Handling extensive cavities in cases of severe tooth decay

A clinical case by our Community member Dr Mujtaba Qaisar

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.

Managing extensive cavities resulting from severe tooth decay presents significant challenges in dental practice. These cases often involve substantial loss of tooth structure, necessitating comprehensive treatment approaches to restore both function and aesthetics. Effective management includes thorough debridement of decayed tissue, precise preparation of the cavity, and the application of advanced restorative materials to rebuild and reinforce the affected tooth. Utilizing contemporary techniques and materials, such as adhesive bonding systems and high-strength composites, ensures durable and lasting outcomes for patients suffering from severe dental decay.

styleitaliano style italiano initial situation extensive cavities severe tooth decay restorations

Fig.1
A common scenarios of severe tooth decay, a critical step in these cases is the examination process, which plays a crucial role in potentially preserving the tooth’s vitality.
A 14-year-old patient presented with significant sensitivity to cold, which subsided shortly after exposure. Upon examination using electric pulp tester EPT, the initial response registered at 28, with relief observed within 6 seconds, indicating the tooth’s continued vitality.

styleitaliano style italiano X-ray examination extensive cavities severe tooth decay restorations

Fig.2
The X-ray examination reveals no periapical lesion, and the electric pulp test indicates reversible pulpits with no need for pulp extirpation.

styleitaliano style italiano extensive cavities severe tooth decay restorations caries removal

Fig.3
Keeping the tooth vital is preferable according to the selective caries removal (SRC) and caries removal endpoint (CRE) guidelines. Careful cavity preparation is essential to prevent pulp exposure, and cusp reduction is performed to ensure a long-lasting, durable restoration. Pre-wedging is also done to support the enamel and prevent tearing of the rubber dam.

styleitaliano style italiano extensive cavities severe tooth decay restorations etching and bonding

Fig.4
After performing selective etching and bonding with GC G2 Universal Bond (GC Corporation, Tokyo, Japan), the buccal cusp was shaped freehand.

styleitaliano style italiano buccal view for cusp buildup extensive cavities severe tooth decay restorations

Fig.5
Buccal view for cusp buildup.

styleitaliano style italiano matrix placement extensive cavities severe tooth decay restorations

Fig.6
Constructing the mesial marginal ridge using the HD matrix and twin ring from Bioclear (Tacoma, Washington, USA), then applying HFO Bulk Fill Flowable Composite (Micerium S.p.A., Avegno, Italy) on the cervical shoulder. It is spread with an LM Arte instrument (LM-Dental, Parainen, Finland) to ensure no air bubbles are trapped, followed by rebuilding the box using G-aenial Accord by GC Corporation (Tokyo, Japan). Wrapping the PTFE Teflon tape between the ring and matrix helps achieve maximum convexity.

styleitaliano style italiano proximal contact extensive cavities severe tooth decay restorations

Fig.7
Properly established proximal contacts and contours are crucial for preserving the structural integrity of the dental arch and promoting periodontal health. Inadequate contact and poorly constructed contours can lead to food impaction and the development of periodontal pockets.

styleitaliano style italiano extensive cavities severe tooth decay restorations finishing

Fig.8
The side view post-finishing and polishing reveals a restoration that is both functional and natural. The final gloss was achieved using the EVE TWIST polishing wheel (EVE Ernst Vetter GmbH, Pforzheim, Germany). ENA brown and white stains (Micerium S.p.A., Avegno, Italy) were used to fill the grooves, preventing further staining and mimicking the natural appearance.

styleitaliano style italiano extensive cavities severe tooth decay restorations final situation

Fig.9
Final situation.

Conclusions

  1. Restoring the buccal cusp to its original shape before placing the matrix simplified the process and achieved a natural contour and contact point.
  2. Composite restorations can be highly effective when managed with precision. It is crucial to pay meticulous attention to every detail, from cavity design and matrix system selection to the final polishing, in order to achieve long-lasting ,durable, and minimal stain restorations.

Bibliography

    1. Alleman, D. S., & Magen, P. (2012). A systematic approach to deep caries removal end points: the peripheral seal concept in adhesive dentistry. Quintessence International, 43(3).
    2. Restorations, P. D. (2021). by Salvatore Scolavino, Gaetano Paolone. Publisher: Quintessence Pub Co.
    3. Deljoo, Z., Sadeghi, M., Azar, M. R., & Bagheri, R. (2016). The effect of different polishing methods and storage media on discoloration of resin composites. Journal of dental biomaterials, 3(2), 226.
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