Direct Posterior Resin Restorations

Part 1 - Direct posterior resin case overview

Instructors:

Dr. Ross Nash, DDS 

Dr. Ross Nash, DDS

Ross Nash, D.D.S., F.A.A.C.D., the co-founder and director of Ross Nash Seminars, is considered an authority on all types of cosmetic dentistry. Dr. Nash earned his undergraduate degree from North Carolina State University and his Doctor of Dental Surgery Degree from The University of North Carolina School of Dentistry. He has a private dental practice in Charlotte, where he has focused on esthetic and restorative dentistry since 1980.

Dr. Nash removes old restorations

This is Larry and Larry is a typical dental patient today with some large amalgams in his maxillary molars and premolars. Larry has been through some orthodontic treatment. We're doing some anterior work for him and we moved some things around at the orthodontist. He has developed a space between the molar and premolar which is catching food plus the amalgams really are not as high quality today as we would like and he's asking to be replaced with tooth colored alternatives.

Larry is a banker. You know the banking industry is not too great right now. He's actually in search of a job. He wouldn't object to me telling you that. And so really he'd like to be as economical as possible on these replacements. So we've chosen direct composite rather than an indirect procedure for that. You can see the teeth involved teeth #3, #4 and #5. Let me see if I can give you a mirror shot. You can see we have MOD at least on the molar.

There will be at least a DO on the second premolar and a DO on the first premolar. There's our beginning shot and we're going to anesthetize with Septocaine and then we're going to place a rubber dam. So now we have the rubber dam in place and we're ready to begin our preparations. So the first thing we're going to do of course is remove the old restorations and I'm going start out with a 245 carbide bur and we'll remove the amalgam. This is an electric KaVo handpiece rather than air rotor, high torque, very quiet handpiece.

All right. What I like to illustrate is as is often the case we can all ready see some proximal decay on the adjacent tooth. So we're now going to have an MOD on the second premolar. As you can see the objective is simply to remove the amalgam and any affected tooth structure. We're not really worried about retention and resistant form like you would be with amalgam. So you don't have to remove the kind of tooth structure that you would if you were going to place a larger amalgam.

Simply remove decay, remove the old restoration and affected tooth structure. We'll go ahead and make our proximal box here on the second premolar. So you can see we removed the proximal decay there and now we're going to be shaping the restoration connecting it to the distal portion. And we're going to go right back to the molars to continue our amalgam removal. I'm going to use a slow speed, round carbide bur to remove the rest of the amalgam and any decay that we find.