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Clinical Case
Using Triodent V3 Rings and V3 Matrices to control the contact
            points for direct posterior composites
                    by Dr Graeme Milicich




                                       US: 1-800-811-3949               UK:    0800-311-2097
                                       CA: 1-866-316-9007               NZ:    0800-TRIODENT
                                       INT: +64-7-549-5612              AU:    1-800-350-421
      If you have a great new product idea or wish to contact us for more information on our great
      products, go to www.triodent.com/product-information-request.
Using Triodent V3 Rings and V3 Matrices to control the contact
points for direct posterior composites
By Dr Graeme Milicich, BDS, New Zealand



A 22-year-old patient presented with extensive                      The closed sandwich restoration technique was
decay in several teeth.                                             chosen to provide a sound, impermeable seal to
                                                                    isolate the deep affected dentin using Fuji IX Xtra
The high caries risk status was associated with                     (GC) to replace the lost deep dentin and to layer
her being a professional rower and her constant                     this with Gradia Direct (GC), bonding the two layers
use of sports drinks for electrolyte and hydration                  of the restoration with GBond (GC), a self-etching
management while training. To manage her high                       bonding agent.
risk status, she has substituted the sports drinks
for plain water and now uses solid energy sources                   The closed sandwich technique used in this
for her electrolyte and energy requirements.                        restoration utilizes a selective etching concept
                                                                    to create the best bonds possible to both dentin
To manage the biofilm imbalance and species shift                   and enamel. The enamel margins were selectively
that has become established, she has commenced                      etched with 37% phosphoric acid gel to provide
a treatment program using the CarifreeTM range                      the best bond possible to enamel, and the dentin
of pH elevation products to help in the re-                         was conditioned with 10% polyacrylic acid to
establishment of a healthy biofilm.                                 create the best GIC bond possible. Once the
                                                                    Fuji IX Xtra GIC was placed and manipulated
The second premolar had a symptomless, very                         with a micro-brush dipped in Fuji Lining and the
deep lesion, close to the pulp. Once the decay had                  Fuji Lining polymerized with an LED curing light,
been removed, the decision was made to leave a                      GBond was liberally painted over the enamel and
thin layer of affected dentin directly over the pulp                GIC surfaces and air-thinned after 15 seconds then
horn to avoid a potential exposure.                                 polymerized.

Sectional Triodent matrices and the appropriate                     A thin layer of radio-opaque flowable was then
Wave-Wedges were placed to adapt the gingival                       placed over all the internal surfaces and proximal
margins of the V3 Matrices to the cavity margins.                   box margins and polymerized. Composite
The pin-tweezer tabs on the occlusal section of                     increments were then placed using the 0.5
the matrices were then bent on to the occlusal                      C-Factor concept until the restoration layering
surface of the adjacent teeth to improve visibility.                was completed. Removal of the Triodent V3 Rings
The matrices were then stabilized with molar                        and sectional matrices revealed a restoration that
(green) and premolar (yellow) Triodent V3 separator                 required very little finishing in the marginal ridge
rings and the contact points burnished with a ball                  and embrasure regions.
burnisher. The occlusal surface of the V3 Ring tines
have a low profile and sit flush with the occlusal
surface of the teeth, improving access and visibility.




                                  US: 1-800-811-3949               UK:    0800-311-2097
                                  CA: 1-866-316-9007               NZ:    0800-TRIODENT
                                  INT: +64-7-549-5612              AU:    1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                             Case Study   2
Using Triodent V3 Rings and V3 Matrices to control the contact
points for direct posterior composites
By Dr Graeme Milicich, BDS, New Zealand




1                                                                       2




Completed cavity ready for restoration. Triodent sectional matrices,    Enamel margins are selectively etched with 37% phosphoric acid
Wave-Wedges and V3 Rings have been placed to create sound               gel for 15 seconds and rinsed.
contact points.




3                                                                       4




The dentin is conditioned with 10% polyacrylic acid for 10 seconds,     Fuji IX Xtra is carefully injected into the depths of the cavity and
rinsed and gently dried.                                                manipulated on to the dentin using a very small micro-brush dipped
                                                                        in Fuji Lining. The Fuji Lining is polymerized for 10 seconds.



                                     US: 1-800-811-3949                UK:   0800-311-2097
                                     CA: 1-866-316-9007                NZ:   0800-TRIODENT
                                     INT: +64-7-549-5612               AU:   1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                           Case Study      3
Using Triodent V3 Rings and V3 Matrices to control the contact
points for direct posterior composites
By Dr Graeme Milicich, BDS, New Zealand




5                                                                       6




GBond (self-etching resin bonding agent) is liberally applied to the    A thin layer of radio-opaque flowable is placed over all internal
etched enamel and GIC surfaces for 10-15 seconds. Any dentin            surfaces and polymerized.
that was not covered by the GIC is also effectively bonded at this
stage with the GBond. The GBond is then vigorously air-thinned
until there is no movement in the bonding layer before polymerizing.




7                                                                       8




Using the 0.5 C-Factor concept, Gradia Direct was then used in          Completed restoration build-up.
incremental layers to build up the restoration.




                                    US: 1-800-811-3949                 UK:   0800-311-2097
                                    CA: 1-866-316-9007                 NZ:   0800-TRIODENT
                                    INT: +64-7-549-5612                AU:   1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                            Case Study        4
Using Triodent V3 Rings and V3 Matrices to control the contact
points for direct posterior composites
By Dr Graeme Milicich, BDS, New Zealand




9                                                                        10




V3 Rings and matrices removed. There is a film of bonding agent          Completed restoration with good marginal ridge contours and
on the tooth and some thin flash in the region of the marginal ridges    sound, wide contact points.
that required minimal effort to finish off.




