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(A, B): The gingiva covers the cervical margin of the cavity. (C): A round metal matrix, tilted and stabilized with wooden wedges, allows access to the entire cavity. (D): Application of the adhesive system is under full control. (E, F): Application of flowable and regular composite. (G): Restoration before finishing and polishing. (H): Final result.
Source publication
Noncarious cervical lesions (NCCLs) are steadily increasing. Unfortunately, NCCL restorations represent one of the less durable types of restorations due to problems, including isolation and crevicular moisture control, especially in cases where the cervical margin is covered by soft tissue. This article presents a technique that allows us, through...
Contexts in source publication
Context 1
... 65-year-old male presented with class V lesions with deep cervical margins on teeth 21 and 22. After placement of the dental dam, it was impossible to see the entire cavity of tooth 21 ( Figure 1A) and even with pulling down the dam, the cervical margin remained hidden ( Figure 1B). ...
Context 2
... 65-year-old male presented with class V lesions with deep cervical margins on teeth 21 and 22. After placement of the dental dam, it was impossible to see the entire cavity of tooth 21 ( Figure 1A) and even with pulling down the dam, the cervical margin remained hidden ( Figure 1B). ...
Context 3
... proposed method to isolate the cavity and allowed management of the cervical margin and involved the use of a circular metal matrix ( Figure 1C). The matrix was tilted, pushed down adjacent to the tooth, and slid down to fit into the gingival sulcus. ...
Context 4
... this way, a suitable isolation was obtained that allowed the application of adhesive ( Figure 1D), flowable ( Figure 1E) and ''full-body'' composite ( Figure 1F). Finishing and polishing were simplified ( Figure 1G), facilitating the achievement of a good integration of the restoration with the soft tissues ( Figure 1H). ...
Context 5
... this way, a suitable isolation was obtained that allowed the application of adhesive ( Figure 1D), flowable ( Figure 1E) and ''full-body'' composite ( Figure 1F). Finishing and polishing were simplified ( Figure 1G), facilitating the achievement of a good integration of the restoration with the soft tissues ( Figure 1H). ...
Context 6
... this way, a suitable isolation was obtained that allowed the application of adhesive ( Figure 1D), flowable ( Figure 1E) and ''full-body'' composite ( Figure 1F). Finishing and polishing were simplified ( Figure 1G), facilitating the achievement of a good integration of the restoration with the soft tissues ( Figure 1H). ...
Context 7
... this way, a suitable isolation was obtained that allowed the application of adhesive ( Figure 1D), flowable ( Figure 1E) and ''full-body'' composite ( Figure 1F). Finishing and polishing were simplified ( Figure 1G), facilitating the achievement of a good integration of the restoration with the soft tissues ( Figure 1H). Also, tooth 22 had the cervical margin of the cavity hidden by the tissue (Figure 2A). ...
Context 8
... this way, a suitable isolation was obtained that allowed the application of adhesive ( Figure 1D), flowable ( Figure 1E) and ''full-body'' composite ( Figure 1F). Finishing and polishing were simplified ( Figure 1G), facilitating the achievement of a good integration of the restoration with the soft tissues ( Figure 1H). Also, tooth 22 had the cervical margin of the cavity hidden by the tissue (Figure 2A). ...
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Citations
... The resin composite restoration, which is well adapted and contoured with a pre-contoured matrix and remains untouched by cutting instruments, abrasive discs or cups, and finishing instruments, will have filler particles that are not abraded away from the resin matrix, resulting in a smoother surface. Hence, the use of pre-contoured cervical matrices is advantageous in this aspect, wherein no abrasive discs or burs are employed for polishing the restoration, and it consistently helps to form an adequate seal in the critical gingival areas being restored, eliminating the need for difficult operator shaping and finishing [18]. It has also been reported that upon polishing, larger filler particles protrude from the resin matrix, thereby increasing the Ra value [19,20]. ...
Background: Rough surfaces of restorations have an impact on the accumulation of plaque, unaesthetic contour, and marginal adaptation, thereby affecting their functional, aesthetic, and clinical performance and the long-term stability of the restoration. Several polishing systems are currently in use for composite restorations, but information on their impact on surface roughness is limited. The present study aimed to determine the surface roughness of class V composite restorations polished using pre-contoured cervical matrices and to compare it with a conventional disc polishing system.
Materials and methods: Twenty maxillary anterior teeth were collected and used in the study. Class V cavity preparation was done, and the cavities were restored with two types of composites (microhybrid and nanohybrid) from commercially available brands (Ivoclar and Dentsply) and finished and polished using two polishing systems (super-snap and pre-contoured cervical matrices). The evaluation of surface roughness was done using an atomic force microscope (AFM).
