DT India & South Asia No. 9, 2019

Padma Shri Dr Mahesh Verma appointed as the new VC of Guru Gobind Singh Indraprastha University / News / Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report

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Padma Shri Dr Mahesh Verma appointed as the new VC of Guru Gobind Singh Indraprastha University
01 - 01 view
News
02 - 05 view
Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report
06 - 07 view

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DENTALTRIBUNE
The World’s Dental Newspaper · South Asia Edition

Published in India

www.dental-tribune.in

Dental implant

Dr Udatta Kher

Study revisits
early & late
dental implant
failures &
compares
various implant
removal technique

“Partial Extraction
Therapy (PET) will
become the default
technique in the
future.” Dr Udatta
Kher

” Page 02

9/19

Causal link

” Page 03

Unica Anterior

Genetic study
suggests a causal
link between
dental caries and
cardiovascularmetabolic factors

” Page 05

Developing tight
proximal contacts in
anterior teeth using
Unica Anterior
matrix – A case
report

” Page 06

Padma Shri Dr Mahesh Verma appointed
as the new VC of Guru Gobind Singh
Indraprastha University
by Dental Tribune South Asia

Dr Mahesh Verma
Has been appointed as the new
VC of Guru Gobind Singh
Indraprastha UniversityDigital
Dentistry

Padma Shri and B. C. Roy
awardee Dr Mahesh Verma,
who was serving as the
Director-Principal of Maulana
Azad Institute of Dental
Sciences, New Delhi, has been
announced as the new ViceChancellor of Guru Gobind
Singh Indraprastha University
(GGSIPU), in a notification
released by the Secretary,
Higher
Education,
Delhi
government.
The
higher
education
department of Delhi Government
has appointed Dr Mahesh
Verma, an eminent academician,
researcher, administrator as
the new VC of Guru Gobind

Singh Indraprastha University
(GGSIPU) for the next five
years. Before this appointment,
Dr Mahesh Verma served as
the director of Maulana Azad
Medical Institute of Dental
Sciences (MAIDS).
Dr Verma has received
the State Award from the
Government of Delhi in 2001, the
B. C. Roy Award in 2007, and the
civilian award of Padma Shri in
2014, when he was included in
the Republic Day honours. He is
also a fellow of the Royal College
of Surgeons & Physicians,
Glasgow; Fellow, Royal College
of Surgeons, England; Fellow,
Royal College of Surgeons,
Edinburgh; Fellow, International
College of Oral Implantologist;

and an honorary member of the
American Dental Association.
Dr Verma will focus on the
development of infrastructure,
multidisciplinary
research,
ensuring student and employee
welfare— once he takes over as
the VC of the university which
has over 128 colleges.
While
serving
as
the
Director-Principal of Maulana
Azad Institute of Dental Sciences
(MAIDS), the dental wing of
Maulana Azad Medical College,
New Delhi, Dr Verma helped
MAIDS evolve from a dental
school of meagre proportions
into a Centre of Excellence
with a daily count of over
1200 inpatients. An Outlook Marketing and Development

Research Associates (MDRA)
survey of premier Indian dental
schools placed MAIDS as the
best dental school in India.
As
a
World
Health
Organization (WHO) fellow,
Dr Verma is involved in WHO
social and community projects
as well as institutional projects
of the Council of Scientific and
Industrial
Research
(CSIR),
Indian Council of Medical
Research (ICMR). One of his
projects is the development of
indigenous dental implants
involving Indian Institute of
Technology and the CSIR, funded
by the Ministry of Science and
Technology.

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[2] =>

2

News

9/19

Study revisits early & late dental
implant failures & compares various
implant removal techniques
by Dental Tribune International
ZURICH,
Switzerland:
Clinical
evidence
has
established dental implants
as a great treatment option
to replace missing teeth.
However, even with the high
success rates reported, like in
every medical technique, there
are possibilities of biological
complications that may lead to
implant failure, necessitating
the removal of the implant. A
recent study by the University
of Zurich has revisited the
reasons for implant failure and
compared different techniques
used for implant removal.
A literature search identified
28 studies, conducted up to
2018, that had assessed implant
failures, removal techniques and
the reinsertion of implants in a
previously failed site.
The researchers classified
the factors for implant failures
into different categories. Peri-

