To keep the cusp or to cover it?

A clinical case by our Community member Dr. Khalid Jamal Mohammed

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.

Art and science this how Dentistry is defined worldwide, therefore, this concept should be practiced even in the easiest cases In this case the patient is suffering from food stagnation and sensitivity while eating or drinking Cold food and beverages. While examining the patient’s suspected tooth we can clearly see amalgam filling that is not fully adapted. All the tools required in this case were simple when compared to the results achieved.

styleitaliano style italiano old infiltrate amalgam filling old infiltrate amalgam filling

Fig.1
This patient suffered from mild discomfort due to food impaction around an old amalgam filling on tooth 24 which also had decay on the distal side.

styleitaliano style italiano isolation with rubber dam before amalgam removal

Fig.2
Isolation with rubber dam was done before amalgam removal according to ADA’s protocols.

styleitaliano style italiano cavity with caries after removing old filling

Fig.3
The amalgam was removed first.

styleitaliano style italiano cavity with clean enamel margins

Fig.4
Then the prozimal caries was successfully removed.

styleitaliano style italiano lm cusp misura for overlay cavity design

Fig.5
Before proceeding, the cusp needed to be measured to choose the final cavity configuration. The LM Arte Cusp Misura is known to be ideal for evaluating the thickness of the natural tooth structure and choosing the restorative technique to be used. If the forked instrument tip penetrates up to its marks, the tooth structure is too weak to withstand occlusal forces with a direct restoration, and other clinical options must be considered.

style italiano styleitaliano lm arte anterior instruments
style italiano styleitaliano lm anterior instruments
styleitaliano style italiano lm cusp misura for cusp thickness assessment

Fig.6
Using the LM Cusp Misura to measure the required lingual cusp reduction.

styleitaliano style italiano measuring instrument for cusps

Fig.7
Using the LM Cusp Misura to identify the minimum amount of reduction required for the buccal cusp.

styleitaliano style italiano cusp measurement

Fig.8
Another view shows LM Cusp Misura in action.

styleitaliano style italiano cavity build-up

Fig.9
The peripheral enamel was exposed and the residual material in the cavity was removed in order to achieve an ideal surface for adhesion.

Video 1
This video shows the LM Misura in action under microscope magnification.

styleitaliano style italiano overlay cavity design

Fig.10
Cusp reduction was made based on the measurements taken by LM Cusp Misura.

styleitaliano style italiano digital scan for overlay restoration

Fig.11
A 3D scan was taken. Note how clear is the vision of the occlusal relationship between the maxillary and mandibular teeth and the available space for the indirect restoration.

styleitaliano style italiano digital model of overlay restoration

Fig.12
3D model showing the overlay project.

styleitaliano style italiano occlusion model for overlay cad

Fig.13
3D model showing the patient’s occlusion with the indirect restoration.

styleitaliano style italiano milled lithium disilicate overlay

Fig.14
Emax overlay on cast.

styleitaliano style italiano isolation of overlay cavity

Fig.15
Rubber dam isolation. Teflon was used to protect the adjacent teeth.

styleitaliano style italiano etching before overlay cementation

Fig.16
The whole preparation was etched with orthophosphoric acid.

styleitaliano style italiano bonded overlay cavity

Fig.17
After bonding.

styleitaliano style italiano bonded emax overlay

Fig.18
After overlay cementation

styleitaliano style italiano max overlay on tooth 24

Fig.19
Buccal view of overlay in position right after rubber dam removal.

styleitaliano style italiano one month after indirect overlay restoration

Fig.20
One month follow-up.

Conclusions

Dental equipment is in continuous evolution to facilitate our work; moreover, devices such as digital impressions and CAD-DAM can reduce the time required for a procedure.

Bibliography

1. Veneziani M. Posterior indirect adhesive restorations: updated indications and the Morphology Driven Preparation Technique, Int J Esthet Dent 2017, 12(2):204-230
2. Musella V. Modern Aesthetic Dentistry: An A to Z Guided Workflow. Quintessence Pub 2017
3. Magne P. Composite Resins and Bonded Porcelain: The Postamalgam Era? J Calif Dent Assoc 2006 34(2):135-147
4. Duarte S et al Adhesive Resin Cements for Bonding Esthetic Restorations: a Review, QDT 2011, 34:40-60

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