Results: The surface roughness parameters (Ra-arithmetic mean/average line roughness and Sa-average surface roughness) of the class V cavities restored using pre-contoured cervical matrices were significantly lower for both the tested resin composites.
Conclusion: The surface roughness of Class V cavities restored using pre-contoured cervical matrix systems was significantly less for both microhybrid and nanohybrid composites.
... Besides, the difficulty to perform a correct cervical contour and a correct finishing and polishing (particularly close to the gingival tissue) are common problems. It is known that moisture control and gingival retraction are essential for the success of class V restorations, precisely because they interfere with the adhesive process [8][9][10] . ...
Introduction: Non-Carious Cervical Lesions (NCCL´s) are pathological conditions of multifactorial etiology. Aim: This case report highlights the use of a cervical matrix for technical simplification of the procedure of class V restoration. Case report: Patient attended a specialized center for diagnosis and treatment of non-carious diseases, complaining of dentin hypersensitivity and aesthetic discomfort due to loss of tooth structure in the cervical region. The proposed treatment plan was basic periodontal treatment and subsequent restoration of all cervical lesions that had a loss of tooth structure greater than 1 mm. The transparent cervical matrix was used to promote correct anatomical contour of the cervical third of the buccal surface and the emergence profile. Conclusion: The use of the cervical matrix is presented as a facilitating tool for the restorative treatment of NCCL´s.
... Regarding the involvement of dental hard tissues, NCCLs can affect only the dental crown, only the root, or they can extend into crown and root tissues. For the latter ones, the difficulties during adhesive restorative treatments are known, such as obtaining direct clinical access and the appropriate isolation of the operative field [57,58]. In the presented study, most lesions had a radicular evolution. ...
Non-carious cervical lesions (NCCLs) are considered the irreversible losses of dental hard tissues at the cemento–enamel junction, in the absence of acute trauma and dental caries. The aim of this study was to highlight the presence of NCCLs in cervical areas based on specific macroscopic aspects in order to establish their clinical form, size and location and to confirm the role of optical coherence tomography (OCT) examination in the early diagnosis of these lesions. For this study, 52 extracted teeth were used, which did not have endodontic treatments, fillings or carious lesions in the cervical area. All teeth were examined macroscopically and OCT was used to evaluate the degree of occlusal wear, the presence and clinical form of NCCLs. Most NCCLs were identified on the buccal surfaces of the premolars. The most frequently encountered clinical form was the wedge-shaped form, with a radicular location. NCCLs present most frequently in the wedge-shaped form. Teeth that presented several NCCLs were identified. The OCT examination is an adjunct method to evaluate the clinical forms of NCCL.
... Whenever hypersensitivity, cosmetic issues, or visible flaws occurs due to NCCLs, they should be restored with appropriate restorative material; otherwise, it may lead to the initiation of caries, pulpal infections, or even displacement of the tooth [7]. Restoring NCCLs, however, is a challenging task because it doesn't provide any retention form due to its saucer or wedge-shaped cavity; also, the formation of sclerotic dentine is not suitable for adhesion on the tooth surface and margins of the cervical area, which is frequently placed sub-gingivally obstructing the filling access, thereby making the moisture control difficult [8,9]. 1 1 1 1 1 1 The motive for restoring the NCCLs is to replace the lost tooth structure as well as to occlude the open dentinal tubules. Most of the NCCLs have mixed cavity margins positioned on the enamel, dentin, or cementum. ...
Introduction
Three different tooth-colored restorative materials were evaluated and compared for postoperative sensitivity using a split-mouth design. This is a double-blinded clinical trial assessed for a one-month follow-up period in patients with non-carious cervical lesions (NCCLs).
Materials and Methods
A total of 60 NCCLs in 20 participants were considered in this split-mouth design study and randomly divided into three different groups: Flowable composite (n = 20), resin-modified glass ionomer cement (RMGIC) (n = 20), and Zirconomer® (n = 20). The restorations were evaluated for postoperative sensitivity at baseline (BL-day 0), three, seven, and 21 days using the Schiff cold air sensitivity scale. Data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States) using a post hoc test for postoperative sensitivity and one-way Anova to analyze all the groups together at the time interval of three, seven, and 21 days.
Results
In Group 1 (flowable composites) and Group 3 (Zirconomer), a statistically significant difference in terms of reduced postoperative sensitivity was seen after three and seven days. However, a significant reduction in postoperative sensitivity was seen after three, seven, and 21 days in Group 2 (RMGIC).
