Custom shield Technique

When treating cavities involving the undermined buccal, palatal or lingual cusp, if the thickness is less than 2mm reducing cusp's height is usually recommended . Either a direct or indirect restoration is then planned for the patient.

If we plan to restore the cusps with direct composite restoration, it often gets very difficult to restore cusp's height and shape in a free-hand method, often resulting in either under-filled or over-filled restoration requiring lots of occlusal adjustment and finally loss of anatomy and shape.

With the "Custom Shield technique” the height and the anatomy of the cusp are registered before its reduction through the use of a silicone index. This index is then used to mold directly the cusp exactly as it was before reduction.

In this article I present a case of a restoration of maxillary first molar using the custom shield technique.

Fig. 1- Initial situation: the black hue under the buccal cusps of maxillary first molar is an                          indication that removing the decay will result in loss of buccal cusps anatomy.

Fig. 2- Rubber Dam isolation is Performed.

Fig. 3  - The custom shield is made by placing a small amount of putty  material buccally and                           occlusally.

Fig. 4 - The cavity is cleaned till affected dentin is reached and confirmed with chemical dye check and with sharp spoon excavator, the weak cusps are reduced .

Fig. 5- The deep cavity is lined with RMGI liner (Vitrebond, 3M ESPE).

Fig. 6- Selective etch and bond application ( single bond universal, 3M ESPE)

Fig.7-  The composite is placed on the custom shield and adapted on to the tooth and photo-cured.

Fig. 8- After curing the buccal cusp anatomy is restored.

Fig. 9- The rest of the tooth is stratified cusp by cusp incrementally following natural anatomy.

Fig. 10- Some brown stains are added to define the sulcus and add depth .

Fig. 11- Finally top layer is cured under glycerin and then finished grossly with 100 micron burr in slow speed and soflex discs( 3M ESPE)

Fig. 12- Pre polishing is done with so flex spinals ( 3M ESPE)

Fig. 13- Occlusion is checked and adjusted and final finishing and polishing is done.

Fig. 14- Final result showing well integrated composite restoration following natural tooth contours

Fig. 15- Two weeks post-op