Dr Ivan Raychev

The contacts

Very often during the treatment of a proximal caries lesion, we also find a caries lesion at the contact area on the proximal surface of the neighboring tooth. In such cases, it is less invasive to treat this area during the same appointment. The cavity is small and modified, and the restorative protocol includes a small occlusal opening to insert flowable restorative material. A transparent sectional matrix enables control over the application and the light curing of the cavity. In this specific case, the levels of the proximal occlusal ridges are not the same. The follow-up shows no signs of papilla trauma or inflammation.


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Here is a follow-up on a case that I posted two months ago. The contact is stable, and although the teeth touch in a very narrow, point-like area, the papilla is healthy with no signs of trauma and no food impaction interdentally. This is a valuable observation: it is not the size of the contact, whether small or broad, that matters, but rather the complex integration of the contact position, size, and interdental embrasures.

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The closing of black triangles with direct composite using the open matrix technique is a non-invasive approach to correcting black triangles. Although it may seem easy, controlling the transition between the composite and the intact enamel surface, especially proximally, is quite challenging. Essential requirements include absolute saliva control and retraction using a rubber dam, clean surface to ensure the adhesion and magnification to control the placement of the composite portions and to achieve a flawless transition. In this case, I used the thickest rubber dam - for isolation , to clean the teeth surfaces, and magnification at 8x by to place the composite - by

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Sometimes, it is not easy to restore small proximal caries defects, especially between the canine and the first premolar, when the proximal anatomy has an extremely prominent convexity and the cervical proximal surface is concave.


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All the balls are brown

This case presented a significant challenge, as it was my first attempt at designing and finishing chairside central incisors directly in the clinic. The central incisors are crowns crafted from by . The lateral incisors were directly restored using composite material, also by . Additionally, there was an instance of external resorption in the left central incisor, which we successfully sealed using bioceramics.

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Практиката на д-р Иван Райчев набира студенти по дентална медицина за позицията на стажанти, които да подсилят и освежат екипа. Търсим кандидати, които да донесат остроумието си, но и да не забравят да вземат със себе си усмивката.

При интерес можете да изпратите актуална снимка и автобиография на : [email protected]

Благодаря за поканата . Изключително добре организирано събитие. Дентална Академия Родопи

Another case involved a broken incisor. The fracture was clean, and the fragment fit perfectly, simplifying the adhesive cementation process. However, the pulp was exposed. It had been exposed for about an hour. The patient, an 11-year-old, was treated with the goal of preserving pulp vitality. After one month, pulp vitality tests yielded positive results. Cementing the broken fragment back in place was determined to be the easiest method to restore the tooth’s natural aesthetics and functionality.

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I've encountered several cases of fractured central incisors in the past few weeks, all involving children playing sports. Restoring a single incisor, particularly in children, is challenging due to the complex colors and opacities of young teeth, and the rapid change in color value when the teeth dehydrate. Therefore, we often consider cementing the broken piece back in place as the preferred treatment when feasible. The limitations of this approach often relate to how precisely the broken part fits; if it is a single piece or multiple smaller pieces. The ideal scenario is a single piece that fits perfectly. In cases where the broken piece doesn't fit well or isn't the entire defect, we extend our indications. We then fix the piece with resin key to maintain its position during cementation, and restore the missing parts with dental composite.


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📣Представяне на лекциите 𝗧𝗵𝗲 𝗖𝗹𝗮𝘀𝗵 𝗼𝗳 𝗖𝗼𝗺𝗽𝗼𝘀𝗶𝘁𝗲𝘀 𝟮𝟬𝟮𝟰
Очаквайте лекцията на Dr Ivan Raychev от отбора на Ivoclar
➡️31 Март (Неделя) от 11:00 до 12:30ч.
🗣️Тема: Предвидимост на резултатите - композитни обтурации във фронта в контекста на цялостната рехабилитация на съзъбието при зъбно изтриване.

Запишете се на ➡️ www.theclashofcomposites.com

I often encounter one particularly tricky aspect in both direct and indirect restorations: creating reliable, tight, and anatomically correct contacts with adjacent teeth—a goal that, despite decades of practice and exploration, remains elusive and continually challenging.

Over the years, I've used various techniques, matrices, and approaches in my quest to perfect this aspect of dental restoration. Each case brings its own set of complexities, and the journey towards achieving this 'never achieved goal' is both arduous and fascinating.

Here are some insights and images from recent treatments of proximal caries on a lower molar. Currently, the matrices that I use are double curved, very thick, and rigid (50 microns).

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Minimally Invasive Tooth Restoration: Strategic Approach

This case emphasizes meticulous diagnostics and strategic planning in restoring two adjacent teeth. The goal was to minimize the removal of healthy tooth structures.
Prior to the restorative procedure, a diagnostic evaluation, including x-ray caries diagnostics, transillumination, and clinical examinations, was conducted. This phase aimed to identify caries extent, assess surrounding tissues, and determine the most conservative treatment approach.
Recognizing the connection between adjacent teeth, a simultaneous preparation strategy was employed to minimize cutting of healthy structures.
Matrix Selection:
For precision and efficacy, two matrices were chosen. A transparent matrix provided visual control during premolar restoration, while a rigid metal sectional matrix ensured stability and ideal contact points in molar restoration.

