This 30 year old female patient attended for a dental assessment and clinically the upper left first maxillary molar was verified to have caries clinically and radiographically. There were no symptoms. Appropriate dietary counselling, analysis and preventive measures were implemented to reduce the caries risk overall and a direct restoration method was considered to be the most appropriate. There are many different composite systems available along with layered composite techniques. This patient sought a simple, durable technique which would provide her with a tooth coloured restoration, simple to place and durable. The patient was keen to have a simple technique with reduced clinical time. As this was an asymptomatic carious lesion a restorative option which was minimally invasive was sought.
This mirror image indicates the hypo-mineralised enamel appearance which has not yet cavitated. An occlusal stamp registration was therefore possible to record the profile of the cusps. Local anaesthetic was administered and the tooth isolated using rubber dam.
A minimally invasive approach was used to remove caries ensuring that the cavity is not over prepared and there is no residual caries or hypomineralised enamel left. Care was taken to ensure complete caries removal particularly affecting the enamel dentine junction. Pulpal irritation was prevented by the use of irrigated burs to avoid high temperatures.
A selective etch technique was employed (Super Etch® SDI), where the enamel is etched for 15 seconds. Zipbond® Resin was then applied, gently air dried and light cured. These products are all compatible and designed to be used in the workflow described.
A flowable composite resin was then applied to ensure that the junction between the Bulkfill composite and the resin remains uncompromised. Aura Easy Flow® was applied taking particular care to avoid any air pockets prior to light curing. (The cavity margins can be checked with a sharp instrument prior to curing to ensure good application).
A flowable composite resin was then applied to ensure that the junction between the Bulkfill composite and the resin remains uncompromised. Aura Easy Flow® was applied taking particular care to avoid any air pockets prior to light curing. (The cavity margins can be checked with a sharp instrument prior to curing to ensure good application).
Aura Bulkfill® is a single shade posterior nanohybrid composite with the optimal physical properties required for a posterior composite. It is easy to place and has a 5mm depth of cure. The strength is derived from the ultra high density glass filler.
Composite was placed and light cured for 20 seconds. The technique employed for this occlusal restoration was to build up the cusps and light cure to reduce the risks of postoperative pain. The final 1mm of composite was placed and the occlusal stamp taken preoperatively applied to re create the original tooth form and cusp contour.
Once the final layer of composite was applied, the occlusal stamp was pushed into position and any excess composite removed prior to light curing. The rubber dam was then removed and the restoration polished with a composite polishing bur and cups. In this case no occlusal adjustments were necessary.
The Final Result
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