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Composite Applications for Our Pediatric Patients

By Carla Cohn DMD

There are so many excellent composite resin materials to choose from in the dental market today that it can be overwhelming to know which to use, and when. Many of the composite resin materials come with features that are compelling. Bioactivity, bulk fill, sonic fills, ultra-polishable, low shrinkage, self leveling, nano hybrid, specialized aesthetic shading systems, universal use, the list of attributes available goes on and on. Ultimately, we want the very best for our patients and their restorations. At the same time, it is inconceivable that we carry the inventory in our practice of each material that has a distinct attribute. A simple and unique solution is OMNICHROMA, a resin restorative material manufactured by Tokuyama Dental America. OMNICHROMA combines a number of excellent properties such as excellent esthetic properties due to uniform sized 260 nm supra-nano spherical SiO2-ZrO2 filler particles. These fillers result in unprecedented color matching, extremely high polishability, and color stability. Physical-mechanical properties due to the types of fillers and high fill content of 79% weight/68% volume give the material high wear resistance, high compressive strength, and exceptional handling. As the name implies OMNI = all, or universally + CHROMA = a quality of color combining hue and saturation (Merriam Webster Dictionary). OMNICHROMA is a universal shade that blends and reflects allowing us to be able to use this one OMNICHROMA composite shade for a multitude of different tooth shades.

Little patients have little patience. When treating children, simplicity and durability of materials is key to successful restorations. The less time spent in a child’s mouth, the better. Although primary dentition is transitional, the occlusal forces, bruxing, and wear and tear are substantial in a short period of time. Intracoronal restorative materials for primary teeth must deliver reliable physical and mechanical properties in order to have successful long-lasting restorations. In my experience, highly filled composite resin combined with excellent isolation and technique yield reliable restorations.

Case study #1 

4-year-old boy presented with early childhood caries. I completed full mouth rehabilitation under general anesthetic consisting of full coverage crowns, intra-coronal composite restorations, and extractions. The focus and feature in this case study is a simple intra-coronal restoration on primary tooth H / 63. Pre-operative photos showing caries and a shade guide for reference. Teeth were prepared using a high-speed Pana-Max (NSK) with a #556 carbide bur ensuring an adequate undercut in preparation to incorporate some mechanical retention. Figures 1 - 2. Enamel was etched using phosphoric acid etch and Bond Force (Tokuyama Dental America) as adhesive in a selective etch technique and light cured. In this case, due to some remaining dark dentin, OMNICHROMA BLOCKER (Tokuyama Dental America) was used and light cured. Figure 3. OMNICHROMA (Tokuyama Dental America) was placed in bulk (2mm), as the lesion was minimal in depth and light cured. Figures 4 - 5. Resulting restoration shade blended beautifully providing a functional and aesthetic result. Figure 6.

IMG_0715 figure 1 anterior pre-op ASHFigure 1 IMG_0719 figure 3 anterior prep ASHFigure 2 IMG_0726 figure 6 OMNICHROMA uncured ASHFigure 3
IMG_0725 figure 5 anterior OMNICHROMA placement uncured ASHFigure 4 IMG_0724 figure 4 anterior blocker cured ASHFigure 5 IMG_0730 figure 9 OMNICHROMA final ASHFigure 6
 

Case study #2 


5-year-old boy presenting with upper right quadrant decay to be restored with intracoronal composite restorations. Primary teeth A / 55 and B / 54 were isolated using rubber dam with slot style preparation. Figure 7. Teeth were prepared using a high-speed Pana-Max (NSK) with a #556 carbide bur ensuring an adequate undercut in preparation to incorporate some mechanical retention. Figure 8. Enamel was etched using phosphoric acid etch and Bond Force (Tokuyama Dental America) was used as adhesive in a selective etch technique and light cured. Lesions were filled in single increment with OMNICHROMA (Tokuyama Dental America), shaped and light cured Figures 9 - 11. Final photo shows a virtually invisible restoration Figure 12.

IMG_0770 figure 10 posterior pre-op TCFigure 7 IMG_0771 figure 11 posterior preparation TCFigure 8 IMG_0773 figure 13 OMNICHROMA fill TCFigure 9

IMG_0774 figure 14 OMNICHROMA shape TCFigure 10

IMG_0778 figure 15 OMNICHROMA uncured TCFigure 11 Figure 12

 

