Non-carious Class V lesions, found at the cervical region of the tooth, often require restorative treatment due to aesthetic, functional, or sensitivity issues. This article explores the use of modified dental clamps in Class V restorations, particularly when treating non-carious cervical lesions with composite materials. Understanding this process is essential for dental professionals to achieve long-lasting and aesthetic outcomes.

What Are Non-Carious Class V Lesions?

Class V lesions refer to the wear or loss of tooth structure at the cervical margin of the tooth, close to the gum line. Although non-carious, these lesions can arise due to:

• Abrasion (tooth brushing habits),
• Corrosion (chemical erosion),
• Abfraction (stress-induced fractures at the cervical margin),
• Or a combination of these factors.

Restoring these lesions can improve aesthetics, relieve hypersensitivity, and prevent further structural loss. However, before initiating any procedure, it’s crucial to identify and control the causative factors to prevent recurrence.

Steps in Class V Composite Restoration for Non-Carious Lesions

1. Prophylaxis and Shade Selection

Proper initial cleaning (prophylaxis) ensures a contaminant-free surface for bonding. Shade selection is also critical in composite restorations, especially in visible areas, to match the natural appearance of the tooth.

2. Isolation Using a Modified Dental Clamp

To effectively restore Class V lesions, isolating the operative field is crucial. Modified dental clamps, such as the #212 clamp, are often used to retract the gingiva and expose the cervical margin. This step ensures better access and visibility, helping to improve restoration quality.

Modification Techniques for Retraction Clamps:

• Stabilize the clamp with a low-fusion compound to ensure it doesn’t shift during the procedure. Small cones of the compound, softened in a flame, are applied to the clamp wings and secured in place to maintain stability throughout the restoration.

3. Adhesive Application and Bonding

A two-step bonding technique with etching is commonly used:

1. Etching: Apply etchant first to the enamel and then extend it to dentin. Leave it for about 15 seconds before rinsing and keeping the dentin moist.
2. Adhesive Application: Apply multiple layers of adhesive, using mild air jets between layers to evaporate the solvent. Excess adhesive is carefully removed to prevent pooling around the margins and on the clamp.

This bonding process ensures strong adhesion to both enamel and dentin, crucial for Class V restorations where margins often transition between these tissues.

4. Composite Insertion and Curing

The composite is inserted in small increments to reduce polymerization shrinkage, which could otherwise stress the bond and lead to marginal gaps:

• Cervical and Occlusal Insertion: Start by adapting the composite to the cervical margin before moving to the occlusal area. Cure each layer individually to maintain integrity and shape.
• Layering Technique: Using thin layers and varying translucency in composite materials allows for a natural, aesthetic restoration that mimics the tooth's original appearance.

5. Finishing and Polishing

Proper finishing and polishing are essential for the longevity and appearance of the restoration:

• Initial Finish: Using a scalpel blade or flexible abrasive discs, remove excess adhesive and resin from the margins.
• Final Polish: Rubber dam and clamp removal should be delayed until polishing is complete to avoid gingival interference. Polishing pastes and felt discs are ideal for achieving a smooth, shiny surface that resembles natural tooth enamel.

Benefits of Using Modified Dental Clamps in Class V Restorations

Using modified dental clamps during Class V composite restorations has several advantages:

• Improved Access: Retracts soft tissue for better visibility and access to the lesion.
• Enhanced Stability: Ensures that the restoration process proceeds without clamp displacement.
• Minimized Contamination: Maintains a dry, isolated operative field, which is essential for bonding.

Conclusion

Restoring non-carious Class V lesions with composite materials and modified dental clamps provides both aesthetic and functional benefits. By following a structured protocol that includes thorough isolation, adhesive bonding, incremental composite application, and precise finishing, dental professionals can deliver long-lasting, natural-looking restorations.

This approach highlights the value of modified clamps in Class V restorations, offering an efficient solution for clinicians and improved outcomes for patients.