This 29 year old female patient attended for restoration of the upper right maxillary second premolar. This tooth had recurrent caries noted clinically and had a pre existing extensive composite restoration. A direct restoration was preferable for this patient. Preventive advice and dietary analysis was implemented and a direct restoration was appropriate to prevent disease progression.  There were no symptoms and functionally, this tooth was subjected to extensive masticatory forces, so the option of a direct robust restorative method, was considered to be the optimal option to preserve as much tooth tissue as possible and minimise the likelihood of further tooth fracture.

Coronal Radiolucency noted

Coronal Radiolucency noted

Failing Composite with Distal Fracture

Failing Composite with Distal Fracture

Clinically, the tooth exhibits distal fracture and only the thin buccal walls remain. The buccal enamel wall also exhibits enamel hypoplasia. Local anaesthetic was administered and the tooth isolated. The restoration was carefully removed and a sectional matrix system applied.

Isolation and Sectional Matrix System

Isolation and Sectional Matrix System

Secured Distal contact

Secured Distal contact

A selective 15s enamel etch was carried out with 37% Phosphoric acid (SDI Super etch®), and then Zipbond® resin was applied and gently scrubbed into the etched tooth surface and dentine. The resin was then gently air dried and light cured for 10s.

Application of Zipbond®

Application of Zipbond®

Placement of Aura easy Flow®

Placement of Aura easy Flow®

A flowable composite, Aura Easy Flow® was applied taking particular care to avoid any air pockets prior to light curing. (The cavity margins can be checked with a sharp instrument prior to curing to ensure good application)

Once the distal box and contact had been recreated, the matrix system was applied to recreate the mesial contact. The buccal hypoplasia was also removed and restored using a minimally invasive technique.

Luna® Shade A2, Composite was placed and light cured for 20 seconds. The technique employed for this restoration was to build up the cusps individually and light cure to reduce the risks of postoperative pain.  The occlusion was checked and the restoration polished.

This case is an everyday restorative challenge where a large restoration has fractured and the patient is keen to pursue a direct restoration. The case summary aims to demonstrate the work flow related to a direct technique using an SDI materials

by

Jatinder Heer / JH Dental Clinic

Leave a Reply