Whenever I begin a new case, my first thoughts generally center on the materials I can use that will help me build a successful treatment, because a great result really does come down to material choice. This case features a team of Kuraray Noritake Dental restoratives used with the injection molding technique. My young patient was a 9-year-old girl who was just about to begin orthodontic treatment.

The first thing I noticed for this case was that I needed a higher strength flowable material, yet I also wanted high polishability, and composites are not all the same in terms of these features. While there is no shortage of these types of products in the dental market, I chose CLEARFIL MAJESTY ES Flow because its high polishability really sets it apart. For me, the decision was a no-brainer. Why? Particularly with a case like this one, I’m putting a material into a tight space and I need it to be able to flow well while using the injection molding technique. The polishability, flowability, and viscosity of CLEARFIL MAJESTY ES Flow are ideal for this type of treatment.

Case in Point

With this particular case, which was a referral from the patient’s orthodontist, I needed to idealize the size of the patient’s undersized peg laterals, teeth Nos. 7 and 10, to put them in a reference point for better placement during orthodontic treatment (Figure 1).

I began by painting a plaque disclosing gel onto tooth No. 10 to identify plaque and biofilm attached to the tooth surface (Figure 2). Next, I applied air abrasion on the tooth to clean the surface because we were striving for 100% clean enamel (Figure 3). Teflon tape was applied to all adjacent teeth to protect them from any adhesive or restorative materials during the procedure (Figure 4)

Next, I placed phosphoric acid onto the tooth to begin the etching process (Figure 5). I then applied CLEARFIL Universal Bond Quick 2 onto the tooth for an application of no less than 3 seconds. Following this, I used air thinning to evaporate the solvent while leaving a thin, porous layer of the adhesive (Figure 6). I followed this with a light-cure of the tooth.

Injection Molding

For the injection molding, I inserted the molding stent, placing a little bit of light pressure toward the gingiva with my finger. I then inserted the CLEARFIL MAJESTY ES Flow tip through the incisal edge and all the way down to the gingival portion, slowly “backfilling” as I worked the needle out of the stent (Figure 7).

After light-curing through the stent (Figure 8), I then removed the stent (Figure 9) as well as the Temporary Anchorage Device (TAD) at the top of the incisal ledge and began the final step of finishing and polishing.

Final Thoughts

The treatment detailed in this case lasted about an hour. Much of the preparation, such as impressions, wax-up, and creating the stent was completed prior to the patient arriving for this appointment. My young patient—as well as her parents—were very pleased with the results, and the patient was very excited to begin a new experience with her orthodontic treatment.

TROY SCHMEDDING, DDS, AAACD

Dr. Schmedding is a 1993 honors graduate of the Arthur A. Dugoni School of Dentistry in San Francisco, CA. He maintains a private practice in Walnut Creek, CA, where he focuses on esthetic and functional dentistry. An Accredited member of the American Academy of Cosmetic Dentistry, he lectures both nationally and internationally on esthetics and restorative materials. He also has written and published numerous articles on restorative materials and protocols. Dr. Schmedding serves as a key opinion leader for numerous manufacturers, helping to develop and bring new products to market.