A clinical case by our Community member Dr. Muhammed Bahadeen
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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.
This 17-year-old patient suffered from caries, incisal wear, and gingivitis, mostly due to poor hygiene. He also wanted a good-looking smile.
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.
After isolation and preliminary cleaning and preparation of the cavities.
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.
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.
After finishing the restorations, the primary anatomy was marked using a pencil and then carved into the composite following those lines.
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.
Applica from LM Arte kit Anterior and LM Arte SOLO Anterior are my instruments of choice for anterior composite work.
At the ned of treatment, before rehydration of the composite and healing of the gingiva.
After one week, with healing gingiva.
One year later, after his oral hygiene session, we proceeded to re-polish the restorations using the Lucida composite polishing system.
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.
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.
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.