Conclusion
In this study, RMGIC showed reduced postoperative sensitivity after restoring NCCLs compared to Zirconomer and flowable composites. Compared with flowable composites and Zirconomer, RMGIC showed better clinical performance in terms of less postoperative sensitivity after restoring NCCLs.
... As stated above, there are many factors that contribute to the long-term success of intrasulcular restoration. Since the composite during layering and subsequent polymerization comes into contact with the matrix itself, this excludes contact with oxygen which could otherwise prevent its adequate polymerization [6,19]. The matrix is used as a "mold" for the apical portion of the restoration; it will not require subsequent finishing, which could induce the formation of superficial roughness that could interfere with the periodontal health [20,21]. ...
Some clinical situations, such as the closure of pronounced diastemas, and the trans- formation of malformed, small, or peg-shaped teeth, require a rebalancing of dental proportions accompanied by a modification of the gingival contour. A traditional treatment plan can include surgical, prosthetic, and/or orthodontic treatments. In some cases, it can be considered too invasive, and not all patients are willing to undertake long therapies. To overcome these limitations, a possible solution could be the application of the Biologically Active Intrasulcular Restoration (BAIR) tech- nique, which allows us to modify the natural emergence tooth profile using simple intrasulcular direct restorations. The aims of this paper are to investigate possible effects on gingival health, and to assess the patient satisfaction about the aesthetic intervention performed. Periodontal data were collected, and patient satisfaction was registered using the VAS questionnaire. All sites healed without complications, no adverse events were registered or reported by the patients, and no signs of periodontal morbidity were visible. The results show that the patients evaluated the final aesthetics in a positive way, and they perceived a good condition of periodontal health as well. The intervention is felt as almost painless, and patients do not report significant post-operative distress. In conclusion, the BAIR technique can provide a valid therapeutic alternative for patients for whom traditional treatments are not indicated. It is a minimally invasive intervention where both the operating times and the biologic and economic costs are reduced.
... NCCLs should be restored when hypersensitivity, aesthetic problems, or obvious defects are engendered [5]; otherwise, they could result in caries, pulp diseases, or even tooth fracture. However, challenges always exist in restorative treatments, including saucer or wedge-shaped NCCLs that have no retention form, sclerotic dentin on the surface that is unfavourable for adhesion, and a cervical margin that is usually located subgingivally, which obstructs filling access and makes the control of moisture difficult [6][7][8]. ...
... Previous studies have reported on restorative materials and techniques for improving the clinical performance of cervical restorations [5,[8][9][10]. The retention rate of NCCLs in toothcoloured restorations has been shown to decrease significantly over time, with an average retention rate of 85.4% after 3 years and 56.5% after 10 years [11]. ...
... Because a low-viscosity composite can flow into irregularities as well as the margins, it may be more adaptable than a highviscosity composite with fewer marginal defects. Similar to the experience shared by Giachetti [8] and Perez [9], using a matrix properly can improve gingival marginal continuity, provide good cervical contour, and reduce the finishing and polishing steps. For both test materials, a significant increase in the number of scores of 2 and 3 was observed over time regarding the aesthetic properties of surface lustre, surface staining, marginal staining, and aesthetic anatomical form. ...
Objectives
This prospective, randomized, split-mouth clinical trial assessed the 3-year clinical performance of a highly filled flowable composite and a conventional paste-type composite in non-carious cervical lesions (NCCLs).Materials and methodsA total of 84 NCCLs in 27 subjects were included in this split-mouth design study and randomly divided into two groups: a highly filled flowable composite Clearfil Majesty ES Flow group (ES, n = 42) and a conventional paste-type composite Majesty group (MJ, n = 42). Clearfil SE Bond was used following the manufacturer’s instructions. The restorations were evaluated at baseline (BL) and 1, 2, and 3 years using FDI (World Dental Federation) criteria. Data were analysed by a paired chi-squared test for intergroup comparisons and the Friedman test for intragroup comparisons (α = 0.05).ResultsBoth groups had a 97.3% retention rate at the 3-year evaluation. The acceptable scores (FDI scores 1–3) for each criterion exhibited no significant difference between the MJ and ES groups at any time point (p = 1.00). The marginal adaptation performance of ES was significantly better than that of MJ at every evaluation point (p < 0.05).Conclusions
The 3-year clinical performance of ES in NCCLs was similar to that of MJ. When the restorations were clinically acceptable, ES showed better marginal adaptation than MJ.Clinical relevanceCompared with conventional paste-type composites, highly filled flowable composites showed similar clinical performance and better marginal adaptation for restoring NCCLs after 3 years.Trial registrationTRN: ChiCTR1900028484. Date of registration: December 22, 2019, retrospectively registered.
