Class III Carious Lesion: Step by Step for a Right Protocol

A clinical case by our Community member Dr Muhammed Bahadeen

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

Anterior teeth presented with extensive class III carious lesion can be a challenge to restore since the clinician have to deal with different refractive indices of enamel and composite, and blend them well so that there will be no evidence of any refraction and grey line appearance. The article presented a step by step protocol for class III carious lesions.

style italiano styleitaliano initial situation class III carious lesion class 3

Fig.1
The patient comes to the clinic with multiple class III carious lesions. An initial photograph is crucial to show the patient the evolution of the treatment.

style italiano styleitaliano initial situation class III carious lesion class 3

Fig.2
The lesion has extended labially and undermined the enamel.

style italiano styleitaliano shade selection class 3 restoration class III carious lesion

Fig.3
Simple button technique for shade selection was applied here for enamel and dentin shade.

style italiano styleitaliano class III isolation

Fig.4
The isolation of the teeth was performed after shade selection.

style italiano styleitaliano class III cavities preparation

Fig.5
After caries removal, a peripheral seal zone must be seen and cleaned all around the remaining caries near the pulp to avoid exposure and keep the vitality of the pulp.
Then, the dentin was disinfected with chlorhexidine.

style italiano styleitaliano beveled surface class III

Fig.6
On the labial surface, after removing all the unsupported enamel, the surface should be beveled and exposed with some dentin so it can be blended with the dentin composite shade and later on with the enamel shade.

style italiano styleitaliano Palatal wall creation class III

Fig.7
The palatal shell was created using translucent enamel.

style italiano styleitaliano Enamel placement class III

Fig.8
The translucent enamel shade resembles the natural enamel shade optically.

style italiano styleitaliano Proximal wall creation class III

Fig.9
Proximal wall is also created using enamel shade and now it is ready to receive dentin shade.

style italiano styleitaliano Dentin shade placement class III

Fig.10
Dentin shade is placed and blended with the bevel.

style italiano styleitaliano Enamel placement class III

Fig.11
Enamel shade is placed above the dentin shade and blended with the bevel.

style italiano styleitaliano Composite placement class III

Fig.12
Same procedure was performed on the lateral incisor and the rest of the teeth.

style italiano styleitaliano final situation finishing and polishing class III restoration

Fig.13
Prior to more fishing and polishing.

style italiano styleitaliano class III restoration final result

Fig.14
Final result.

Conclusions

Class III restorations can be quite difficult since the clinician have to choose the shade perfectly and have to follow good protocols. This is important to avoid grey line formation due to different refractive indices of enamel and composite material. Plus, the composite material thickness control is essential for that matter.

Bibliography

  1. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
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