Case study #3 

3-year-old boy presented with gross caries requiring multiple restorations. Anterior presentation of carious primary tooth F / 61. I chose a strip crown restoration as preferred technique due to large caries on multiple surfaces. Figures 13 -14. In primary dentition, one must take into consideration the small bondable surface of primary anterior dentition, forces that these teeth will endure and resultant flexure. Combined, these factors lead to a higher than anticipated failure rate of bonded composite restorations in this area of the child’s mouth. Tooth prepared for strip crown restoration using a high-speed Pana-Max (NSK) with a rough tapered diamond bur, increasing the bondable area by creating a rough and undulating surface. I used a total etch technique with phosphoric acid etch followed by Bond Force (Tokuyama Dental America) and light cured. Placement of OMNICHROMA BLOCKER (Tokuyama Dental America) to mask darkened dentin and light cured Figure 15. Strip crown form filled with OMNICHROMA (Tokuyama Dental America) and light cured. Figure 16. Celluloid strip crown form is removed and I polished the entire restoration using a combination of SofLex discs (3M) and Enhance polishing cups (Dentsply Sirona) resulting in a durable esthetic restoration Figures 17 and 18.

IMG_0799 figure 17 anterior pre-op NDFigure 13 IMG_0800 figure 18 anterior pre-op NDFigure 14 IMG_0803 figure 20 anterior prep and blocker NDFigure 15

IMG_0808 figure 21 anterior strip crown form filled with OMNICHROMA NDFigure 16 IMG_0811 figure 22 anterior final NDFigure 17 IMG_0812 figure 23 anterior final NDFigure 18

 


I have had the good fortune to use Tokuyama Dental America products for at least a decade. With the introduction of OMNICHROMA, Tokuyama Dental America has hit a home run. Nothing is as satisfying as helping our little patients regain a happy, healthy smile. Together, the right materials and techniques help us to hit it out of the park.

 

Dr. Cohn is a general dentist, devoted solely to the practice of dentistry for children. She maintains a private practice at Kids Dental in Winnipeg, Canada. She is proud to be a member of the American Academy of Pediatric Dentistry Speakers Bureau, Catapult Education Speakers Bureau, Pierre Fauchard Academy, and a cofounder of Women’s Dental Network. Dr. Cohn has been named as Dentistry Today’s Leader in Continuing Education multiple years in a row. She has published several articles, and webinars and enjoys lecturing on all aspects of children’s dentistry for the general practitioner both nationally and internationally.

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By Carla Cohn DMD There are so many excellent composite resin materials to choose from in the dental market today that it can be overwhelming to know which to use, and when. Many of the composite resin materials come with features that are compelling. Bioactivity, bulk fill, sonic fills, ultra-polishable, low shrinkage, self leveling, nano hybrid, specialized aesthetic shading systems, universal use, the list of attributes available goes on and on. Ultimately, we want the very best for our patients and their restorations. At the same time, it is inconceivable that we carry the inventory in our practice of each material that has a distinct attribute. A simple and unique solution is OMNICHROMA, a resin restorative material manufactured by Tokuyama Dental America. OMNICHROMA combines a number of excellent properties such as excellent esthetic properties due to uniform sized 260 nm supra-nano spherical SiO2-ZrO2 filler particles. These fillers result in unprecedented color matching, extremely high polishability, and color stability. Physical-mechanical properties due to the types of fillers and high fill content of 79% weight/68% volume give the material high wear resistance, high compressive strength, and exceptional handling. As the name implies OMNI = all, or universally + CHROMA = a quality of color combining hue and saturation (Merriam Webster Dictionary). OMNICHROMA is a universal shade that blends and reflects allowing us to be able to use this one OMNICHROMA composite shade for a multitude of different tooth shades. Little patients have little patience. When treating children, simplicity and durability of materials is key to successful restorations. The less time spent in a child’s mouth, the better. Although primary dentition is transitional, the occlusal forces, bruxing, and wear and tear are substantial in a short period of time. Intracoronal restorative materials for primary teeth must deliver reliable physical and mechanical properties in order to have successful long-lasting restorations. In my experience, highly filled composite resin combined with excellent isolation and technique yield reliable restorations. Case study #1  4-year-old boy presented with early childhood caries. I completed full mouth rehabilitation under general anesthetic consisting of full coverage crowns, intra-coronal composite restorations, and extractions. The focus and feature in this case study is a simple intra-coronal restoration on primary tooth H / 63. Pre-operative photos showing caries and a shade guide for reference. Teeth were prepared using a high-speed Pana-Max (NSK) with a #556 carbide bur ensuring an adequate undercut in preparation to incorporate some mechanical retention. Figures 1 - 2. Enamel was etched using phosphoric acid etch and Bond Force (Tokuyama Dental America) as adhesive in a selective etch technique and light cured. In this case, due to some remaining dark dentin, OMNICHROMA BLOCKER (Tokuyama Dental America) was used and light cured. Figure 3. OMNICHROMA (Tokuyama Dental America) was placed in bulk (2mm), as the lesion was minimal in depth and light cured. Figures 4 - 5. Resulting restoration shade blended beautifully providing a functional and aesthetic result. Figure 6.

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