Dr Charles Brandon presents a solution to food trapping and caries using COLTENE BRILLIANT EverGlow
Initial presentation and examination
The patient, who was a 41-year-old female, attended for a routine exam, as
she was not satisfied with a previous dentist. She was looking for a more comprehensive and thorough assessment, with greater information given about the current health of her teeth.
The patient presented with a sound medical history, with no pre-existing medical conditions. She was not taking prescribed medications, there were no known allergies and she was a non-smoker.
The results of the examination indicated that oral health was optimal and periodontal health was also very good. However, the patient had an issue of food trapping between the first and second molars in the upper left quadrant, which had led to the development of caries interproximally (Figure 1 top).
The diagnosis was made following localised inflammation around the proximal space. An ICDAS 4 carious lesion was identified on the mesial surface of the UL7 and an ICDAS 3 lesion in the distal surface on the UL6.
A full Basic Periodontal Examination (BPE) was completed for the patient and all intra and extraoral soft tissues were thoroughly checked. A Temporomandibular Joint (TMJ) examination was also completed.
After we had identified the site of food trapping, radiographs were taken where the caries were identified. Sensibility testing was completed on the UL7, where deep caries were present. Sensibility of the tooth was confirmed.
The pathway in this case involved a restoration of the UL6 offered as a direct resin. Restoration of the UL7 was offered either as a direct resin, or as an indirect ceramic. For the purpose of conserving tooth tissue, the patient opted for direct resin restoration and was happy for me to proceed on this basis.
Anaesthetic was achieved with a buccal infiltration and palatial intraligamentary infiltration using Articaine 4%. Following placement of a rubber dam, the site was isolated using a HYGENIC® Fiesta® Colour Coded Winged Clamp for an upper left molar (available from COLTENE). Caries were removed, starting with the large lesion in the UL7 (see Figure 2). The distal lesion in the UL6 could be accessed directly without need to break the proximal enamel; this meant that direct removal of the caries could be achieved (see Figures 3 and 4).
All enamel margins were bevelled using a Flame-style Burr in yellow grit and Dura-Green stone. Both sites were sandblasted with 27um aluminium oxide. A wide margin of selective enamel etch was then used for 20 seconds with 37% orthophosphoric acid.
Bond was liberally applied, allowed to rest for 30 seconds on cavity surfaces, and then air-dried for 10 seconds under a gentle stream of air. Flowable resin with high filler content was used to restore the distal surface of the UL6. A ROEKO steel matrix band, from COLTENE, was placed around the UL7 to adapt the mesial wall during restoration.
The UL7 was built up in stages using heated COLTENE BRILLIANT EverGlow™ A2 / B2, starting with the wall of the tooth. The matrix band was removed and the remainder of the tooth was constructed freehand. Finally, the restored surfaces were coated with glycerine gel and given a 40-second cure to set the oxygen-inhibited layer.
The rubber dam was then removed and finishing was completed using the DIATECH™ Universal Shaping and Finishing Kit from COLTENE, to blend enamel margins and also remove any surface roughness.
Outcome and appraisal
We ended up with a significantly improved contact point, which, following the two-month review, has allowed the total resolution of the inflammation seen in the gingivae (Figure 5). The accurate replication of the proximal marginal ridge and the correct positioning of the fossae of the tooth also help guide food away from the contact point when chewing.
COLTENE BRILLIANT EverGlow allows for a great degree of sculptability and remains malleable when working, especially when heated. These resins have a relatively high translucency, which blend very nicely with the tooth’s natural level of translucency. I was able to produce a more adapted and functional restoration with a highly cosmetic finish. ROEKO steel matrix bands, also from COLTENE, are also a huge asset when trying to isolate teeth.
Dr Charles Brandon is a dentist at S3 Dental. In this case he used BRILLIANT EverGlow from COLTENE. To find out more visit www.coltene.com