Clinical case: Direct Posterior composite Restoration (LL7 Class II)
Treatment date: 19/10/2011
Patient name: S! "!#:2$ %ears old Presentation complaint: &ants to restore LL7 t'at 'ad a (ract)red old composite (illin* R+,: no an% disorder RD,: patient 'ad some composite (illin*s #-tra.oral e-amination: not'in* a/normal Intra.oral e-amination: So(t tiss)e 0ormal 1ral '%*iene !ood Periodontal stat)s 0ormal +issin* teet' and prost'etic &or2 LL$ 0o prost'etic replacment 3ailed restorations LL7 old composite Caries 4L$5 LL65 4R$ 7italit% test: LL7 is 8ital &it' normal response to cold and 'ot stim)li Radio*rap'ic e-amination: LL7 &it' secondar% caries )nder old (illin* 1ccl)sion e-amination Static occl)sion Class I occl)sion 0ormal arc' si9e and s'ape Some spacin* o( lo&er incisors and midline s'i(t to t'e le(t /% :mm D%namic occl)sion Sta/le ICP !ro)p *)idance on le(t and ri*'t lateral e-c)rsions 0o &or2in* side or 0;S inter(erences S'ared anterior *)idance &it' minimal posterior discl)sion d)e to minimal anterior o8er.lap
Treatment options disc)ssed &it' t'e patient: Direct composite (illin* Indirect composite or porcelain inla% Restoration &it' a cro&n a(ter caries restoration "(ter disc)ssin* &it' patient s'e c'ose<s t'e direct composite as it<s t'e least inter8enti8e and more economic (or 'er Treatment plane To remo8e all old composite (illin* material and restore &it' direct composite tec'ni=)e Treatment s)mmer%: Pre.operati8e s'ade selection (">) and centric stops mar2in* L" administration o( 2? lidocaine R)//er dam isolation Remo8al o( old composite (illin* and e-ca8ation o( (loor caries )ntil 'ard dentine is reac'ed Disin(ection o( ca8it% /% application o( 2@? sodi)m '%poc'lorite "pplication o( 7ITR1A10D li*'t c)red !I linin* material on t'e 8er% deep part o( ca8it% and li*'t c)rin* "pplication o( sectional matri- and tried to appl% a &ed*e /)t &as not s)ccess()l "cid etc'in* )sin* >7? p'osp'oric acid (or total o( >0 sec (or enamel and 10 sec (or dentine5 ;as' and dr% t'e ca8it% &it'o)t desiccation o( dentine "pplication o( /ondin* a*ent (rom >+#SP# and li*'t c)re 3irst application o( clear transl)cent composite to restore t'e distal &all o( ca8it% and conto)rin* t'e matri- &it' t&ee9ers &'ile assistance c)res t'e composite5 I &as care()l to create a *ood contact &it' distal toot' and not to create an o8er.'an* "pplication o( small increments startin* &it' 1@mm (loor la%er (irst and a small &ed*e s'aped increments to red)ce t'e C (actor and P1S Startin* s'ade &as ">5 t'en "2 (or t'e ne-t la%er and t'en enamel la%er "(ter completin* t'e (illin*5 minor occl)sal adB)stments &ere made )sin* (ine *rit polis'in* diamond /)r a(ter 1@ min)tes5 centric stops &ere c'ec2ed a*ain and polis'in* (inis'ed )sin* polis'in* points and diamond paste (rom 4LTR"D#0T Intra.oral apical radio*rap' &as ta2en to con(irm *ood contact point o( distal &all and LL6 and ins)rin* no o8er.'an* material 3inal !.coat &as placed Critical appraisal: *ood anatomical (orm5 conto)r5 s'ade and accepta/le occl)sal (orm " /etter &a% &as to )se a clear silicone 2e% (rom a dia*nostic &a-.)p to reac' a /etter occl)sal (orm Inter.pro-imal contact is *ood and no o8er.'an* as seen on radio*rap'ic e-amination 1n (ollo&.)p 8isit t'e patient reported no P1S and s'e &as com(orta/le eatin* on t'is side