... Hence this method provides a simple approach for isolation and good at restoring the anatomical contours with minimum overhangs. [4] In the present study, both the groups were found to be equally effective in restoring NCCLs immediately and after 6 months of placement. Hence, the choice of isolation technique depends on the clinical conditions and clinician choice. ...
Context: Proper method of isolation plays a key role in the restoration of noncarious cervical lesions (NCCLs).
Aims: The aim of this in vivo study was to compare the efficacy of two isolation techniques in restoring NCCLs using flowable composite.
Settings and Design: Forty patients who fulfill the inclusion criteria were selected based on the power of the study (0.86). The participants were divided into two groups according to the split-mouth design.
Materials and Methods: In Group A, lesion isolation was done using the Mylar matrix band with photocurable gingival barrier, and in Group B, using Metal matrix band and gingival barrier. The restorations were assessed immediately and after 6 months, using modified US Public Health Service criteria: marginal integrity, marginal discoloration, wear, retention, secondary caries, and postoperative sensitivity.
Statistical Analysis: IBM SPSS (version 21.0) software was used. McNemar's and Chi-square tests were performed, considering P < 0.05 for statistical significance.
Results: Both the groups demonstrated satisfactory clinical performance. Upon inter- and intragroup comparison of the two isolation methods, there was no statistically significant difference (P > 0.05).
Conclusions: Within the limitations of the study, both the groups performed similarly in isolation of NCCLs. However, long-term clinical studies must be needed for further evaluation.
... The proposed method makes use of a circular metal matrix to isolate the operative site and, at the same time, to move the soft tissues and provide clear access to the intrasulcular portion of the tooth. 1 By doing so, a proper isolation is obtained, allowing the application of adhesives and composites. ...
Clinical Relevance
It is possible to modify the natural emergence profile of the tooth using simple intrasulcular direct restorations. The shape of the intrasulcular part of the restoration will determine the design of the gingival contour.
SUMMARY
Some clinical situations, such as the closure of pronounced diastemas and the transformation of malformed, small, or peg-shaped teeth, require a rebalancing of dental proportions accompanied by a modification of the gingival contour. A traditional treatment plan might require surgical, prosthetic, and/or orthodontic treatment, but in some cases, these therapeutic options could be considered too invasive and not always the best solution. Moreover, not all patients are ready to undergo irreversible, long, and expensive procedures. To overcome these limitations and to solve all of these clinical problems in a rapid and noninvasive way, we propose a new technique that allows us to modify the natural emergence profile of the tooth using simple intrasulcular direct restorations. Using the Biologically Active Intrasulcular Restoration technique, it is possible to rebalance tooth shape and dimensions, gingival level and contour with low biological and economic costs. This method, which does not require any preparation of the dental tissues, is reversible and minimally invasive. It is applicable to patients of all ages, and results are obtained in a single appointment.
Subject. The article reflects the results of research aimed at determining the rational design features and working out the manufacturing technology of micro-prostheses for the replacement of wedge-shaped dental defects. The goal is to develop a new method of treatment of patients with wedge-shaped dental defects, based on the creation and implementation of micro-prostheses made using modern CAD/CAM technologies. Methodology. A patent search and analysis of the literature data was carried out, which showed the need to develop a new replacement structure that meets the requirements of aesthetics, ensuring its durability and effectiveness of treatment. The resulting cavity was scanned, and the proposed structure was made from a block of feldspar ceramics (Cerec Blocs, Sirona, Germany) by grinding using the Cerec digital complex (Sirona, Germany). Results. Based on the obtained data, a method for replacing wedge-shaped dental defects in the clinic of orthopedic dentistry was proposed, using the author's design of the inlay; rational features of the structure were developed and justified, and the method of its manufacture was developed, using CAD/CAM technologies. Conclusions. To date, the use of digital technologies at the stages of orthopedic treatment of patients with defects of the hard tissues of the teeth, and in particular, when replacing wedge-shaped defects, is of particular relevance. It seems promising to introduce methods of scanning, three-dimensional modeling, and manufacturing of replacement structures by grinding, to replace this type of dental defects. The proposed method is modern and highly technological, and also allows you to get an accurate and aesthetic design of a complex shape, in one visit to the clinic by the patient.
