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Revitalization and Restoration Following Deep Caries

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Dr. Elvio Durando

A 37-year-old female patient presented with concerns about tooth No. 3. Another clinician had diagnosed caries and recommended root canal treatment, so she came to our office to find out if a root canal could be avoided. Other teeth needed restoration, but we focused our attention on this particular tooth with deep caries. Testing for sensitivity was performed, and the patient told me that she experienced sensitivity when consuming cold beverages. It was determined that the sensitivity was related to the stimulus.

The provisional restoration and carious tissue were removed via both manual excavation and low-speed rotary instruments. The pulpal chamber showed a translucency, and due to the vicinity of the pulp, a liner (TheraCal LC, BISCO) was used to protect the pulp. TheraCal LC acts as a barrier and pulp protectant, with the added benefit of also releasing calcium and generating an alkaline pH.

After placing TheraCal LC, selective enamel etching was performed using 37% phosphoric acid for 20 seconds. The etched surface was rinsed and excess moisture was removed. We then used a universal adhesive system (ALL-BOND UNIVERSAL, BISCO), applying a layer over the preparation in accordance with the manufacturer’s instructions. ALL-BOND UNIVERSAL can be used as a self-etch or total-etch adhesive, depending on the clinical case and the indication of the acting professional. After light curing the adhesive, a layer of flowable composite was placed.

The tooth was now vital once again, and the patient was asked to return in 30 days. The patient no longer experienced pain or sensitivity.

A ceramic inlay was the planned final restoration. The molar was prepped and scanned (CEREC Omnicam, Dentsply Sirona) for the purpose of fabricating the inlay. When the ceramic was fully crystalized, a 20-second hydrofluoric acid treatment was performed and then cleaned before silane was applied.

I prepared the tooth using ALL-BOND UNIVERSAL and a dual-cure cement (eCEMENT, BISCO). The restoration was seated, and excess cement was eliminated and then polymerized, covering the edges with glycerin to avoid the oxygen inhibited layer. We removed the rubber dam, polished the edge, and checked the occlusion of the final restoration.

Go-To Products Used in This Case:

TheraCal LC With its unique ability to stimulate apatite, TheraCal LC, a light-cured, resin-modified calcium silicate, is ideal for direct and indirect pulp capping and for use as a protective base/liner. Because of its excellent handling properties, TherCal LC stays where it is placed to efficiently aid in the regenerative process. Its alkaline pH promotes healing and results in virtually no postoperative sensitivity.

All-Bond Universal All-Bond Universal is the first universal dental adhesive to combine etching, priming, and bonding in one bottle. Unlike other one-bottle adhesives, direct and indirect dental restorations; it will bond to all indirect substrates and is compatible with all composite and resin-based cements without an additional activator.

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