The following clinical case by Dr. John Kanca III, DMD will feature RE-GEN, the latest innovation from Apex. In this case, Dr. Kanca utilizes several trusted, legacy products by Apex, and also incorporates RE-GEN, the first suite of bioactive restorative materials on the market to incorporate Bioglass! Bioglass provides calcium, phosphate and fluoride ions to the tooth surface. This promotes regeneration of the tooth structure and forms a zone of inhibition to prevent bacterial growth and secondary decay. 


"Bioactivity has great promise for the future of restorative dentistry but to maximize its potential it must be delivered to the vulnerable site directly. Described here is a protocol for assuring that. If these materials realize their potential, they will lengthen the service life of resin composite restorations." - Dr. John Kanca III, DMD
1. The patient presents with decay in the mesial of the first molar.

2. The cavity is uncovered and the decay is removed.
3. The preparation is further explored to be sure as much decay as possible has been removed. In some cases, it is beneficial to leave affected dentin to avoid potential pulp exposures. While some argue this, when using a bioactive adhesive (RE-GEN) there is no debate.
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4. A caries stain is employed to make certain decay is evacuated
5. Once the decay has been eliminated the preparation process is complete and the restorative process can begin.
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6. The first step in my protocol is to place a matrix band and wedge. In this case, I'm using the Triodent system.


7. The cavity is then etched with a 37% H3PO4 gel for at least 15 seconds. Alternatively, RE-GEN Cleanser could be used as the etchant. If using the RE-GEN Cleanser it should be applied for 20 seconds prior to rinsing.


8. The etchant is rinsed away and visible moisture is removed from the surface of the tooth.


9. DesensiMAX is applied to the cavity and left wet. DesensiMAX is a highly effective desensitizing solution which also provides fluoride to the tooth surface, contains a combination of glutaraldehyde and chlorhexidine which are well known antimicrobial agents, and has the ability to prevent bond degradation. The use of DesensiMAX adds a few seconds to the protocol but provides several unique benefits worth the extra effort.


10. Now RE-GEN Universal is liberally applied to the cavity. RE-GEN Universal is a single bottle, universal bonding agent. It contains a blend of "bonding" monomers including MDP to generate high bond strengths to all restorative materials. What sets it apart is it contains bioactive ingredients that deliver: calcium, phosphate and fluoride ions directly to the compromised tooth structure. These ions have been proven to promote bone and tooth regeneration, making this the first restorative material to promote "healing" within the restoration.

11. The RE-GEN Universal is then dried, gently at first to minimize splatter and loss of material from the cavity, and then thoroughly until all the solvent has been removed.

12. Prior to light activation, a bioactive flowable, RE-GEN Flowable , is applied in a thin layer. This thin layer improves radiopacity at tooth / adhesive interface and provides a "bioactive recharging source" for the adhesive layer.

13. The adhesive and the flowable are light-activated together. It is recommended that when inserted this way, the combination should light activated for 20 seconds with an activation unit with a power density of at least 1000 mW/cm2 or two cycles of 3 seconds with an activation unit having a high power mode. 


14. The cavity was then incrementally filled with a resin composite, Exquisite Restoration , from Apex Dental Materials. The proximal box was restored first.


15. Then the remaining cavity was restored.

16. The restoration is shaped
17. The occlusion is adjusted


18. The restoration is polished
 
For years, there has been much discussion around ion release and regeneration (healing) of tooth structure. Prior to now, materials have failed to deliver the proper ions in the proper ratios directly to the compromised tooth structure where they can be most impactful. Adhesives essentially seal the tooth prior to any release of the bioactive materials. These materials had no chance to deliver on the promises of functional bioactivity. After extensive research and development, RE-GEN is now able to deliver ions within the adhesive while providing exceptional bond strengths and properly sealing the tooth. The RE-GEN suite is the most significant development within dental adhesion since the mid-90s. These functional restorations are a game changer for restorative dentistry. Consider sampling or purchasing RE-GEN to experience the next generation of bioactive materials!

 
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