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