Attending Physician: Li Chuan

AKJ Stomatological Hospital Medical Chief Inspector

Guangdong Provincial Hospital branch manager

Guangdong Senior Stomatology special committee

Member of Shenzhen private oral administration branch

German Dental Scholar/ Senior dental implant restoration specialist/ Dental academic leader

Specializing in oral clinical career for more than 20 years, Dr. Li Chuan is a well respected AKJ medical director with an excellent oral treatment capability. Li is also a successful leader in a research institution and international exchange programs, often invited to participate in domestic and international academic conference trainings. Specialized in dental implant restoration, highly skilled in multiple areas and accumulated tens of thousands of outstanding cases of oral implant restoration. Director Li Chuan’s success and accomplishments were based on his moral values, the desire to learn, the loved by peers and patients.

Preserving the vitality of the tooth is a very important issue, as much as we can, this is should be our goal for treatment, save our tooth pearl; deep caries is one of the daily routines of cases that we face it in our dental practice with many confusion in how to deal with these cases; in this is case we will know how to manage, how to remove the decay and how is the best adhesion protocol to keep our tooth functional and asymptomatic after this procedures. The success of these cases starting from the diagnosis, isolation, technique of caries removal, adhesion protocol, the technique of application to the coronal restoration.

Through this time my concern was focused on root canal treatment and by following style Italiano website, group and staff mentors my concern of isolation for coronal restoration and the perfection to get this masterpiece coronal restorations increased and my scope of passion become more global rather than focused in a closed box.

Img. 1 – Preoperative picture showing the deep caries chief complaint of the patient just slight pain with cold or air and can not chew well on this side.

Img. 2 – Preoperative radiographic picture had been taken to aid in diagnosis to see the extension of the lesion in a 2D way, somehow I know that I am very close to pulp horn.

Img. 3 – Proper isolation to keep all the procedures under clean and dry field heavy rubber dam sheet in blue color wingless clamp N 26 (Ash) soft interproximator (Bioclear) aid in the retention of the rubber dam.

Img. 4 – Removal of the caries starting laterally not vertically, I did not go to dig vertically; caries should be removed totally form the wall first like in this figure and the pulpal decay still exist.

Img. 5 – After all the boundaries became clean, the excavation started by excavator size 51/52 (maillefer).using the lateral cutting side not the front cutting tip in a peeling motion. All the infected dentin had been removed.

Img. 6 – Picture showed there is no any caries. I am so lucky that there is no exposure there is other school that support partial excavation of caries unless there is no pain and depend on the outer enamel seal.

Img. 7 – Cavity had been re-wetted, cleaned and toileted by chlorohexidine gluconate 2% it is a matrix metaloprotenase inhibitors and preserve adhesive bond from degradation.

Img. 8 – Picture showing enamel after etching from 15-30 seconds, then followed by chx application again on dentin deep caries diamond wedge (bioclear) had a huge benefits: push papilla down ward make gingval seal for the band perfectly.

Img. 9 – Sectional matrix 50 micron of Tor Vm enagaged by sectional ring dentsply and supported by teflon apically to increase gingival seal.

Img. 10 – Two step self etch adhesive had been used after selective etch used for enamel only then the

proximal wall had been build up: it was started by flowable composite on the gingival floor then followed by small increament of heated packable composite then cured then followed by heated packable composite till wall had been finished the best scenario to finish the main bulk of the cavity fast use bulk fill composite ,here i depend on heated packable composite in many layers in adjunctive of flowable composite .. application usually by condensa (style italiano instruments) then followed by bond brush to remove excess of flowable composite and increase adaptation of composite to the tooth structure.

Img. 11 – Restoration had been finished anatomy had been sculpted by applica and fissura (style italiano instrument).

Img. 12 – shofo browny for polishing.

Img. 13 – ss white of bioclear for polishing.

Img. 14 – Restoration become glossy after polishing and become characterized after composite tent applied.

Img. 15 – Post operative picture.

Img. 16 – Direct composite restoration after polishing and finishing.

Img. 17 – Composite restoration in function occlusion analysis, no high points.

Img. 18 – Post operative radiographic picture checking marginal adaptation.

Conclusions:

Perfect isolation keeping preserve vitality of the tooth. 

Lateral cutting increases visibility and decrease chance of exposure.

Selective etching technique followed by two step self etch adhesive decrease post operative sensitivity and give perfect coronal seal.