Exstensive carious lesions

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.

Direct restorative is a common choice when it comes to young patients. This said, when resorting to direct techniques, especially in extensive carious lesions, good protocols and instruments are a must.

styleitaliano style italiano patient with extensive proximal carious lesions

Fig.1
This 17-year-old patient suffered from caries, incisal wear, and gingivitis, mostly due to poor hygiene. He also wanted a good-looking smile.

styleitaliano style italiano occlusal view of decayed teeth

Fig.2
A direct approach was selected to restore his smile. We decided to go for direct composite veneers for the central and lateral incisors, and filling of the canine.

styleitaliano style italiano rubber dam isolation of multiple cavities

Fig.3
After isolation and preliminary cleaning and preparation of the cavities.

styleitaliano style italiano composite palatal shell for direct incisor restoration

Fig.4
After cleaning all the cavities, each tooth was built with free hand because of the extensive caries, that made any impression and wax-up unreliable.

styleitaliano style italiano large cavities on canine and lateral incisor

Fig.5
Cleaning of left lateral and canine. After removing the outer infected dentin layer, an underlying layer of uninfected, partially demineralized and physiologically remineralizable dentin was found, which was preserved during clinical treatment.

styleitaliano style italiano pencil marks for direct veneer texturization

Fig.6
After finishing the restorations, the primary anatomy was marked using a pencil and then carved into the composite following those lines.

styleitaliano style italiano steps of finishing and polishing

Fig.7
An abrasive disc was used to contour the mesial and distal line angles. Then, to polish a goat hair brush was used with a 5 micron paste, and followed by two Eve twist discs at low speed. As a last step, the Lucida felt wheel was used together with the Lucida polishing paste.

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style italiano styleitaliano diashine lucida
styleitaliano style italiano LM applica and LM solo anterior by styleitaliano

Fig.8
Applica from LM Arte kit Anterior and LM Arte SOLO Anterior are my instruments of choice for anterior composite work.

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styleitaliano style italiano composite veneers with gingivitis

Fig.9
At the ned of treatment, before rehydration of the composite and healing of the gingiva.

styleitaliano style italiano one week after restoration healing gingivitis

Fig.10
After one week, with healing gingiva.

styleitaliano style italiano lucida star felt and paste

Fig.11
One year later, after his oral hygiene session, we proceeded to re-polish the restorations using the Lucida composite polishing system.

styleitaliano style italiano one year follow up after direct composite veneering

Fig.12
One year follow up. Although the patient has very poor oral hygiene, good finishing and polishing protocols and follow-up can significantly contribute to success of the treatment.

Conclusions

Direct composite restorations are a minimally invasive procedure, and also an excellent choice for patients at a young age. Following the correct and detailed steps of layering and polishing protocols, and the patient complying to follow up visits and at-home hygiene instructions, excellent long term results can be obtained for the patient.

Bibliography

Fusayama T. Two layers of carious dentine: diagnosis and treatment. Oper Dent, 4 (1979), pp. 63-70.
Manauta J, Salat A. Layers: An atlas of composite resin stratification. Quintessenza Edizioni, 2012.

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