (Signum, Kulzer). The composite is always blended
composite to tooth to achieve a seamless integration of the restoration.
Elimination of oxygen inhibition Zone: K Y jelly (Johnson &
Johnson) is coated on top of the final enamel layer and cured for 40
seconds to remove oxygen inhibition zone. The top layer of composite
exposed to ambient air has some free monomer radicals that do not
form polymer chains completely. This may entrap powder generated
from mechanical finishing and polishing and the composite could ABOUT THE AUTHOR
change colour over time with interaction of pigments present in food
affecting the long term stability of the restoration. Dr. Sanah Sayed is a Cosmetic
Dentist practicing in Pune. She has
Finishing & Polishing protocols: A red ring round ended bur is used completed her BDS from D.Y. Patil
to shape transitional line angles and create surface texture. We start Dental College (Navi Mumbai) and
polishing with Soflex discs (3M) at 15-20,000 RPM and intermittent Advanced Esthetics from Manipal
water. This can be followed by spirals that are diamond impregnated Dental College.
available from 3M or Eve polishers (Ivoclar). A buff with Diamond
polishing paste is then used (Prisma Gloss/ Ultradent) to achieve the
final lustre.
All polishers should be used as per manufacturer’s instructions.

Dental Practice i March-April 2023 i Vol 19 No 2 37