GENERAL DENTISTRY

“Teflon tape technique”:

synergy between isolation and lucidity
Paul Leonard Schuh, Dr med dent/Hannes Wachtel, Prof Dr med dent/Wolfgang Bolz, Dr med dent/
Christian Maischberger, Dr med dent/Andreas Schenk, CDT/Mathias Kühn, Dr med dent

The aim of this article is to introduce and illustrate the “Teflon free access to subgingival areas with variable gingival retrac-
tape technique,” which provides good lucidity in combination tion. Furthermore, this principle can also be applied to other
with excellent isolation of the working field. It is intended to indications, such as Class V restorations or deep core buildups.
serve as a supplement to the gold standard rubber dam for the The technique described is therefore flexible and easy to use.
adhesive working dental practitioner. Primarily, the Teflon This combination allows a fast integration of the Teflon tape
tape technique (Teflon is a registered trademark, and not affil- technique into the daily workflow of the dental practitioner.
iated with Teflon tape) is particularly suitable for the adhesive (Quintessence Int 2019;50:488–493; doi: 10.3290/j.qi.a42483)
cementation of restorations with very thin margins. It allows

Key words: adhesive dentistry, dental technology, isolation, prosthodontics, restorative dentistry, veneers

The creation of a harmonic smile with the help of porcelain The advantage of the non-prep technique is a combination
laminate veneers has become a well-established treatment of maximum preservation of natural tooth structure, a highly
alternative in the field of esthetic dentistry.1 A well-structured natural visual appearance, and a bonding interface that is
preparation and treatment plan in combination with a highly restricted to enamel.6 The veneer thickness may be reduced to a
skilled dental technician is mandatory to achieve functional minimum of 0.3 mm, which could lead to challenges in the adhe-
and esthetically pleasing results. Thus a close interaction sive luting process. The manually applied pressure during adhe-
between dental practitioner and dental technician is of the sive luting should be kept to a minimum, especially in areas with
highest importance to successfully meet patients’ expectations. very thin margins as there is an increased risk of fracture. The
Various techniques have been introduced to decrease the beaks of rubber dam clamps bear another risk, as they may pro-
thickness of veneers in order to minimize the substance loss voke chipping of the thin veneer margins in the apical area.
during the preparation of the teeth.2 Nowadays, the primary The “Teflon tape technique” (using polytetrafluoroethylene
objective is to work as minimally invasively as possible. To pre- [PTFE] tape, and not affiliated with Teflon, a registered trade-
serve as much natural tooth structure as possible, non-prep mark of Chemours) is a simple alternative to the usage of rub-
veneers are the terminal point of this aim, with an adhesive ber dam. It enables good visibility of the working field and its
bonding interface between the tooth and veneer located at the subgingival regions in combination with a satisfactory mois-
enamel surface.3 The following techniques assure the least ture control. These properties offer the dental practitioner the
invasive preparation of the teeth: dental bleaching to lighten possibility to achieve a clean and dry working field, which is
the teeth, mock-up with subsequent guided preparation,4 or required to guarantee the success and longevity of adhesive
digital smile design in combination with guided preparation.5 bonding between tooth and prosthetic restoration.

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 Schuh et al

1 2 3

Fig 1 Right side view. Fig 2 Anterior view. Fig 3 Left side view.

4 5
6
Fig 4 Overlay digital model and digital Fig 5 Overlay digital model and wax-up:
wax-up: anterior view. incisal view.
Fig 6 Simulation of new esthetics with the
mock-up.

Method and materials adapt to the new position of the jaw. The new vertical dimen-
sion was determined by the height of the Aqualizer and as a
A 25-year-old patient consulted the Implaneo Dental Clinic result the vertical opening was set to 2 mm. Subsequently the
(Munich, Germany) because of a recommendation. He was maxillary wax-up was manufactured by the dental technician
unhappy with his attrited maxillary incisors and wished to (Figs 4 and 5).
obtain information on possible treatment options. The clinical
examination showed moderate attrition of the maxillary sec-
Mock-up and preparation
ond molar to second molar and mandibular canine to canine
(teeth 17 to 27 and 33 to 43 according to FDI notation). With the help of the wax-up a silicone key for the mock-up was
prepared. This key was utilized to show the new situation and
possible outcome to the patient (Fig 6), and may also be used
Esthetic analysis and model mounting
to produce a provisional restoration. The mock-up itself was
The analysis included intraoral and extraoral portrait photogra- then produced using Protemp A2 Crown Temporization Mate-
phy (see Fig 26), with and without cross polarization (Figs 1 to rial (3M Espe).
3).7,8 The relationship of the maxilla to the skull was captured The preparation of the teeth could be avoided and limited
and measured using the PlaneSystem (Zirkonzahn).9 The arbi- to polishing the enamel surface. Prior to the impression the
trary position of the mandible was set with an Aqualizers Slim double-cord technique11,12 was used to retract the gingiva. The
low volume (Dentrade).10 used cords were Ultrapak 000 and 1 (Ultradent). The impression
According to these parameters an adjusted splint for the of the maxilla was performed with Permadyne (3M Espe). To
maxilla was fabricated to give the patient the opportunity to transfer the newly set position of the mandible to the articula-

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7 9

Fig 7 Plaster cast: anterior view. Fig 9 Cast with veneers, maxillary canine
to canine (teeth 13 to 23).

Fig 8 Plaster cast: occlusal view.

10 11 12

Fig 10 Veneer on maxillary right central Fig 11 Ceramic restorations. Fig 12 Try-In with acrylic shells.
incisor (tooth 11).