implantitis and inability to attain
or maintain osseointegration
were included under biological
factors.
Mechanical
factors
included implant fractures. Bone
overheating, site contamination
and malpositioning etc. were
grouped under iatrogenic errors.
Prosthesis design and functional
overload were categorised as
functional reasons.
The study showed that
an early implant failure is
typically caused by deficient
osseointegration - either the lack
of attaining it or maintaining it,
or by bone overheating or site
contamination. Late implant
failures are caused by implant
fractures,
malpositioned
implants and progressive periimplantitis. To date, peri‐
implantitis remains the main
reason for late implant failures
(81.9%). Early implant failure
results in implants that are
generally mobile and easy to
remove. Late implant failure

means the implants can be at
least partially osseointegrated
in the apical region. Most late
failing implants are not mobile
and, therefore, are more difficult
to remove.
For
implant
removal
techniques, the study compared
tooth extraction set, trephine
burs,
piezo-surgery,
laser
surgery, the counter-torque
ratchet technique (CTRT) and
electrosurgery. The study found
trephine burs to be the bestknown method for implant
removal. However, the study
recommended that the CTRT
method, alone or combined,
should be the first choice for the
removal of implants because of
its low invasiveness.
Furthermore, the researchers
studied the survival rates
of implants placed in the
previously failed sites, which
was, irrespective of early or late
failure, in the range of 71–100%
over five years.
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A recent study has shown peri-implantitis to be the main reason for
dental implant failure. (Photograph: Kasama Kanpittaya/Shutterstock)

Little data is available
regarding
zirconia
implant
removal. The unique physical
properties of Zirconia make
it necessary to use a different
approach for the removal of
zirconia implants as compared
to titanium implants.
“If removal is required,
interventions should be based
on considerations regarding
minimally
invasive
access
and management as well as

predictable
healing.
(Post)
Operative
considerations
should primarily depend on the
defect type and the consecutive
implantation plans,” concluded
the authors in their paper.
The study, titled “Removal of
failed dental implants revisited:
Questions and answers”, was
published online in Clinical and
Experimental Dental Research
on 21 August 2019, ahead of
inclusion in an issue.
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[3] =>

News

9/19

“Partial Extraction Therapy (PET) will
become the default technique in the
future.” Dr Udatta Kher
4. How did your journey
of Partial Extraction Therapy
(PET), and more specifically,
Socket Shield (SS) begin?
I was introduced to the socket
shield procedure by my dear
friend Dr T.V.Narayan in 2013. It
sounded absurd to me back then.
I was truly inspired by the cases
presented by Maurice Salama
and Jorge Campos Aliaga on
Dental XP and that led me to
learn more about the procedure.
I was astonished at the beautiful
outcome of my very first case
of socket shield. I waited for 1
year to see the follow-up before
I performed the procedure again
and I haven’t looked back! I am
so convinced in my mind that
the Partial Extraction Therapy/
Socket shield will become the
default technique of placing
implants in the future.
In this interview Dr Udatta Kher provides answers to all the clinically relevant topics in implantology.

by Rajeev Chitguppi,
Dental Tribune South Asia
Dr Udatta Kher has made
significant contributions to the
field of implant dentistry. He has
developed a wealth of clinical
evidence on Socket Shield. He
has also developed MITSA an innovative technique that
has simplified the sinus lift
procedure and made it userfriendly for the beginners. He
is a well-known educator in
implant dentistry, providing
quality training through his
academy ‚Impart Education.‘
In this interview, Dr Udatta
Kher provides answers to all
the clinically relevant topics in
implantology.
Dr Udatta Kher graduated
from Govt. Dental College and
Hospital, Mumbai in 1991 and
completed his post-graduation
in Oral Surgery from the same
institute in 1995. He practices
in Mumbai and specializes in
Implant Dentistry. He is the
Director of ‘Impart Education’
an academy for training dentists
in the field of Implant Dentistry
and Full Mouth Rehabilitation.
Dr Udatta is an Xpert on Dental
XP, the largest portal in the
world for Continuing Dental
Education. He is also a registered
ITI speaker. He is the Consultant
Oral Surgeon and Implantologist
to the Hon Governor of
Maharashtra. He has the unique
distinction of having lectured in
all the continents of the world in

the field of Oral Implantology.
An avid traveller, trekker, and
photographer, Dr Udatta knows
how to maintain work-life
balance. He can be contacted at
www.drkher.com

1. For the esthetic areas, ITI
guidelines recommend that
immediate implants should
be reserved only for the ‚most
ideal‘ cases to prevent the
buccal tissue loss. Else, one
should simply go for an‚ early‘
placement. We know that you
have been a strong proponent
of‚
Socket
Shield.‘
So,
nowadays, how many of your
anterior implant esthetic cases,
percentage-wise, go for socket
shield vs immediate implants
vs early implants?

