A 51-year-old patient presented to hygiene recall revealing a fractured amalgam restoration and deep secondary caries on tooth No. 14 exhibiting signs of reversible pulpitis. Selective caries removal using caries dye was performed, and the preparation was cleaned using air-particle abrasion with 29-µm aluminum oxide and Sylc® Bioglass. A bonded full-coverage onlay or "overlay" was then prescribed. A modified circumferential wide band was placed and sealed with sterile teflon tape. Immediate dentin sealing was performed using G2-BOND Universal (GC America, gc.dental/america). Deep margin elevation (DME) technique was used to move the deep mesial margin coronally with a highly filled injectable composite (G-ænial™ Universal Injectable, GC America). This approach enables bonding under absolute isolation, a conservative preparation, and ease of impression/digital scanning. Subsequently, a short-fiber-reinforced composite (everX Flow™, GC America) was used for the remainder of the restorative foundation. A fully crystallized lithium-disilicate CAD/CAM block (GC Initial® LiSi Block, GC America) requiring no firing was selected as enamel replacement. The restoration was luted with a universal resin cement (G-CEM ONE™/Adhesive Enhancing Primer, GC America). At recall, the restored tooth tested vital with resolution of symptoms and a pleasing esthetic integration.
KEY TAKEAWAYS
Strong, well-sealed restorative foundations coupled with immediate dentin sealing simplify indirect ceramic work while enabling lasting, durable results. Modern flowable/injectable materials have highly desirable esthetic and physical properties for these indications.
Isolation techniques, most notably rubber dam, allow clinicians to perform modern adhesive dentistry effectively while simultaneously increasing efficiency and patient comfort during restorative procedures.
Contemporary materials such as fully crystallized lithium disilicate blocks and high bond strength universal cements can be used to achieve high-level adhesion in an efficient workflow without sacrificing quality.
Kevin Anderson, DMD
Private Practice, Saint Paul, Minnesota
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