I recently attended the American Academy of Cosmetic Dentistry meeting and listened to Dr. Newton Fahl speak about a new composite technique for restoring abfraction (NCCL) lesions. He uses a direct/indirect technique, which I have started to do and have found it so much easier than trying to layer composite on a convex surface. He prepares a small ball of shade-selected composite and places it into the defect and extends it slightly beyond the marginal areas and cures it. He then pops it off; it releases quite readily. The inlay should have wings on it so that it wraps onto the interproximal surface. These wings will be very thin as it feathers onto the rest of the tooth (think bull horns). He then micro abrades the “cemented” surface of this inlay. The tooth is addressed next by placing a long bevel on the cavosurface margin, placing retraction cord, micro etching or pumicing the surface to be bonded. He then uses the total etch system and light cures the resin after air thinning it. The inlay will seat because you have air abraded it. Use a shade appropriate flowable composite and lay it on the inlay and push it into place and cure again. You are assured excellent adaptation of the inlay with a composite bonded layer. He uses this technique when doing a quadrant of these types of lesions. The finish and polish is routine and less time consuming. It's a nice change in technique and has made restoring these types of lesions more enjoyable.
Mary Anne Salcetti, DDS, PC, Spear Education Visiting Faculty.