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Thank you for the recognition

Closing distances between the teeth with just one opacity - enamel . One layer , one shade only.

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Treatment of a patient with tooth wear. The protocol involved increasing the vertical dimension of occlusion to create space for conservatively restoring the worn surfaces. This was achieved by initially restoring the lower and upper frontal segments to raise the vertical dimension of occlusion while maintaining the central position of the mandible. Subsequently, we addressed the posterior segments, isolating and restoring them individually using a rubber dam.

Here the focus is on the restoration of one of the posterior segments. The approach is additive, involving modifications only to teeth structures affected by caries. After removing the caries, we prepared the affected surfaces using aluminum oxide. After the bonding procedures, we covered the worn surfaces with composite material . The proximal contacts were ensured by using a combination of transparent and metal sectional matrices.

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The restoration of the lower incisors marks the initial stage in managing tooth wear using direct composite. During this phase, we both restore the shape of the lower incisors and incrementally elevate the vertical dimension of occlusion (VDO) while preserving the central position of the lower jaw. In this particular case, we achieved the restoration of the worn surfaces freehand using two layers with different opacities (enamel and dentin, specifically by ). The preparation involved only 29-micron Al2O3 , and no drills were employed in the process.

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A Customized Tooth Restoration

In this intricate case, the lingual surface of the canine is in contact with the medial proximal surface of the first premolar. Access to the caries is from the buccal surface of the premolar. For the restoration, we used two matrices: a sectional plastic transparent matrix (Bioclear) for the canine and a sectional recurved metal matrix for the proximal and buccal surface of the premolar (Tor VM). After the adhesive procedure, we filled the cavity with flowable composite ( Flow ) and pressed it with the Bioclear matrix. The convex surface of the matrix is directed towards the cavity to create the concave lingual surface of the canine. While holding the matrix in place with a composite instrument (a ball burnisher), we polymerized the composite through the transparent Bioclear matrix. The lingual surface of the canine was completed. Then, we restored the premolar with the metal sectional matrix. It was a unique and non-standard situation, requiring improvisation to create proper contacts and surfaces.

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Efficient Protocol for Restoring Worn Central Incisors.

This case presents an efficient and noninvasive protocol for restoring worn central incisors . Initially, teeth were restored freehand to establish the desired shape without composite bonding. Subsequently, a silicone index was created to replicate these initial restorations. This silicone index served as a guide for recreating the approved shape during the final restoration, which was bonded and placed over the prepared surfaces. Tooth surfaces were meticulously prepared with aluminum oxide, followed by total etching and the application of 4th-gen adhesive. The core was constructed using dentin opacity ( A3, ), with blue and white characterization. The labial incisal two-thirds were covered with bleached enamel (Empress Direct, Ivoclar). The finishing process involved Soflex disks (3M), Sylc powder ( ), and OptraGloss Spiral (Ivoclar). This protocol ensures noninvasive, rapid, and predictable results for central incisor restoration.

Effective Management of Cervical Erosive Defects on Lower Premolars: A Noninvasive Adhesive Restoration Protocol

Erosive defects on the buccal surface of lower premolars, primarily localized in the cervical third, with exposure of dentin within the defect. Notably, the preserved enamel forms a continuous border along the gum line, creating an appearance of a depressed or invaginated section within the buccal surface. Remarkably, these defects exhibit no signs of caries or plaque accumulation, though there may be a thin layer of pigments on the exposed dentin surface. Probably the defects are result of the combination of erosion and mechanical abrasion (vigorous toothbrushing)

The adhesive restoration of these defects requires proper rubber dam isolation to prevent any leakage, especially in the critical cervical area. To achieve this, an additional clamp and Teflon tape are used. The preparation of the defect involves air abrasion using the Aquacare device and aluminium oxide powder (Al2O3), followed by the application of a total etch adhesive protocol with a fourth-generation dental adhesive.

The restoration itself comprises two layers of different opacities. The dentin is restored with a high chroma dentin opacity material (Empress Direct, Ivoclar), which is then overlaid with a bleached enamel layer (Empress Direct, Ivoclar). The final polymerization takes place under the protection of glycerin gel. For finishing and polishing, the OptraGloss polishing system by Ivoclar is utilized to ensure the restoration's optimal appearance and function.

In conclusion, this protocol offers a noninvasive, easy, fast, and effective way of managing such defects, ensuring protection from further tooth wear, as well as functional and aesthetic restoration of the affected teeth.

