Clinical case: Posterior direct composite

LL4(class I), LL5(Class II) and UR5 (Class II)

Treatment date 13/10/011
Patient name !"# $%e 3& 'ears
Presentin% complaint: demands cro(ns )or UL* and LL* t+at +ad root canal
treatment, patient +ad LR* remo,ed a)ter RCT t+at )ract-red, and dose not
(ant to loss t+e UL* and LL*"
R.!: .edicall' )it patient
R/!: Patient +ad a root canal retreatment o) LL* and core 0-ild -p in
preparation to 0e restored (it+ a cro(n"
#1tra2oral e1amination: $ll normal"
Intra2oral e1amination:
3o)t tiss-e 4ot+in% a0normal
5ral +'%iene 6ood, cer,ical stains on all teet+
d-e to +ea,' red tea drin7in%
Periodontal stat-s 4o 0leedin% on pro0in%, and no
recession
#1tracted teet+ LR*, all (isdom teet+ 'ears 0ac7
8italit' test and RCT 4o -n2restored necrotic teet+ UL*
and LL* +ad RCT
9ailed restorations LL: (it+ old and )ract-red
amal%am, UL* old 6I )illin% t+at lost
anatomical )orm
Caries UL4,5,: UR5 LL4,5 LR4,5,:
LR5,:
Prost+etic (or7 454
Radio%rap+ic e1amination: ), LL5(Class II) and UR5 (Class II) 0ot+ distal
caries close 0-t did not reac+ to p-lp space,UL* and LL* (it+ %ood ;-alit'
o0t-rations, no apical pat+osis, no 0one loss
#1amination o) occl-sion: some (ear present on lo(er canine and incisors
3tatic occl-sion:
37eletal and dental class I
4ormal arc+ si<e and (idt+
3ome spacin% o) -pper anterior teet+
and minor spacin% o) lo(er arc+ teet+
/'namic occl-sion:
3ta0le ICP and coincides (it+
RCP (45 s+i)t present)
Canine %-idance on le)t mo,ement
%ro-p )-nction on ri%+t side d-e to
canine attrition
3+ared e,en contacts at protr-si,e
mo,ements
4o Posterior inter)erences on ="3
or 4"="3
Treatment plane: To restore cario-s teet+ 0e)ore doin% an' prost+etic (or7,
t+is (rite2-p (ill disc-ss t+e treatment o) LL4(class I), LL5(Class II) and UR5
(Class II) 0ot+ distal caries
Treatment sta%es:
3ta%e I:
Pre2operati,e s+ade selected )or LL4,5 and UR5 s+ade is $3 t 0od'
and $ at c-spal area, material selected is 350>T(-ni,ersal composite)
0od' and enamel )or LL4,5 and 6R$/I$ posterior composite )or UR5
$dministration o) local anaest+esia 0' in)iltration o) ? LI/5C$I#4#
Centric stops mar7ed and r-00er dam application"
I -se 9#4/#R=#/6#3 as a protecti,e aid )or ad@acent teet+ d-rin%
pro1imal ca,it' preparation" !and e1ca,ator (as -sed to remo,e deep
caries o) UR5 and lo( speed +and2piece )or LL4,5
/isin)ection o) t+e ca,it' (it+ "5? sodi-m +'poc+lorite, and i -se
8ITR5A54/ (3.) as a linin% material in deep ca,it' areas to red-ce
P"5"3
$pplication o) sectional t+in metallic matri1 and (ed%es t+en t+e matri1
+older is applied, t+e metal matri1 is conto-red to +a,e a %ood contact
(it+ ad@acent toot+
Usin% 3:? p+osp+oric acid )or 0 seconds on enamel onl' and t+e on
dentine also )or 10 seconds more to etc+ 0ot+ enamel and dentine )or
optim-m 0ondin%, (as+ and dr' and application o) 0ondin% a%ent
(sin%le 0ond 3.#3P#), a li%+t air stream to e,aporate t+e sol,ent and
to pre,ent )rom poolin% o) 0ondin% a%ent is important"
Incremental application o) small la'ers, )irst la'er 0ein% at )loor and
1"5mm t+ic7ness to ins-re %ood c-rin%, and ne1t increments to contact
one ca,it' (all and t+e )loor o) ca,it' at once to red-ce t+e C )actor,
pol'merisation s+rin7a%e, stress on 0ond inter)ace and toot+ str-ct-re
t+at ca-ses post2operati,e sensiti,it' and/or premat-re )illin% )ail-re"
Incremental application also res-lts in a stron%er restoration and more
morp+olo%ic resem0lance o) toot+ str-ct-re"
/eeper la'ers I c+ose to 0e $3, middle $ and $1 or clear transl-cent
)or )inal enamel la'er"
I c+ec7ed occl-sal stops to see i) t+ere are +i%+ points"
I -s-all' (ait 15 min-tes 0e)ore startin% to )inis+ and polis+ composites
and a c+ance )or t+e patient to rest, or 7eep )inal polis+in% )or t+e
)ollo(2-p appointment a (ee7 later
Usin% r-00er polis+in% points and diamond paste (ULTR$/#4T) )or
occl-sal s-r)ace and 3UP#R234$P polis+in% discs )rom 3!59U )or
pro1imal area %i,es a ,er' %ood polis+ to t+e composite and )inall'
application o) 62coat ma1imi<es aest+etic res-lt"
Critical e,al-ation: t+e restorations %a,e a %ood anatomical resem0lance,
occl-sal )orm, pro1imal contacts, and mar%ins" $lso %ood s+ade matc+in%
(as ac+ie,ed, on )ollo(2-p appointment a (ee7 later patient reported no
P53 or an' discom)ort and patient (as satis)ied (it+ t+e treatment"