Restoring a Deep Cavity the

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By: Dental Product Shopper

5/13/2025

JAMES CHAE, DDS, MS

Dr. Chae graduated from the University of California San Francisco (UCSF) School of Dentistry in 2000 and currently owns Diamond Bar Dental Group in Diamond Bar, CA. He teaches clinical dentistry as an adjunct instructor at the Herman Ostrow School of Dentistry of USC and has published cases with various dental publications, including Dentistry Today, Dental Products Report, Dental Product Shopper and Compendium. Connect with him on Facebook and lnstagram at @jameschaedds, where he shares his work and answer questions.

A 55-year-old man presented with failing restorations on the lower left quadrant, teeth Nos. 18, 19, and 20 (Figure 1). After applying inferior alveolar nerve block with 2% lidocaine with 1:100,000 epinephrine, a clamp No. 24 was placed on the second molar and a rubber dam was inserted. The old defect filling was removed from the second premolar, tooth No. 20 (Figure 2). All the soft caries were removed using carbide round burs (sizes RA 2, 4, 6, and 8) with a slow-speed handpiece (Midwest Shorty, Dentsply Sirona).

Thera Family to the Rescue

The cavity was very deep on the second (Figure 3 and 4) and first molars (Figure 5 and 6). After a clean and neat cavity preparation, a light-cured, resin-modified calcium silicate material (TheraCal LC, BISCO) was placed on the molars. TheraCal LC has many benefits. It can be used as direct and indirect pulp cap, it helps to protect and insulate the pulp,5,6 its calcium release stimulates1* hydroxyapatite and secondary bridge formation,2,3 and it also masks dark amalgam stains and very dark dentin. It’s also easy and fast to place on the tooth.

After placing TheraCal LC, due to the wide depth of the cavity preparation, a base material (TheraBase, BISCO) was also placed on the first molar (Figure 7) and light-cured for 20 seconds to protect the pulp. TheraBase also has unique benefits, including high compressive strength, its ability to absorb occlusal forces without fracturing, and continuous release of calcium and fluoride ions.*

A sectional matrix was placed to restore the second premolar (Composi-Tight 3D Fusion, Garrison) (Figure 8). Then, selective enamel etching was done using 37% phosphoric acid (Figure 9). The teeth were rinsed and dried, and a single-bottle adhesive (All-Bond Universal, BISCO) was applied, lightly dried, and cured for 10 seconds. The second molar and the premolar were restored using a supra-nano filled composite, and the first molar was prepared for a crown after placement of a composite buildup (Figure 10).

An Impressive Result

The final composite restorations looked natural and blended nicely to the tooth (Figures 11 and 12). The final crown preparation was completed after placing 2 retraction cords impregnated with epinephrine (Figure 13). Before the final cementation, a bitewing Xray was taken to confirm that the interproximal margins were sealed (Figure 14). The monolithic zirconia crown (BruxZir, Glidewell) after final cementation also yielded an esthetic result (Figures 15 and 16). All restorations were successful and a vast improvement from the patient’s original smile (Figures 17 and 18).

References:

*BISCO has, on file, the calcium release data for TheraCal LC.

1. Gandolfi MG, Siboni F, Prati C. Chemical-physical properties of TheraCal, a novel light-curable MTA-like material for pulp capping. Int Endod J. 2012;45(6):571-579. doi:10.1111/j.1365-2591.2012.02006.x

2. American Dental Association. Glossary of dental clinical and administrative terms: direct and indirect pulp capping. Accessed April 25, 2025. https://www.ada.org/en/publications/cdt/glossary-of-dental-clinical-and-administrative-ter

3. Gandolfi MG, Siboni F, Taddei P, Modena E, Prati C. Apatite-forming ability of TheraCal pulp-capping material. J Dent Res. 2011;90(Spec Iss A):Abstract 2520.Accessed April 25, 2025. https://www.dentalresearch.org

4. Okabe T, Sakamoto M, Takeuchi H, Matsushima K. Effects of pH on mineralization ability of human dental pulp cells. J Endod. 2006;32(3):198-201. doi:10.1016/j.joen.2005.11.007

5. Sangwan P, Sangwan A, Duhan J, Rohilla A. Tertiary dentinogenesis with calcium hydroxide: a review of proposed mechanisms. Int Endod J. 2013;46(1):3-19.

6. Savas S, Botsali MS, Kucukyilmaz E, Sari T. Evaluation of temperature changes in the pulp chamber during polymerization of light-cured pulp-capping materialsby using a VALO LED light curing unit at different curing distances. Dent Mater. 2014;33(6):764-769.

7. Gleave CM, Chen L, Suh BI. Calcium and fluoride recharge of resin cements. Dent Mater. 2016;32(suppl 1):e26.