                                     US: 1-800-811-3949                 UK:   0800-311-2097
                                     CA: 1-866-316-9007                 NZ:   0800-TRIODENT
                                     INT: +64-7-549-5612                AU:   1-800-350-421
 If you have a great new product idea or wish to contact us for more information on our great
 products, go to www.triodent.com/product-information-request.                                                         Case Study      5

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V3 Contact Points by Dr Graeme Milicich

  • 1. Clinical Case Using Triodent V3 Rings and V3 Matrices to control the contact points for direct posterior composites by Dr Graeme Milicich US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request.
  • 2. Using Triodent V3 Rings and V3 Matrices to control the contact points for direct posterior composites By Dr Graeme Milicich, BDS, New Zealand A 22-year-old patient presented with extensive The closed sandwich restoration technique was decay in several teeth. chosen to provide a sound, impermeable seal to isolate the deep affected dentin using Fuji IX Xtra The high caries risk status was associated with (GC) to replace the lost deep dentin and to layer her being a professional rower and her constant this with Gradia Direct (GC), bonding the two layers use of sports drinks for electrolyte and hydration of the restoration with GBond (GC), a self-etching management while training. To manage her high bonding agent. risk status, she has substituted the sports drinks for plain water and now uses solid energy sources The closed sandwich technique used in this for her electrolyte and energy requirements. restoration utilizes a selective etching concept to create the best bonds possible to both dentin To manage the biofilm imbalance and species shift and enamel. The enamel margins were selectively that has become established, she has commenced etched with 37% phosphoric acid gel to provide a treatment program using the CarifreeTM range the best bond possible to enamel, and the dentin of pH elevation products to help in the re- was conditioned with 10% polyacrylic acid to establishment of a healthy biofilm. create the best GIC bond possible. Once the Fuji IX Xtra GIC was placed and manipulated The second premolar had a symptomless, very with a micro-brush dipped in Fuji Lining and the deep lesion, close to the pulp. Once the decay had Fuji Lining polymerized with an LED curing light, been removed, the decision was made to leave a GBond was liberally painted over the enamel and thin layer of affected dentin directly over the pulp GIC surfaces and air-thinned after 15 seconds then horn to avoid a potential exposure. polymerized. Sectional Triodent matrices and the appropriate A thin layer of radio-opaque flowable was then Wave-Wedges were placed to adapt the gingival placed over all the internal surfaces and proximal margins of the V3 Matrices to the cavity margins. box margins and polymerized. Composite The pin-tweezer tabs on the occlusal section of increments were then placed using the 0.5 the matrices were then bent on to the occlusal C-Factor concept until the restoration layering surface of the adjacent teeth to improve visibility. was completed. Removal of the Triodent V3 Rings The matrices were then stabilized with molar and sectional matrices revealed a restoration that (green) and premolar (yellow) Triodent V3 separator required very little finishing in the marginal ridge rings and the contact points burnished with a ball and embrasure regions. burnisher. The occlusal surface of the V3 Ring tines have a low profile and sit flush with the occlusal surface of the teeth, improving access and visibility. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 2
  • 3. Using Triodent V3 Rings and V3 Matrices to control the contact points for direct posterior composites By Dr Graeme Milicich, BDS, New Zealand 1 2 Completed cavity ready for restoration. Triodent sectional matrices, Enamel margins are selectively etched with 37% phosphoric acid Wave-Wedges and V3 Rings have been placed to create sound gel for 15 seconds and rinsed. contact points. 3 4 The dentin is conditioned with 10% polyacrylic acid for 10 seconds, Fuji IX Xtra is carefully injected into the depths of the cavity and rinsed and gently dried. manipulated on to the dentin using a very small micro-brush dipped in Fuji Lining. The Fuji Lining is polymerized for 10 seconds. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 3
  • 4. Using Triodent V3 Rings and V3 Matrices to control the contact points for direct posterior composites By Dr Graeme Milicich, BDS, New Zealand 5 6 GBond (self-etching resin bonding agent) is liberally applied to the A thin layer of radio-opaque flowable is placed over all internal etched enamel and GIC surfaces for 10-15 seconds. Any dentin surfaces and polymerized. that was not covered by the GIC is also effectively bonded at this stage with the GBond. The GBond is then vigorously air-thinned until there is no movement in the bonding layer before polymerizing. 7 8 Using the 0.5 C-Factor concept, Gradia Direct was then used in Completed restoration build-up. incremental layers to build up the restoration. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 4
  • 5. Using Triodent V3 Rings and V3 Matrices to control the contact points for direct posterior composites By Dr Graeme Milicich, BDS, New Zealand 9 10 V3 Rings and matrices removed. There is a film of bonding agent Completed restoration with good marginal ridge contours and on the tooth and some thin flash in the region of the marginal ridges sound, wide contact points. that required minimal effort to finish off. US: 1-800-811-3949 UK: 0800-311-2097 CA: 1-866-316-9007 NZ: 0800-TRIODENT INT: +64-7-549-5612 AU: 1-800-350-421 If you have a great new product idea or wish to contact us for more information on our great products, go to www.triodent.com/product-information-request. Case Study 5