A Conservative Approach to Advanced Caries

Figures 1a–1c: The patient presented with a large carious lesion on tooth #31. Due to the depth of the lesion and proximity to the pulp, the patient was informed that endodontic therapy and a full-coverage crown may be needed in the future, but at this juncture we could stay with a conservative approach.

Figures 2a, 2b: Utilizing Overjet^® annotation software (Overjet, Inc.; Boston, Mass.), which highlights restorations in blue and outlines decay and caries in red, we were able to determine the progression of the decay. The X-ray on the top (2a) was taken two years prior to consultation; the X-ray on bottom (2b) shows caries developing beneath the previous restoration and its significant progression over that period.

Note: The software highlights radiographic findings, enhancing interpretation, but it does not replace the dentist’s final diagnosis.

Figures 3a, 3b: After I removed the decay, the outline of the pulp chamber was clearly visible, indicating a deep lesion, without pulp exposure. I shaped the tooth in such a way that it would allow me to keep as much enamel as possible for adhesion. Then I applied Lime-Lite^™ cavity liner (Pulpdent Corporation; Watertown, Mass.) to protect the pulp. It is also a great material for bonding.

Figures 4a–4c: I approach every intraoral scan with the understanding that a margin must be clearly identified in order to be restored. This subgingival, nonretentive case required tissue deflection, so I used a twocord technique. I began by packing #00 retraction cord for apical compression of the tissue. Then I placed a second cord size #2 that was treated with Hemodent® (Premier Dental; Plymouth Meeting, Penn.) over the first cord for lateral deflection. The patient then pressed on gauze for five minutes to give the tissue time to retract.

Figures 5a–5c: After scanning, I used the fastdesign.io^™ Software and Design Station, which automatically marked the margins. I selected the InlayAI feature to generate an initial design that closely matched the patient’s anatomy and added slight customization to the design.

Figures 6a–6c: When checking the milling and insertion feature of the software, the areas marked by red arrows indicated unmillable areas at the margin (6a). I was able to correct this in the fastdesign.io software and confirm a clear path of insertion indicated by the green arrows (6b). Prior to milling, I visualized the location of the sprue by viewing the nesting in the block (6c).

Figures 8a, 8b: For the tooth preparation I used acid-etch on both enamel and dentin, followed by Gluma^® (Kulzer North America; South Bend, Ind.) for desensitization and disinfection. I then scrubbed Scotchbond^™ Universal (Solventum; St. Paul, Minn.) for 20 seconds and air-thinned without light curing. For the restoration, I air abraded the intaglio surface with aluminum oxide, cleaned with IvoClean^® (Ivoclar Vivadent AG; Schaan, Liechtenstein), applied Scotchbond Universal, air thinned without light curing, and cemented with Omnichroma Flowable (Tokuyama Dental Corp.; Tokyo, Japan). I used a dry angle and rolled gauze under the tongue to achieve isolation and dryness.

Figures 10a, 10b: The first cord #00 remained after cementation and had to be removed. This step helped eliminate cement remnants from the sulcus. Finally, I took a bitewing X-ray to ensure no residual cement remained and reviewed the image with the Overjet software.

Figures 11a, 11b: I finished and polished the restoration using tools from the BruxZir^™ Adjustment and Polishing Kit (Glidewell Direct; Irvine, Calif.) and the 3M Sof-Lex^™ Extra-Thin Contouring and Polishing Discs Kit (Solventum Corporation; St. Paul, Minn.).