Instrumenting and Restoring a Deep Carious Lesion

Author : Julie Cullen
Published Date 08/01/2013
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A patient presented with a rather extensive radiographic carious lesion on the distal aspect of tooth No. 4.

The carious penetration in the central groove was opened up using a Fissurotomy bur (SS White Burs) to gain conservative access to the active lesion below. The proximal portion of the preparation is extended to allow access for removal of the caries. Also, a diode laser (Picasso, AMD Lasers) was used to remove the interproximal tissue and gain better access to the gingival margin of the cavity for matrix placement. When the convenience and access forms of the cavity were completed, the excavation of the caries with SmartBurs II (SS White Burs) began.

After isolation with Isolite (Isolite Systems) and placement of a sectional matrix (Composi-Tight 3D XR, Garrison Dental Solutions), the preparation was completed. Because of the close proximity to the dental pulp, a liner aiding in regeneration (TheraCal LC, BISCO) was placed on the cavity floor.

When the liner was light cured, a self-etching dentin bonding resin was applied to the enamel and dentin (ALL-BOND UNIVERSAL, BISCO) per the manufacturers instructions and light cured. Next, the first increment of composite material (Aelite, BISCO) was placed into the cavity preparation and light cured. The final increments were then placed, light cured, and finished.

A 330 carbide fissure bur (SS White Burs) was used to remove the existing amalgam, and a Fissurotomy Bur (SS White Burs) was used to remove marginal decay while conserving as much healthy tooth structure as possible.

The first step in the finishing/polishing procedure was to use a 12 blade finishing carbide (SS White Burs) to accomplish anatomic contouring and marginal refinement. Next, the 20 blade finishing carbide was used to prepolish the surface of the composite material and further refine the marginal interface. When the trimming and finishing step was complete, polishing was accomplished with a Jazz Supreme flame shaped rubber abrasive polishing point (SS White Burs). When used with water spray, a slurry develops on the surface of the restorative material that will help to increase the final luster of the restorative material.

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