Wrap-around caries

1 Jun 2016 - 39191

Wrap-around cases are twice as difficult to manage and restore: it is not an easy procedure, therefore the treatment should be as conservative as possible. In this case a modified class two is combined with cervical decay.

Cervical non carious lesions are very hard in isolation, finishing and polishing. In this case the decay only was removed and the intimate contact preserved. In addition, part of it had been restored via injection over molding technique, which is very beneficial in unaccessible areas and where you need perfect adaptation.

Fig. 1

Showing cervical non carious lesion.

Fig. 2

Showing closer scope between the defect and the gum tissues.

Fig. 3

Showing isolation with rubber dam in cooperation with the help of the magical effect of B4 soft tissue retraction clamp, it striped the tooth completely.

Fig. 4

Showing the proximal decay with the cervical defect.

Fig. 5

Caries indicator dye to check the full removal of the decayed tissue.

Fig. 6

After rinsing with water the remaining color indicates the residual caries.

Fig. 7

Teflon application with the help of a retraction cord applicator which increases sealing ability of the rubber dam and simplifies the isolation issue.

Fig. 8

Frontal view after complete caries removal.

Fig. 9

Proximal view for caries removal.

Fig. 10

ContacEZ in closer view.

Fig. 11

Full view of ContacEz: this saw-like device allows and facilitates the delicate matrix band to enter through the intimate contact without any cutting or injury for the neighboring tooth structure.

Fig. 12

Proximal view for Bioclear matrix band wrap around the tooth.

Fig. 13

Frontal view for the Bioclear matrix band showing its various merits: it is a clear one that allows the penetration of the light to accurate depth and does not affect the curing depth of the restoration, plus it is pre-curved so that it takes the normal shape of the tooth eliminating the need for ring or wedges and for pre-burnishing effect.

Fig. 14

Selective etching for enamel only with phosphoric acid 37%, then two step self etch adhesive for dentin and enamel.

Fig. 15

After restoring the proximal part with injection over molding technique by heated composite and flowable composite then the painting brush used for making the restoration blending with the tooth structure.

Fig. 16

Showing finishing stone removing the excess of the composite and finishing it.

Fig. 17

Showing composite polishing in three steps (rock star polish). First step here starting with Shofu Brownie.

Fig. 18

Second step of composite polishing.

Fig. 19

Showing coarse pumice in a disposable cup for second step of polishing.

Fig. 20

Showing SS White Jazz in action during the third step of composite polishing.

Fig. 21

Showing the finished restoration.

Fig. 22

Frontal view of the tooth with the restoration, 14 days recall.

Fig. 23

Full view showing the proximal part and cervical part after restoring both of them.

Fig. 24

Final view after complete tooth rehydration.

Fig. 25

Radiographic picture showing the adaptation of composite cervically and proximally.

 

Conclusions

Preserving tooth structure by removing the decay only increases the integrity of the tooth structure. Injection over molding technique is very useful in unaccessible areas with the merit of perfect adaptation.
Three steps of polishing influence the final result of the restoration and improve its durability.

Bibliography