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Dr. Brian Gray – Washington, DC

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.

Incisal Edge Repair with OMNICHROMA Composite

Repairing a small chip on the incisal edge can be very difficult to match the color and very difficult to obtain a long lasting permanent result. This is especially true if the patient grinds or clenches their teeth. It can be helpful to inform the patient to be careful of bad habits, such as biting nails, pencils, or pens and biting down on hard foods. A night guard should be advised to protect the teeth from hard occlusal trauma at night. When the composite restoration comes out and the patient didn’t follow the dentist’s advice, they have themselves to blame! Getting the shade correct on an anterior tooth is also very important. This article will show how a new composite material called OMNICHROMA (Tokuyama Dental America) works well to blend into the color of the natural tooth using structural color.  

A Shade for All Seasons

I’ve always been a fan of Tokuyama products. Their bonding and composites have consistently been at the forefront of elegant chemistry and continued striving toward simplified treatment. Plus, I have the absolute privilege of testing many of these products before they are released to dentists here in North America.

Two Clinical Scenarios Where OMNICHROMA Improves Your Outcomes

In my practice, I am very focused on creating lifelike restorations that exceed my patients’ expectations. I often find that the standards I hold myself to are higher than those of many of my patients; they are happy with the outcome, but I can always find room for improvement. This mindset is expensive; I have purchased a lot of different materials, instruments and equipment to help me provide the best care. One aspect of my practice where I wanted to improve my game, while streamlining my inventory, was direct composite restorations. I had the opportunity to give OMNICHROMA (Tokuyama Dental America) a try and I have found two particular scenarios where it has exceeded my expectations. 

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