Class V Cervical Restorations

In this month's tip, Dr. Buddy Mopper performs Class V cervical restorations using quadrant dentistry to resolve sensitivity and esthetic issues on three teeth in his patient's mouth.

This patient came to Dr. Mopper expressing dentine hypersensitivity on her second molar and disliking how the two adjacent bicuspids felt. Assessing the teeth, Dr. Mopper finds sclerotic dentin and biofilm on the teeth.

The preparation for this restoration involves lightly freshening up the dentin (going just beneath the free margin) and implementing a long bevel. Seeing that the patient does have excellent gingival health, Dr. Mopper starts the restoration with a micro-diamond bur instead of a typical prophy cup. This bur provides more control and avoids irritating the gingival tissue.

Dr. Mopper runs the micro-diamond bur at 10,000 RPMs with copious amounts of water to smooth out the dentin gently. Using a flame-shaped diamond bur, he takes the margin slightly beneath the free margin (about 0.2 mm) because that's the esthetic zone at the cervical.

Next, Dr. Mopper creates a long bevel with a 6862-012 Brasseler diamond bur. Dr. Mopper then isolates the teeth, in this case, with metal strips. He acid-etches well past the long bevel areas onto the unprepared enamel.

After etching, Dr. Mopper applies three coats of bonding adhesive. Dr. Mopper likes to use a brush to apply the bonding material because you can easily get underneath the free margin without damaging gingival tissue.

Dr. Mopper addressed the challenge of cervical restorations - blending the restoration down to the cervical and having it stay bonded - using a flowable microfill for the foundation. Dr. Mopper places a small amount of Renamel Flowable Microfill at the cervical, knowing that that resin bonds better to the resin than to tooth structure. He slightly underfills the area to keep the concavity. He light cures the composite.

Next, Dr. Mopper applies a small ellipse of Renamel Microfill with the 8AL instrument, tacking it down to the gingival area. He then sculpts and shapes the composite towards the occlusal, cleaving off the excess. Once Dr. Mopper is satisfied with the shape and form, he light cures the microfill.
Since microfills have more shrinkage by nature, Dr. Mopper ensures the margin is sealed by adding another small ellipse of microfill resin to the gingival area. He shapes it with his IPCT instrument, and light cures the material.

After completing the microfill layers on all three teeth, Dr. Mopper starts the finishing process with an 18 bur. Next, he begins to refine the restoration with a series of FlexiDiscs, starting with the Gray Coarse FlexiDisc and continuing with the Blue Medium FlexiDisc. He continues finishing and polishing with the Yellow Fine and Pink Superfine FlexiDiscs.
Dr. Mopper finishes the Class V cervical restoration with Enamelize Polishing Paste, applied with a FlexiBuff for long-term shine.