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Segmental restoration, or the restoration of a whole posterior segment of teeth in one treatment, offers several advantages and benefits in dentistry:
1. Time Efficiency:
* Segmental restoration significantly reduces the overall time required for the restoration process. Instead of multiple visits and treatments, the patient can complete the restoration in a single appointment. T2.
3. Conservative Tooth Preparation:
* One of the major advantages of segmental restoration is the ability to modify tooth preparation. By restoring an entire posterior segment, the occlusal opening to proximal caries lesions can be made smaller. This conservative approach preserves more of the sound tooth structure.
* Preserving healthy tooth structure is crucial for the long-term health of the teeth and helps minimize the risk of post-operative sensitivity.
* The minimal occlusal opening ensures tooth integrity and reduces the risk of tooth cracking
4. Reduction in Restoration Surface Subjected to Forces:
* Smaller occlusal openings and conservative tooth preparation result in a reduced composite surface subjected to masticatory forces. This can contribute to improved long-term durability and function of the restoration.
5. Ease of Composite Application:
* When restoring a whole posterior segment, it can be easier to achieve a well-contoured restoration. This can enhance the esthetic and functional outcomes of the restoration.
6. Improved Esthetics and Function:
* Segmental restoration allows for a comprehensive approach to addressing all dental issues within the segment, including caries, fractures, or wear. This can result in improved esthetics and function, as all aspects of the restoration are considered together.
8. Enhanced Patient Satisfaction:
* Patients often appreciate the convenience and efficiency of segmental restoration.
9. Predictable Outcomes:
* A segmental restoration approach offers a more predictable and holistic solution to dental problems within a specific area of the mouth. It allows for comprehensive planning and ex*****on of the treatment.

It's important to note that segmental restoration may not always be suitable for all cases, and treatment decisions should be made based on the individual patient's needs and clinical considerations. However, when applicable, segmental restoration can be a valuable approach to achieving efficient, conservative, and effective dental restorations.

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Discoloration of tooth 11 resulted from the placement of canal filling material.
To address this issue, internal bleaching with carbamide peroxide was performed. Before the bleaching procedure, the pulp chamber was prepared and sealed with glass ionomer cement (GIC) up to the level of the soft tissue projection to prevent resorption.

Correction of crown invagination on tooth 12.

A single layer of enamel opacity was used for correction.
The tooth was prepared using air abrasion with a 29-micron AlO system, followed by the application of the total etch IV generation adhesive system.
Polishing was carried out through abrasion with using , and final polishing was achieved with from .

Minimally Invasive Direct Composite Correction of Tooth Wear and Existing Incisal Edge Restoration: a Simple Technique Utilizing Two Layers of Two Opacities ( Dentin and Enamel by ).
The initial situation is characterized by an existing direct restoration on the incisal edge of the right upper central incisor that may require improvement from an aesthetic standpoint. Furthermore, tooth wear is observed on the incisal edges of the upper laterals and canines, while the upper central incisor appears to be intact. The composite material is only applied to restore the tooth wear, without covering the labial surfaces. Our primary goal is to preserve the natural beauty of the enamel adding as little artificial material as possible. The most challenging aspect of this technique is achieving an invisible transition between the natural tooth structure and the composite material.

Bonding vs veneers

Дигитален протокол. Фулконтур с 3D тониране. Лабораторна работа Dental Lab Stefan Petrov.

Труден случай, с дълбоко поставена “прагова” препарационна граница под нивото на маргиналния венец, загуба на биологична ширина и хронично маргинално възпаление.
Една възможност за решение с минимално инвазивни процедури и без хирургична намеса:
* Анализ на изходната ситуация. Запознаване с потребностите и разбиранията на пациента. Обсъждане с пациента на установените проблеми и възможните подходи за подобряване на клиничната ситуация.
* Изработване и предоставяне на лечебен план, разглеждащ различните лечебни подходи за постигане на определената/очакваната цел с така нареченото “управление на очакванията на пациента”. “Въвличане” на пациента в решението.
* Ендодонтска подготовка.
* Адхезивно коригиране на праговете до вертикален препарационен дизайн.
* Управление на меките тъкани чрез профила на изникване на временните корони.
* Изработени са корони и фасети, 16-26, дигитален протокол. Фулконтур с 3D тониране. Лабораторна работа Dental Lab Stefan Petrov
Постигнатото:
* Удовлетвореност на пациента.

Пациент на 56 год. Меките тъкани са деформирани и загубили свежия си млад вид. Планирано е подмяна на короните и минимално инвазивно контуриране на меките тъкани чрез профила на изникване на короните и субгингивално почистване.
Утежняващи фактори:
- Увредени зъбни структури от предишни “прагови”изпилявания.
- Развиващи се кариеси поради микро просмукване.
- Девитализирани зъби с намален биологичен потенциал.
- Гингивата е дисфугурирана, атрофирала, груба и с променен цвят.
- Папилите между централните и латералите резци са негативни.
Случаят е решен изцяло адитивно без допълнително изпиляване на зъбни структури. Проведено е кореново лечение. Зъбите са преизградени. Праговете от предишните изпилявания са заличени чрез добавяне на композит. Изпълнен е вертикален препарационен дизайн. Направена е корекция на меките тъкани.
Изработени са корони и фасети, ZrO - 15-25, дигитален протокол. Фулконтур с 3D тониране. Лабораторна работа Dental Lab Stefan Petrov

Лечение на зъбно изтриване и затваряне на разстояния между зъбите.Фасети 15-25, дигитален протокол.
Фулконтур с 3D тониране. Лабораторна работа Dental Lab Stefan Petrov