25 March 2022

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Direct composite rehabilitation in a young patient

Author: Andrea Baldi

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A 19-year-old female patient came to my attention reporting sensibility related to cold on the 2nd quadrant. The general medical history revealed nothing relevant. Clinical and rx bitwewing examination revealed primary interproximal decay of 2.6 mesial, with a possible involvement of 2.5 distal and an occlusal decay of 2.7.  Vitality test was carried out and confirmed that all elements were vital. According to the young age of the patient and the good quantity of sound tissue structure, a minimally invasive approach with direct restorations was proposed.

CLINICAL PROCEDURES
Oral hygiene motivation was carried out, alongside with proper periodontal treatment (scaling, polishing) before taking initial photo and rx bitewing of the quadrant (Fig.1).

Isolation with rubber dam (Fig.2).

Cavity cleaning of all elements (Fig.3). I started with the cleaning of 2.6, in order to perform a direct inspection of 2.5 distal area. Since 2.5 distal presented a minor decay, without the involvement of the distal marginal crest, a slot approach was followed. 

Detail of the prepared slot (Fig.4).

Adhesive procedures were carried out, after sandblasting, with a two-step self-etch adhesive system with selective enamel etching for 30s (Fig.5). 

Detail of matrix adaptation on 2.6 after the competition of 2.5 slot restoration (Fig.7).

Restorations before polishing (Fig.8).

Restorations immediately after rubber dam removal with occlusal contacts (Fig.9).

3 years follow up and final rx bitewings (Fig.10).