Adjacent socket shields in esthetic
zone

The socket shield technique
is the only procedure that can
prevent the inevitable labial bone
loss after extractions of teeth. In
my practice, I perform a socket
shield procedure for every tooth
indicated for an extraction in the
esthetic zone, provided the labial
plate is intact.
In case the preoperative scan
shows an absence of the labial
bone, I choose the ‘Early Implant
Placement’ strategy as per the
ITI guidelines. I see very few
indications for the conventional
extraction and Dual Zone
Grafting protocol in my practice.
2. What were the challenges
you faced in your early days of
implantology regarding implant
placement and restoration in
the anterior esthetic zone?
The biggest challenge I used
to face, was getting an esthetic
restoration from the laboratory.
It was frustrating to build up
peri-implant tissue, and still end
up with an unaesthetic outcome
because of a sub-standard
restoration. Over the years the
lab work in India has improved to
such an extent that it matches the
highest international standards.
It was also disappointing
to see the results of some of the
grafting procedures I performed
in the initial days of my practice.
Also, I didn’t pay much attention
to building soft tissue around
implants in the esthetic zone
due to which I landed up with
unsatisfactory results.

3. A lot of youngsters seek
your advice. What‘s the most
common mistake that you see
in the implants restored in the
esthetic zone nowadays? If
there is one single important
piece of advice you wish to
give the youngsters regarding
implants in the esthetic zone,
what would that be?

The team of clinicians at #JTI2017
- 1st PET consensus, Madrid.

If there is one key to
success in the esthetic zone, it
is the ‘3-D implant positioning’.
Most errors in the aesthetic
zone occur due to malposed
implants. Hence my advice for
youngsters is, irrespective of
what surgical procedure is being
executed, like post-extraction
immediate placement, socket
shield procedure, ridge-split
procedure, ridge expansion of
conventional placement, the ideal
prosthetically-driven
implant
placement is sacrosanct.

5. You were a part of the 1st
international PET consensus
#JTI2017 in Madrid? Can you
share a few insights about the
consensus meeting?

The first PET consensus saw
a group of like-minded clinicians
who were early adopters, getting
together to brainstorm about
the
technique,
indications
and nuances of the socket
shield procedure. Clinicians
like Maurice Salama, Howard
Gluckman,
Micheal
Pikos,
Mitsias Miltiadis, Snjezana Pohl
and others were a part of this
unique event.
I am privileged to be a part
of the PET research group which
will assemble again in 2020 for
the next PET consensus meeting.
The objective will be to provide
more specific guidelines for
case selection, design of the
shield, and management of
complications. The interest in the
field has grown exponentially
and there is a need for clinicians
to share their experiences.
6. What‘s your take on
socket grafting? How many of
your socket grafted cases need

[4] =>

4 News

9/19

grafting again at the time of
implant placement?
I do not perform socket
grafting
routinely
in
my
practice. Actually, I am against
the procedure because of its
inconsistencies. There is no
assurance of volume maintenance
after socket grafting and very
often there is a need for a second
round of grafting during implant
placement. My preference is to
enter the site early at 6-8 weeks
post-extraction
before
the
collapse has set in and perform
the grafting at the time of
implant placement. The only 2
occasions that I have performed a
socket grafting procedure in my
practice is on adolescent patients
for whom an implant placement
had to be delayed.
7. Coming to sinus lift,
the
Minimally
Invasive
Transcrestal
Sinus
Augmentation
technique,
popularly known as MITSA, is
a great technique developed by
you. People feel it‘s a real gamechanger. How did you come up
with this technique? How many
of your own sinus lift cases have
moved from the lateral window
approach to MITSA?
Something close to my heart.
I chanced upon the technique
when I discovered that the 3mm

