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17 November 2021

Direct restoration of 4.6 and 4.7: a clinical case

Author: Alessandro Pezzana


The patient is a woman and she is 24 years old. She arrived in my office for a first visit.

From a medical point of view she has nothing to report if not a mild allergy related to the latex.

The remote stomatognathic history tells of a fixed orthodontic treatment, scaling once a year, and some fillings received during adolescence.

From a dental point of view, the young patient is in first skeletal and dental class, has no symp-toms or signs of periodontal disease and plaque control, even if not perfect, is very good.

The patient reports slight discomfort during ingestion of sweet foods or drinks and during chew-ing on the 4th quadrant.

During the visit, consisting of the physical examination and instrumental examinations such as radiographs bitewings, thermal tests and compression tests (to exclude the presence of typical symptoms of a crack) at the level of the fourth quadrant, she has: amalgam restoration on dental element 4.6 associated with primary mesial caries and primary occlusal caries on 4.7.

The symptoms are not clearly identifiable by the patient but they can be traced back to dental elements 4.6 through diagnostic tests.

The quadrant is rehabilitated through direct composite procedures.


  • FIg 1 initial radiography.

    FIg 1 initial radiography.

  • Fig 2 preoperative initial photograph.

    Fig 2 preoperative initial photograph.

  • Fig 3 Clinical aspect after isolation with latex free rubber dam. Note the loss of some islands of enamel. These are probably the cause of discomfort and symptoms.

    Fig 3 Clinical aspect after isolation with latex free rubber dam. Note the loss of some islands of enamel. These are probably the cause of discomfort and symptoms.

  • <p>                                    Fig 4 Completed  and finished cavity. The presence of fracture lines is excluded and thus the  presence of cracked tooth syndrome, which would have had a completely different treatment plan, is excluded.            <br></p>

    Fig 4 Completed and finished cavity. The presence of fracture lines is excluded and thus the presence of cracked tooth syndrome, which would have had a completely different treatment plan, is excluded.

  • <p>                                    Fig 5 Application  of self-etch adhesive after pre-etching of the enamel (I bond self etch).            <br></p>

    Fig 5 Application of self-etch adhesive after pre-etching of the enamel (I bond self etch).

  • <p>                                    Fig 6 Insertion  of the sectional matrix that adapts optimally to the cervical step and  positioning of the wedge and ring.            <br></p>

    Fig 6 Insertion of the sectional matrix that adapts optimally to the cervical step and positioning of the wedge and ring.

  • <p>                                    Fig 7 Lateral  view of the newly created interproximal wall.            <br></p>

    Fig 7 Lateral view of the newly created interproximal wall.

  • <p>                                    Fig 8 Occlusal  view of the interproximal wall and the presence of a correct contact point.            <br></p>

    Fig 8 Occlusal view of the interproximal wall and the presence of a correct contact point.

  • <p>                                    Fig 9 Deposition  of a thin layer of flowable composite (Venus diamond flow A1).            <br></p>

    Fig 9 Deposition of a thin layer of flowable composite (Venus diamond flow A1).

  • <p>                                    Fig 10 First  apposition with Venus Diamond one.            <br></p>

    Fig 10 First apposition with Venus Diamond one.

  • <p>Fig 11 Second apposition with Venus Diamond one and modeling of the complete occlusal table in a single stroke.<br></p>

    Fig 11 Second apposition with Venus Diamond one and modeling of the complete occlusal table in a single stroke.

  • Fig 12 Use of intensive flowable composite (brown) to characterize the occlusale surface.

    Fig 12 Use of intensive flowable composite (brown) to characterize the occlusale surface.

  • Fig 13 Occlusal aspect of the completed restorations.

    Fig 13 Occlusal aspect of the completed restorations.

  • Fig 14 occlusal check.

    Fig 14 occlusal check.

  • Fig 15 Final radiography

    Fig 15 Final radiography

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