Dental Asia November/December 2023

CLINICAL FEATURE
Shofu Beautifil LS II low-shrinkage composite
(0.85%). In this manner, a natural form and
function was created (Fig. 4).
To build tooth 46, the temporary cement was
removed and a caries dye was applied with
caries endpoint removal. The mesial floor was
almost subgingival, so a deep margin elevation
was decided using a palodent wedge to seal
this critical area from any sulcus fluid coming
from the dam (Fig. 5).
The entire preparation was sandblasted with
50µ aluminum oxide powder for 7-8secs.
Air abrasion compacted the smear layer
in peritubular dentine and thinned the
intertubular dentine.
This ensured the removal of any leftover
temporary cement to provide a cleaner surface
to achieve a predictable bonding strength
over 40MPa. The weakest part of the tooth
was noted, which informed the building of a
biobase incorporating polyethylene fibres
(Fig. 6). With this procedure, the structurally
compromised tooth was protected from
shrinkage stress which otherwise would
cause catastrophic failure of the entire tooth
structure.
A 6th Gen Shofu FL-Bond II was applied on
the tooth using the proper protocol according
to the provided instruction manual. The
6th Gen Shofu FL-Bond is a gold-standard
bonding agent with a high level of bonding
strength to both dentin and enamel. The
bonding strength would not decrease in the
future as compared to a one bottle system.
Once the bond was cured, a thin layer of
2nd Gen Shofu Injectable XSL (slow levelling)
high-strength composite was applied over
the tooth. Care should be taken to ensure a
thickness no more than 0.5mm and curing
should only be done after placement of
Ribbond fibres.
Next, 3mm Ribbond fibres were cut using a
special Ribbond scissors into small pieces
and dipped in unfilled, 4th Gen bond resin,
drying the excess of the bonding agent.
In a process known as ‘wall-papering’, the
Ribbond fibres were applied on the walls,
circumferential inside the tooth including
the pulpal floor (Fig. 7). Then, ramp curing
was done for 40-60secs each on both
the buccal and lingual sides to ensure a
complete curing of deep defect, which
would reduce the shrinkage.
Next the Shofu Beautifil LS II lowshrinkage
composite (0.85%) was
incrementally layered circumferential
over the Ribbond, leaving space in the
middle for dual-cure core build-up (Fig.
8). Thereafter, a dual-cure composite was
injected in the middle and left to cure
for 2-3mins (Fig. 9). With this technique,
the harmful shrinkage stress in such a
Fig. 4: Restoring teeth 47 and 48 with cusp-by-cusp
incremental layering to create a natural form and
function
Fig. 5: Tooth 46 was cleaned free of caries and
tooth-sandblasted for better adhesive procedure.
A palodent wedge was placed for deep margin
elevation
Fig. 6: Tooth 46 showed extensive defects
before the bonding procedure
Fig. 7 Fig. 8: Building a biobase ensured an ideal
Fig. 9
packable composite on the periphery of the tooth
32 DENTAL ASIA NOVEMBER / DECEMBER 2023