Class V (Cervical) Restorations That Just Blend Into the Tooth Using OMNICHROMA

A Class V, “cervical” or “gumline” restoration is one of the most common restorations for a dentist to perform. This type of lesion is either due to trauma (abfraction or toothbrush abrasion), erosion (acid from gastric reflux), or tooth decay and sometimes there is a combination of causes. Many times, especially on anterior teeth, it would be nice to have a simple way to create an aesthetic match for these situations.1

History
A 40-year-old male had decay at the gingival areas of teeth Nos. 18, 19, and 20. The patient did not report any pain, but he had noticed dark yellow areas at the gumline of the teeth. The patient wanted to have his teeth restored to a healthy condition (Figure 1).

Figure 1. A preoperative view of Class V defects and decay on teeth Nos. 18 to 20.	Figure 2. Decay was removed and teeth were prepared for Class V restorations on teeth Nos. 18 to 20.

The patient did not have any medical problems and was in good health. The lower left quadrant was anesthesized with 1 carpule (1.8 mL) of 2% Lidocaine with 1:100,000 epinephrine. The gingival margins on all 3 teeth were packed with Ultrapak (Ultradent Products). With a high-speed handpiece 330 bur and a slow speed No. 4 round bur, the decay was removed on teeth Nos. 18, 19, 20, and the Class V preparations were beveled at the incisal/enamel margins. Complete decay removal was verified with a caries disclosing agent (Seek [Ultradent Products]). The incisal/enamel margins were beveled to increase the bond strength of the Class V restorations. The bevel also helps to blend the color of the composite material to the teeth (Figure 2).

Figure 3. The bonding agent was applied and teeth were ready to receive OMNICHROMA (Tokuyama Dental America).	Figure 4. OMNICHROMA added to the facial of tooth No. 20 prior to light curing.
Figure 5. The results after OMNICHROMA was added, contoured, and light cured on teeth Nos. 18 to 20.	Figure 6. A postoperative view after finishing and polishing teeth Nos. 18 to 20.

Figure 7. On this post-op view, there’s almost perfect color blend between OMNICHROMA and the natural tooth structure.

Next, teeth Nos. 18, 19, and 20 were acid etched with 35% phosphoric acid (Ultra Etch [Ultradent Products]). After rinsing with water and carefully air drying, the bonding agent was applied (Bond Force [Tokuyama Dental America]), air thinned, and then light cured (Figure 3).2
OMNICHROMA (Tokuyama Dental America) was then applied as the restorative material of choice. This new composite material has the ability to blend its color with a single shade to match the surrounding tooth structure. OMNICHROMA is also sculptable and is easy to contour right to the gingival margin. After sculpting the composite and creating a nice emergence profile and a seamless margin, OMNICHROMA was light cured (Figure 4).
Next, the restorations were contoured with a flame-tip diamond bur on a high-speed handpiece right next to the packing cord to ensure a seamless margin. A coarse disc (Sof-Lex Contouring and Polishing Discs [3M]) was used to shape and contour the restorations. The final polish was achieved with medium and fine polishing cups (FlexiCups [Cosmedent]). The final high polish was obtained using a Jiffy Original Composite System (Ultradent Products). The color match was excellent, and the patient couldn’t even tell where the restoration was placed. Using a single shade material like OMNICHROMA makes it a lot easier to restore a Class V composite restoration while knowing the color is going to match almost every time. It is also efficient and beneficial to the dentist and patient to restore all 3 restorations at the same time using a single shade of composite material (Figure 5 to 7).3,4
For more information, call Tokuyama Dental America at (877) 378-3548 or visit tokuyama-us.com.

References

1. Fahl N. Mastering composite artistry to create anterior masterpieces, part 2. J Cosmetic Dent. 2010; 26(4):51-55.
2. Peyton, J. Finishing and Polishing Techniques: Direct Composite Resin Restorations. Practical Periodontics and Aesthetic Dentistry. 2004;5:293.
3. Mopper, W. The Invisible Class V Restoration. Oral Health Group. 2004. oralhealthgroup.com/features/the-invisible-class-v-restoration/.
4. Finlay, S. Conservative esthetics using direct resin. Inside Dent. 2010;5;6(5):96-101.

Dr. Peyton maintains a private practice in Bakersfield, Calif. He graduated from the UCLA School of Dentistry in 1982 and is a part-time clinical instructor there. He is also a lecturer at Esthetic Professionals (Tarzana, Calif) and a part-time instructor for the Fahl Institute, in Curitiba, Brazil. Dr. Peyton has lectured and given workshops for several American Academy of Cosmetic Dentistry (AACD) annual meetings. He has published articles in Practical Procedures and Aesthetic Dentistry and the Journal of Cosmetic Dentistry and is a contributing editor for the Journal of Cosmetic Dentistry. Dr. Peyton is an accredited member, Fellow, and examiner for the AACD.