diameter an osteotome coincides
with the diameter of the Novabone
(Calcium
Phosphosilicate)
cartridge nozzle. The hydraulic
pressure exerted by the viscous
putty provided the right amount
of sinus elevation through a
minimally
invasive
crestal
approach.
The original technique was
developed for the osteotome,
but over the years it has been
used with crestal drills and
Densah drills. However, I feel
for a country like India, where
the cost of equipment and
drills is prohibitive, the original
osteotome technique still has a
place in many practices. It is the
most economical and effective
technique of doing a crestal sinus
grafting.
In my practice, any case
with a residual bone height of
over 2.5mm is managed with
the MITSA protocol. Hence the
number of lateral window sinus
lifts has dropped drastically.
8. Where do you see a place
for cortical - basal implants?
I see a place for this treatment
modality is highly resorbed
jaws
where
conventional
treatment modalities are not
easily possible without extensive
grafting. However, the prosthetic
management of the cases is

way below what we see in
conventional implant dentistry.
For that reason, I don’t fancy that
option in my practice. However,
for cases like post-cancer
resections and reconstructions,
this can be a good tool to improve
the quality of life for patients.
9. What is your take on
All-on-4 and All-on-6?
Very good options for the
right indications. I routinely
perform All-on-4 procedures
for geriatric patients who are
edentulous. In patients who are
rendered edentulous at a younger
age, I opt for the All-on-6 option.
In very young patients, I prefer
to graft and place more implants
to provide a long term solution.
So the decision for me based
on the age of the patient. and
functional needs. However, I am
very selective while performing
immediate loading for full
arches. Many of these cases
receive conventional loading
protocols
10. What‘s your take on
social media dentistry? How
is it influencing the dental
practitioners?
In my opinion, it is the best
thing that has happened to Indian
dentistry. I am a big proponent
of social media as a means of
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sharing clinical work and ideas,
with a large population across the
globe. It is a great tool to inspire
young clinicians to improve
their knowledge and clinical
work. Needless to say, it does not
substitute the need for attending
continuing education programs
to upgrade one‘s skillsets. It acts
as an adjunct to old and time
tested methods of learning.
Never before have we seen so
many wonderful clinicians from
India, showcasing their work
on an international platform.
I believe social media has a big
role to play in this transition.
11. What‘s your take on
mushrooming of academies
and courses in dentistry and
Implantology?
I see that as a healthy sign
of progress. Every aspiring
educator needs to sharpen his/
her skills if he/she has to start
teaching. As more clinicians
choose to share their knowledge
and start teaching, they need to
enhance their own skills if they
are to remain relevant. This has
a positive impact on the number
of clinicians who rise above the
rest and inspire others to do
excel in their craft. There will
always be a few academies and
courses which are below par.
But the clinician is smart enough

to recognise that, due to social
media exposure. Such academies
and courses will cease to exist
very soon.
12. What are your new areas
of interest that you are working
upon currently?
I am currently working
on techniques for simplifying
Implant
Prosthodontics
for
clinicians. That has remained
a challenge for many practices.
The Fast Tracking technique that
we recently published in The
Compendium is an example.
There are a few more concepts in
the pipeline.
I am also working on some
protocols to amalgamate MITSA
and Densah. Since the osteotome
is not a very elegant tool for
surgeries, clinicians have moved
towards drills for improving
the patient experience. I am
working at further refining those
protocols.
Also in the pipeline are some
publications on PET. This is a
golden era for Implant dentistry
in India and I feel privileged to
be a part of these exciting times!

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[5] =>

News

9/19

Genetic study suggests a
causal link between dental
caries and cardiovascularmetabolic factors

For the first time, researchers have been able to pinpoint genes that can have an effect on oral health and
also their systemic effects. (Image: Arek Socha/ Pixabay)

by Dental Tribune International
UMEÅ, Sweden: Researchers
from the Institute of Odontology
at Umeå University in Sweden
collaborated with the Bristol
Dental School in the UK, in the
largest study of its kind, in order
to improve our understanding
on the role our genes in oral
health. The team collected metadata from thousands of patients
and was able to identify 47 new
genes with connections to tooth
decay. Also, they used Mendelian
randomisation to find a genetic
link between oral health and
cardiovascular- metabolic factors
According to the 2016 Global
Burden of Diseases, Injuries and
Risk Factors Study, dental caries in
permanent teeth and periodontitis
were the leading and 11th most
prevalent causes of disease
worldwide in 2016. Another study
in 2015 estimated the global cost of
dental diseases to be more than 540
billion US dollars. Even after knowing
that the genetic contribution to oral
health outcomes and the heritability
of dental caries and periodontitis
happens to be as high as 50%, the
nature of this contribution remains
poorly characterised. We know
that an increased understanding
of genetic factors can improve
our knowledge of the aetiology
and clinical management of oral
diseases, yet the role of genes in
oral health remains understudied.

