CASE REPORT
Diagnosis and Treatment Planning
A 50-year-old patient presented with symptoms of severe sensitivity. Clinical evaluation and consultation revealed an old amalgam restoration (tooth No. 30), old composite (tooth No. 29), active caries (tooth No. 31), potholes, and visible cracks due to bruxism (Before Image). Pulp testing was done, revealing vital and healthy pulps.
Prerestorative Considerations
The following considerations were completed before any restorative treatment was initiated: First, prior to administering anesthesia and rubber dam isolation, the preoperative contact zone and excursive occlusal patterns were evaluated. Next, the shade of the tooth was determined. Shade selection must be accomplished prior to dental dam placement to prevent improper color matching as a result of dehydration and elevated values.3 When teeth dehydrate, air replaces the water between the enamel rods, changing the refractive index, which makes the enamel appear opaque and white.4
Before starting any restorative procedure, it is important (if physically permissive) to place a dental dam after anesthesia administration to achieve adequate field control and protect against contamination.5
Operative Treatment
Once the rubber dental dam (Hygenic [Coltène/Whaledent]) was placed, the first step was to remove the old amalgam in tooth No. 30, composite in tooth No. 29, and the decay in tooth No. 31 (Figure 1). The preparations were then scrubbed with a 2% chlorhexidine digluconate aqueous solution (BISCO). One can simply remove diseased tooth structure and be able to maintain (with confidence) the integrity of the natural enamel/dentin as much as possible. The Hawe SuperMat Matrix System (Kerr) was used to separate the cleaned preparations prior to bonding.
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| Figure 1. The rubber dam has been placed (Hygenic [Coltène/Whaledent]), and removal of amalgam, composite, and decay was accomplished. |
Figure 2. Placement of Vertise Flow (Kerr) with the applicator tip after air-drying the cavity preparations. |
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Figure 3. The self-adhering flowable composite was brushed with moderate pressure onto the cavity floor for 15 to 20 seconds. |
Figure 4. Light-curing with the Optilux 501 (Kerr) curing light. |
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Figure 5. The rest of the preparation was etched for 15 seconds with 35% phosphoric acid (Ultra-Etch [Ultradent Products]), then rinsed for 5 seconds and gently air-dried. |
Figure 6. OptiBond Solo Plus (Kerr), a single-component adhesive, was applied for 20 seconds, air-thinned, and then light-cured. |