Composite Resin Restoration
A 31-year-old female presented with no major complaints, but she frequently had food trapped between teeth Nos. 29 and 30 and she had to carry floss at all times. She had no known dental allergies and was in excellent health.
During a routine periodic examination following dental prophylaxis, I noted discoloration at the margins of teeth Nos. 29 (distal-occlusal composite) and 30 (occlusal composite) that was not present during the last periodic exam 6 months before. The restoration on tooth No. 29 was failing, and a light, borderline open interproximal contact trapped food below the contact. Tooth No. 30 presented with a distal fracture line. Using DEXIS, both teeth Nos. 29 and 30 looked radiographically sound.
I determined that tooth No. 29 needed to be replaced to evaluate the discoloration and create a tight interproximal contact, preventing food entrapment. Because of the fracture, I decided it was ideal to replace tooth No. 30 and address the fracture line at the same time.
I discussed multiple treatment options with the patient, including no treatment at all. I emphasized that we would use a minimally invasive procedure. We discussed materials, including porcelain and indirect and composite resin options. The patient chose composite resin because it was the least expensive and the restoration was small.
After removing the composite resin in tooth No. 29, I noted that achieving ideal interproximal contacts would be difficult because of the angle of teeth Nos. 29 and 30. The mesial of tooth No. 30 was scratched with a bur by the previous treating clinician, resulting in an irregular surface that trapped both plaque and stain. Without doing more damage, I recontoured the mesial surface of tooth No. 30 with NTI Trimming and Finishing Carbides (AXIS|SybronEndo), and then polished it with Alpen Polishers in Composite PLUS grit (COLTENE). This minimized surface roughness, but also presented a challenge because it made the interproximal contact more difficult to restore. Using the SmartView Sectional Matrix System (DentiSmart) made the restoration of this large contact easier.
The patient and I were both pleased with the final outcome that restored proper esthetics and function. The patient was happy that a simple distal-occlusal composite restoration in tooth No. 30 was ideal, and the fracture was insipient and did not extend beyond the borders of the restoration.