One of the reasons for this is that
the complex nature of tooth decay
and periodontitis requires extensive
studies to draw firm conclusions.
Genome-wide
association
studies (GWAS) have been in use
to study the genetic basis of dental
caries and periodontitis. GWAS for
dental caries have investigated overall caries experience, specific
presentations of disease and the
presence or absence of disease in
paediatric populations. However, to
date, few reliable genetic-association
signals have been found. GWAS
for periodontitis have investigated
the presence or absence of disease,
quantitative measures of periodontal
status, severe presentations of
disease, molecular and microbial
intermediaries of disease and
composite phenotypes such as
GWAS for principal components
which aim to capture multiple facets
of periodontal health. Even these
studies, to date, have not yielded
consistent evidence of specific genetic
contributions to periodontitis.
One should know the difference
between the genotype and the
phenotype. A genotype is a part
of the genetic makeup of an
individual. Genotype interacts
with the environment and imparts
a phenotype - a set of observable
characteristics in an individual.
Genome-wide analyses need good
statistical power for the studies. The
logistical and economic challenges
in obtaining detailed and refined

phenotypes in large populations
have made the recent studies focus on
taking advantage of extremely large,
population-based, cohorts with
both genetic data and less-refined
proxy phenotypes. The need to
work on highly refined phenotypes
may reduce the sample size and
subsequently the statistical power of
the study. Hence studies have started
working on large cohorts, focusing
on the presence of less well defined
but informative phenotypes. This
trade-off has enabled the researchers
to find successful association
signal discoveries for several
complex traits, yielding important
biological insights. In order to
achieve further understanding of
genetic contributions to caries and
periodontitis, a shift in analysis
scale—afforded by a similar
approach
to
measurement—is
required.
In the current study, the
researchers
have
synthesised
evidence from two sources; the
Gene-Lifestyle Interactions in Dental
Endpoints (GLIDE) consortium,
which is a unique collection of
epidemiological
cohorts
with
detailed information on clinical
endpoints of dental diseases; and
the UK Biobank (UKB), which
contains less-refined self-reported
oral health data at a larger scale.
The UKB data alone may not be
enough to yield adequate biological
meaning and relevance of the
approximate measures, but when

combined with the more detailed
clinical information in GLIDE, this
combination of complementary
resources provides great information
on the genetic association.
Researchers, in order to fulfil
the large data requirement, took the
data from nine international clinical
studies with 62,000 participants
and merged it with the data on
self-reported dental health from
the UK Biobank, involving 461,000
participants. Ingegerd Johansson,
Senior Professor at the Institute of
Odontology, the lead researcher at
Umeå University, said, “The study
makes it clear that teeth are part
of the body. Among other things,
we can see that there seems to be a
causal link between risk factors for
cardiovascular disease and tooth
decay.”
Using this combination of
resources, the researchers could
identify 47 novel risk loci for dental
caries. The study showed that
the heritability of dental caries is
partially shared with a range of
complex traits. The genes linked to
tooth decay included those that help
form teeth and the jawbone, those
with protective functions in saliva
and those which affect the bacteria
found on the teeth. The research
also confirmed a previously known
immune-related gene to be linked to
periodontitis.
The researchers used a technique
called Mendelian randomisation,
to find a genetic link between
oral health and cardiovascularmetabolic risk factors such as
smoking, obesity, education and
personality. Applied analysis using
Mendelian randomisation suggested
that dental caries has undesirable
downstream effects on general
health. Together, these findings
improve our understanding of the
potential causes and consequences
of an important complex disease.
The researchers have stated that
there might be a causal link between
decay and some cardiovascularmetabolic risk factors.
The study, titled “Genomewide analysis of dental caries and
periodontitis combining clinical and
self-reported data”, was published on
24 June in Nature Communications.