13 14 15

Fig 13 Try-In shells made from acrylic. Fig 14 Isolation of the maxillary central in- Fig 15 Conditioning with 35% phosphoric
cisors (teeth 11 and 21). acid.

tor, an adjusted splint was used. Because of the lack of tooth and Burnout acrylic shells (Zirkonzahn) (Figs 12 and 13) in com-
preparation, no provisional restoration was needed. After bination with Try-In Paste (Variolink Esthetic, Ivoclar Vivadent).
mounting of the casts, the acrylic Try-In and Burnout shells New intraoral pictures to document the outcome of the restor-
(Zirkonzahn) were created (see Figs 14 and 15). The next step ations were taken.
was the fitting of the shells and finally the porcelain veneers
were completed with DC Ceram A2 (Ceramay) (Figs 7 to 11).
Adhesive luting
The adhesive luting followed the protocol of the Teflon tape
Try-in
technique. At first it is recommended to retract the lips with
The try-in is needed to verify the color, shape, and fit of the OptraDam (Ivoclar Vivadent). A retraction cord size 1 (Ultrapak,
future porcelain veneers. This step is used as a cosmetic fitting Ultradent) is packed into the sulcus to displace the free gingiva.
and can also be appropriate to select the adhesive luting This step is free to diversification. The size of the cord deter-
agent.13 In this case, the try-in was performed with the Try-In mines the horizontal and vertical retraction of the gingiva and

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16 17 18

Fig 16 Adhesive luting of the maxillary Fig 17 Light curing. Fig 18 Isolation of the maxillary right
central incisors (teeth 11 and 21). lateral incisor and canine (teeth 12 and 13).

19 20

Fig 19 Adhesive luting of the maxillary right Fig 20 Isolation of the maxillary left lateral
lateral incisor and canine (teeth 12 and 13). incisor and canine (teeth 22 and 23).

21 22

Fig 21 Adhesive luting of the maxillary left Fig 22 Anterior view of the maxillary
lateral incisor and canine (teeth 22 and 23). canine to canine.

is therefore mainly responsible for the lucidity in the retracted After successful isolation, the surface preparation of teeth
zone. This step is followed by the isolation of teeth from oral soft and the ceramic restoration prior to the luting procedure is per-
tissues with Teflon tape. The thickness of the Teflon tape should formed. Hydrofluoric acid (9% concentration; Porcelain Etch,
be less than 0.7 mm. The sequence of application of the Teflon Ultradent) was used to roughen the ceramic luting surface. It
tape strips is as follows: one strip is used as mesial restriction of was then wetted with Monobond Plus (Ivoclar Vivadent) and
the luting area; one strip is used as the distal restriction; and one air-dried. The Veneer Me System (Veneer Me, Smile Line) was
strip is placed on the vestibular gingiva and partially placed into used to simplify and accelerate this sensitive procedure. Phos-
the gingival sulcus. This last strip lies above the retraction cord phoric acid (35%; Ultra-Etch, Ultradent) was used to remove the
and is used to enhance its isolation and moisture control effects. dental smear layer, and the dental surface was conditioned

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23 24 25

Fig 23 Treatment completion: right view. Fig 24 Treatment completion: anterior view. Fig 25 Treatment completion: left view.

26 27

Fig 26 Portrait before treatment. Fig 27 Portrait after treatment.

with Optibond FL (Kerr Dental). This two-step adhesive system Conclusion

is appropriate in combination with the total etch technique.14
For the restorations, adhesive luting agent Variolink Esthetic The Teflon tape technique is a reasonable amplification of the
(Ivoclar Vivandent)6 was used. The recommended number of isolation opportunities in the field of restorative dentistry. It
simultaneously luted restorations is two (Figs 14 to 22). The can be seen as a hybrid form in between absolute and relative
removal of excess luting material has to be accomplished prior isolation procedures. The aim is not to replace the gold stan-
to light curing. The Teflon tape was removed and remaining dard rubber dam15 but to offer the dental practitioner an addi-
cured luting agent was removed with a surgical blade Nr. 12D tional option for a safe isolation.
(Swann-Morton). In order to finish the treatment the occlusion The extent of access to the critical, subgingival areas can be
has to be checked and if necessary adjusted. At the reevalua- determined by the size of the used retraction cord. Therefore it
tion appointment after 1 week another occlusion check was is possible to achieve a horizontal or vertical retraction. The
performed and photographs were taken (Fig 23 to 27). combination of horizontal and vertical retraction is also feasi-

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ble. A wide variation of options may develop from this concept. prevents the unwanted closure of approximal areas with the
The Teflon tape ensures excellent moisture control and pre- adhesive luting agent.
vents the sulcus from being filled with adhesive luting agent. The Teflon tape technique creates superb lucidity and visi-
Additional retraction is also possible if required. The protection bility, assuring a reliable and easy workflow. This provides the
of the adjacent teeth during surface conditioning of treated adhesive working dental practitioner with an additional and
teeth enhances the workflow for the dental practitioner and efficient technique that can be easily included in daily practice.

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Paul Leonard Schuh Paul Leonard Schuh Implaneo Dental Clinic, Munich, Germany;
and Charité Berlin, Department of Prosthodontics, Geriatric
Dentistry and Craniomandibular Disorders, Berlin, Germany
Hannes Wachtel Implaneo Dental Clinic, Munich, Germany; and
Charité Berlin, Department of Prosthodontics, Geriatric Dentistry
and Craniomandibular Disorders, Berlin, Germany
Wolfgang Bolz Implaneo Dental Clinic, Munich, Germany
Christian Maischberger Implaneo Dental Clinic, Munich, Germany
Andreas Schenk Implaneo Dental Clinic, Munich, Germany
Mathias Kühn Implaneo Dental Clinic, Munich, Germany

Correspondence: Dr Paul Schuh, Implaneo Dental Clinic, Richard-Strauss-Straße 69, 81679 Munich, Germany.
Email: p.schuh@implaneo.com

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