Deep Facial Caries Treatment
A 37-year-old healthy female presented for new patient examination and evaluation. She had not had dental care in more than 6 years and was concerned with the appearance of her front tooth.
Visual examination, digital radiographs and fiber optic transillumination (FOTI) with SDI diagnostic attachment indicated that the decay was rather severe and would require immediate attention.
Discussion involved explaining the potential depth of decay and what treatment modalities would have to be used. I explained that we would probably need to remove tissue to fully access the extent of the decay and that there was also the probability that this tooth would require endodontic treatment. The patient agreed to treatment because she wanted to save the tooth.
After administration of local anesthetic and isolation of the area with Isolite, tooth No. 9 was prepared. Visualization was aided by the use of Rose Microsolutions dental loupes (4X magnification). As excavation of the decay was initiated it became clear that the decay was very deep and extended subgingivally.
I advised the patient that I would need to remove the gingival tissue to identify the extent of the lesion. She agreed. The tissue was removed with a Picasso Lite laser (AMD Lasers), exposing the extent of the damage from the decay. As with any laser use, eye protection is required and the SafeLoupe Laser Filters (DentLight) were directly attached to my loupes to allow continued use of magnification while working with the laser.
Preparation was completed, and excavation of the depth of decay identified necrotic pulpal exposure. I informed the patient and extirpation of the necrotic pulp was achieved. Dry cotton pellets with MCP were placed in the chamber area and sealed with TheraCal LC (BISCO). After isolating the gingival aspect of the preparation, Riva Bond bonding agent (SDI) was placed and cured, followed by placement of a giomer flowable composite (Beautifil Flow Plus, Shofu)to seal the gingival margins. The remainder of the preparation was restored with a giomer composite, shades A2 and A3, then trimmed and polished.
Endodontic access was then made from the lingual aspect of tooth No. 9 and endodontic treatment was carried out and completed.
A very nice final result was achieved, both esthetically and clinically. Next stop: periodontal management.