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[6] =>

6 Clinical

9/19

Developing tight proximal contacts
in anterior teeth using Unica Anterior
matrix – A case report

characterisation of the adjacent
tooth.
The final enamel layer was
contoured to match the mesial
transitional line angle of 21
using a Mylar Pull Through
method against the cured mesial
wall with good contact already
established with the Unica.
Finishing was carried out with
finishing discs (Shofu Snap-on
Discs) and Soflex Spirals (3M
ESPE). Polishing was done with
Prisma Gloss polishing paste
(Dentsply) and a rubber.

Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report (Dr. Nisha Deshpande)

by Dr Nisha Deshpande,
Dental Tribune South Asia
This article is a case report
of a direct composite restoration
of a fractured central incisor
where the proximal contact
was developed using the Unica
Anterior Matrix.
Composites are one of the
most widely used materials for
the restoration of anterior teeth
defects. Modern composites,
with their excellent physical and
optical properties combined with
newer generations of bonding
agents, provide clinicians with
the ability to deliver predictable
lifelike biomimetic restorations.
When finished and polished well
using the correct protocol, these
restorations can survive for a
long time in the patient‘s mouth,
eliminating or at least reducing
the need for more expensive
and lab- dependent indirect
restorations.
Even though the handling
characteristics
of
modern
composites are far superior, one
of the major problems faced by
the clinician while restoring
anterior teeth is the development
of good interproximal contacts
and contours. Matrix application
is a critical step in achieving this
objective in anterior composite
restorations.
Matrix systems used in the
anterior region can be broadly
classified into flexible and rigid.
Flexible matrices include the
popular transparent mylar strip
and soft splint templates, and

the rigid matrices include putty
index matrix and pre-contoured
sectional matrix (posterior).
The Mylar strip can be used
with a pull-through method
in cases where the adjacent
tooth has a flat contact area.
The disadvantage of this
matrix, when used alone, is its
flexibility making it challenging
to contour large areas leading to
irregular contours and contacts.
Posterior contoured sectional
matrices have often been used
for this purpose but have their
limitations
when
restoring
teeth where the adjacent tooth
has a flat contact area. Another
problem commonly faced is the
stabilisation of the matrix when
restoring adjacent lesions. It also
becomes cumbersome to restore
multiple surfaces of the same
tooth and multiple adjacent
lesions as it is extremely timeconsuming. In cases where a
Class V cervical defect also needs
to be addressed, none of these
matrices can be adequately used.
To overcome all these
limitations, the Style Italiano
group has developed a new
matrix for anterior teeth called
the Unica Anterior.
Unica is a simple matrix
specifically
developed
for
anterior restorations such as
class III, IV, V, direct stratification
composite veneers, and shape
modifications. The placement
wings allow the operator to place
and adapt the matrix quickly and
efficiently. Its contoured shape

adapts correctly to the different
morphologies of anterior teeth
and makes it possible to restore
interproximal
and
cervical
margins at once, even in the
presence of rubber-dam or
gingival retraction cords, thus
reducing chair-time significantly.
Furthermore, Unica anterior
matrix, once positioned, allows
visualising the final shape of the
restoration easily.
This article is a case report
of a direct composite restoration
of a fractured central incisor
where the proximal contact
was developed using the Unica
Anterior Matrix.
Case Report
A 32-year-old man walks
into our dental office with the
chief complain of a broken front
tooth. On examination, a Class
IV fracture is seen involving the
enamel and dentin of 11. The
IOPA did not show any significant
findings, and the tooth reacted
positively to vitality testing.
It was decided to restore the
tooth with Direct Composite
Resin. Preoperative photographic
records were taken. Small buttons
of different shades (dentin, body
and enamel shades of A1 and
A2) of composite resin were
placed on the adjacent teeth and
photographs were taken with
different settings to ascertain
the correct value and chroma of
the material to be used (button
technique).
Rubber dam isolation with
floss tie ligature was carried

