Clinical case: Posterior direct composite

LL4(class I), LL5(Class II) and UR5 (Class II)

MSc Aesthetic dentistry
reatment date !"#!$#%$!!
Patient name &'( A)e "* years
Presentin) complaint: demands cro+ns ,or UL- and LL- that had root canal
treatment, patient had LR- remo.ed a,ter RC that ,ract/red, and dose not
+ant to loss the UL- and LL-'
RM&: Medically ,it patient
R0&: Patient had a root canal retreatment o, LL- and core 1/ild /p in
preparation to 1e restored +ith a cro+n'
(2tra3oral e2amination: All normal'
Intra3oral e2amination:
So,t tiss/e 4othin) a1normal
5ral hy)iene 6ood, cer.ical stains on all teeth
d/e to hea.y red tea drin7in)
Periodontal stat/s 4o 1leedin) on pro1in), and no
recession
(2tracted teeth LR-, all +isdom teeth years 1ac7
8itality test and RC 4o /n3restored necrotic teeth UL-
and LL- had RC
9ailed restorations LL: +ith old and ,ract/red
amal)am, UL- old 6I ,illin) that lost
anatomical ,orm
Caries UL4,5,: UR5 LL4,5 LR4,5,:
LR5,:
Prosthetic +or7 454
Radio)raphic e2amination: ), LL5(Class II) and UR5 (Class II) 1oth distal
caries close 1/t did not reach to p/lp space,UL- and LL- +ith )ood ;/ality
o1t/rations, no apical pathosis, no 1one loss
(2amination o, occl/sion: some +ear present on lo+er canine and incisors
Static occl/sion:
S7eletal and dental class I
4ormal arch si<e and +idth
Some spacin) o, /pper anterior teeth
and minor spacin) o, lo+er arch teeth
0ynamic occl/sion:
Sta1le ICP and coincides +ith
RCP (45 shi,t present)
Canine )/idance on le,t mo.ement
)ro/p ,/nction on ri)ht side d/e to
canine attrition
Shared e.en contacts at protr/si.e
mo.ements
4o Posterior inter,erences on ='S
or 4'='S
reatment plane: o restore cario/s teeth 1e,ore doin) any prosthetic +or7,
this +rite3/p +ill disc/ss the treatment o, LL4(class I), LL5(Class II) and UR5
(Class II) 1oth distal caries
reatment sta)es:
Sta)e I:
Pre3operati.e shade selected ,or LL4,5 and UR5 shade is A" t 1ody
and A% at c/spal area, material selected is "5$>(/ni.ersal composite)
1ody and enamel ,or LL4,5 and 6RA0IA posterior composite ,or UR5
Administration o, local anaesthesia 1y in,iltration o, %? LI05CAI(4(
Centric stops mar7ed and r/11er dam application'
I /se 9(40(R=(06(S as a protecti.e aid ,or ad@acent teeth d/rin)
pro2imal ca.ity preparation' &and e2ca.ator +as /sed to remo.e deep
caries o, UR5 and lo+ speed hand3piece ,or LL4,5
0isin,ection o, the ca.ity +ith %'5? sodi/m hypochlorite, and i /se
8IR5A540 ("M) as a linin) material in deep ca.ity areas to red/ce
P'5'S
Application o, sectional thin metallic matri2 and +ed)es then the matri2
holder is applied, the metal matri2 is conto/red to ha.e a )ood contact
+ith ad@acent tooth
Usin) ":? phosphoric acid ,or %$ seconds on enamel only and the on
dentine also ,or !$ seconds more to etch 1oth enamel and dentine ,or
optim/m 1ondin), +ash and dry and application o, 1ondin) a)ent
(sin)le 1ond "M(SP(), a li)ht air stream to e.aporate the sol.ent and
to pre.ent ,rom poolin) o, 1ondin) a)ent is important'
Incremental application o, small layers, ,irst layer 1ein) at ,loor and
!'5mm thic7ness to ins/re )ood c/rin), and ne2t increments to contact
one ca.ity +all and the ,loor o, ca.ity at once to red/ce the C ,actor,
polymerisation shrin7a)e, stress on 1ond inter,ace and tooth str/ct/re
that ca/ses post3operati.e sensiti.ity and#or premat/re ,illin) ,ail/re'
Incremental application also res/lts in a stron)er restoration and more
morpholo)ic resem1lance o, tooth str/ct/re'
0eeper layers I chose to 1e A", middle A% and A! or clear transl/cent
,or ,inal enamel layer'
I chec7ed occl/sal stops to see i, there are hi)h points'
I /s/ally +ait !5 min/tes 1e,ore startin) to ,inish and polish composites
and a chance ,or the patient to rest, or 7eep ,inal polishin) ,or the
,ollo+3/p appointment a +ee7 later
Usin) r/11er polishin) points and diamond paste (ULRA0(4) ,or
occl/sal s/r,ace and SUP(R3S4AP polishin) discs ,rom S&59U ,or
pro2imal area )i.es a .ery )ood polish to the composite and ,inally
application o, 63coat ma2imi<es aesthetic res/lt'
Critical e.al/ation: the restorations )a.e a )ood anatomical resem1lance,
occl/sal ,orm, pro2imal contacts, and mar)ins' Also )ood shade matchin)
+as achie.ed, on ,ollo+3/p appointment a +ee7 later patient reported no
P5S or any discom,ort and patient +as satis,ied +ith the treatment'