Occlusal view following preparation of the teeth for full-coverage crowns.įigure 5. To achieve an adequate ferrule for the crowns, the margins were placed subgingivally to position them apically to where the resin ended interproximally and to ensure removal of any recurrent decay.įigure 4. Some dark dentin discoloration was noted on both preparations but, using an explorer, it was found to be hard tissue (Figure 4). This would act as pulpal protection and to provide better retention form for the crowns to be placed. A small area of resin was left on the occlusal of the premolar preparation and distal of the molar as it was intact with no noted dentin breakdown marginally. During preparation, most of the existing composite restoration was removed along with any recurrent decay. The 2 teeth were prepared for full-coverage crowns utilizing diamonds in a high-speed handpiece. To correct this clinical issue and provide the best long-term result with the remaining tooth structure, full-coverage crowns were indicated.Ĭlinical Protocol A local anesthetic ( Septocaine ) was administered to locally infiltrate the posterior right maxilla. Contour of the teeth had allowed a food trap between the 2 teeth, and that was a primary concern for the patient. Structurally, both teeth would have insufficient healthy tooth structure once the existing composite and recurrent decay were removed to retain and support new directly placed restorations. Preoperative bite-wing radiograph demonstrating recurrent decay at the distal of the first molar and extensive existing composite restorations. Occlusal view of the large defective resin restorations on the maxillary first molar and second premolar.įigure 3. Maxillary first molar and second premolar requiring crowns due to large, failing, previously placed composite resin restorations.įigure 2. A bite-wing radiograph showed an open margin on the distal of the molar and that the direct resins restorations were moderately deep (Figure 3).įigure 1. Additionally, a crack was noted on the mesial marginal ridge of the second premolar. The first molar presented with an existing MOD composite and the second premolar with an existing DO composite, with both teeth having the current direct restorations replacing approximately 60% of the coronal structure (Figure 2). The maxillary right first molar and second premolar had large defective resin restorations with recurrent decay at the restoration margins (Figure 1). 8 For example, tissue shrinkage, at the low power setting utilized by the diode laser, is not a problem.ĬASE REPORT Diagnosis and Treatment Planning A 55-year-old female patient presented for a dental examination and prophylaxis. Unfortunately, electrosurgery, due to its high wattage (power at the tip) and deeper cell effect, has certain soft-tissue complications that have been reported in the literature. 5-7 In the past, as an alternative to retraction cords and pastes, some practitioners have used electrosurgery to open the sulcular tissue around the preparation to allow better capture of the preparations margins. 4 Diode lasers have been demonstrated to be safe and effective with an excellent tissue healing response. One of the treatment benefits of the diode laser is the ability to improve restorative impressions. The price of diode lasers has decreased throughout time, making them a more cost-effective option. Lasers are becoming standard equipment in the dental practice. This becomes more problematic as the preparation margin needs to be placed deeper in the sulcus due to presentation of caries or old restorative materials necessitating an adequate preparation to achieve a restorative ferrule. 2 With hemorrhagic tissue, removal of the retraction cord or paste may reinitiate bleeding, preventing the impression material from fully capturing the preparation margins. 1 Those methods, which require additional time to allow the chemicals within the product to cause vasoconstriction of the blood vessels within the sulcular tissue prior to an impression, are technique sensitive. Retraction cords and pastes have been available for many years to help dilate the sulcus, thus exposing the prep margins for an optimal impression. When the restoration does not fit the prepared margins, recurrent caries as well as periodontal issues, such as chronic inflammation of the gingiva, will likely occur in time. INTRODUCTION Fixed restorative dentistry success is dependent on the exquisite fit of restorations.
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