out to provide absolute isolation
required for the bonding
protocol. A 2mm wide bevel
was given with a diamond point
and finished with finishing
discs involving the enamel and
dentin on the buccal surface of
the fractured tooth. The palatal
portion of the fracture line was
only smoothened to remove any
overhanging enamel.
The tooth was etched with
37% Phosphoric Acid (D tech)
for 20 seconds. After thorough
rinsing with water and light airdrying, two coats of Universal
Bonding Agent (Single Bond
Universal, 3M ESPE) was applied,
air thinned and photocured for
20 seconds. Palatal shell was
made with A2 Enamel (Filtek
Z350XT) using a mylar strip and
index finger held palatally for
support.
At this stage, the Unica
Anterior Matrix (Polydentia) was
adapted and secured by pulling
the palatal wings and placing an
interdental wedge. A2 Enamel
was then applied and compacted
against the matrix mesially to
form the mesial surface of the
restoration.
Once we have an adequate
‘box’ with tight interproximal
contact, it becomes relatively
easy to finish the final layering.
In this case, A2 Dentin, A2 Body,
and A2 Enamel shades were
used to complete the restoration.
White opaque tints were also
added before the final enamel
layer to mirror the white spot

Conclusion:
With their excellent aesthetic
and mechanical properties,
composite resins have emerged
as the most minimally invasive
alternatives to restoring anterior
teeth. It is now possible to achieve
life-like restorations, which
are also extremely biomimetic.
Establishing good contacts and
contours in the anterior region
is of paramount importance not
just from an aesthetic but also a
functional point of view.
Understanding
the
limitations of the material in
every situation and adapting
newer techniques should be our
focus to make our restorations
more predictable and durable.
References
1.
S h e r w o o d
IA,
Rathakrishnan
M,
Savadamaoorthi KS, Bhargavi
P, Vignesh Kumar V. Modified
putty index matrix technique
with mylar strip and a new
classification
for
selecting
the type of matrix in anterior
proximal/incisal
composite
restorations. Clin Case Rep.
2017;5(7):1141-1146.
Published
2017 Jun 1. doi:10.1002/ccr3.1006
2.
Ayush Goyal, Vineeta
Nikhil, and Ritu Singh, “Diastema
Closure in Anterior Teeth Using
a Posterior Matrix,” Case Reports
in Dentistry, vol. 2016, Article ID
2538526, 6 pages, 2016. https://
doi.org/10.1155/2016/2538526.
3.
Fellippe L. A., Monteiro
S. Jr, De Andrada C. A., Di
Cerqueira A. D., and Ritter
A. V.. 2005. Clinical strategies
for success in proximo-incisal
composite restorations. Part
II.
Composite
application
technique. J. Esthet. Restor. Dent.
17:11–21. [PubMed]
4.
Manauta J, Salat A .
LAYERS An atlas of composite
resin stratification. Quintessence
books 2012

[7] =>

7

Clinical

9/19

Fig 1

Fig 2

Fig 3

Fig 4

Fig 5

Fig 6

Fig 7

Fig 8

Fig 9

Fig 10

Fig 11

Fig 12

Fig 13

ZDr
Nisha
Deshpande
graduated from Government
Dental College and Hospital,
Mumbai in 2007. She was
the recipient of the ViceChancellor‘s Gold Medal for
scoring highest marks in her

final BDS examination from
Maharashtra University of
Health
Sciences
(MUHS)
having topped the University
in 2006. She has received the
Post Graduate Certificate in
Aesthetic
Dentistry
from

State University of New York
at Buffalo, USA in 2011. She
is a member of the European
Society of Cosmetic Dentistry
(ESCD)
and
the
Indian
Academy of Aesthetic and
Cosmetic Dentistry (IAACD).

She is currently pursuing the
International
Certification
In Aesthetic and Restorative
Dentistry from Egas Moniz
University, Caparica, Portugal.
She can be contacted at
nishadamle@gmail.com.

Author:

Dr Nisha Deshpande
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[8] =>

7 News

7/19

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[cover] => DT India & South Asia No. 9, 2019

[toc] => Array ( [0] => Array ( [title] => Padma Shri Dr Mahesh Verma appointed as the new VC of Guru Gobind Singh Indraprastha University [page] => 01 ) [1] => Array ( [title] => News [page] => 02 ) [2] => Array ( [title] => Developing tight proximal contacts in anterior teeth using Unica Anterior matrix – A case report [page] => 06 ) ) [toc_html] =>

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