CASE REPORT 2
Diagnosis and Treatment Planning
A 16-year-old had previous treatment for a root canal in tooth No. 10 which had considerable microleakage and subsequent bleeding of surrounding tissue (Figure 10).
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Figure 10. Pretreatment photo (Case 2) shows restoration discolored due to microleakage on tooth No. 10 with unhealthy gingival tissue. |
After consultation using photographs of present conditions, and presentation of restorations that solved similar dilemmas for other patients, the decision was made to restore the tooth with a direct nanohybrid composite restoration similarly to what was described in case report 1.
Restorative Treatment
The existing restoration was removed, and the remaining tooth structure was properly prepared and cleaned. The soft tissue exhibited considerable bleeding, which had to be controlled to prevent the type of staining and microleakage in the future that we were in the process of correcting (Figure 11).
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Figure 11. Following bleaching treatment, the defective restoration was removed and the tooth prepared, leaving hemorrhaging gingival tissue. |
Figure 12. Expasyl was compressed into the gingival sulcus to arrest bleeding. |
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| Figure 13. With gingival bleeding arrested, a Greater Curve (Greater Curve) band matrix facilitated the bonding protocol completed with OptiBond FL bonding agent and Premise B1 nanocomposite. |
Figure 14. A full-smile photo, taken one year post-treatment, reveals an aesthetic restoration with healthy surrounding tissue. |
Expasyl tissue management paste was placed with compression and allowed to remain for 3 minutes (Figure 12). Following rinsing, tissue bleeding had totally halted, allowing us to proceed with the bonding procedure. The tooth was then acid etched, then rinsed with water and properly dried. The tooth was then encircled with a Greater Curve (Greater Curve) matrix band to control the perimeters as we added adhesive materials (Figure 13). OptiBond FL was applied with 2 primer layers that were appropriately dried to evaporate the alcohol solvent. The OptiBond FL resin layer was then painted over the primer and light cured for 10 seconds. Premise B1 shade composite was sculpted and cured in multiple layers to control polymerization shrinkage. Finishing was completed with carbide finishing burs followed by polishing with silicone cups and polishing brushes.
A photo taken one year postoperatively shows a restoration that blends nicely with the adjacent natural teeth (Figure 14). The gingival tissue surrounding the tooth had returned to normal coloration and contours.