Dr Neha Momin is the winner of the best case with toughest case selection and the popular choice award in the DR Pronto Esthetic Challenge 2, 2021-2022
Introduction
At first glance, a class III direct restoration can appear to be a fairly routine procedure. However, placement of physiologically contoured, esthetic Class III composite restorations can be a deceivingly difficult procedure. Often, these types of lesions present with limited clinical access, making traditional paste composites tough to place without creating marginal voids.
Flowable composites are better suited for this task due to their ease of placement. With all parameters being "ideal," a bioactive resin may be perfectly suited to restore these types of lesions, as long as it can produce the desired esthetic result.
With Activa ™(Pulpdent ®, USA), we have the ability to treat the tooth from within and strengthen tooth structure by replacing the missing calcium and phosphate that is lost in the decay process. Activa ™ is the first esthetic restorative to not only give us fluoride release and recharge, but also calcium and phosphate, which are the building blocks of tooth structure. This brings strength to the restoration and allows to truly restore a tooth, not just repair it.
Activa™ Pronto chemically bonds to teeth and seals against bacterial microleakage. It is far more durable than glass-ionomers and resin-modified glass-ionomers (RMGIs), and is as strong as and even more fracture resistant than traditional composites, which are hydrophobic and do not have bioactive properties.
Case Report
A 22- year old female patient presented with a chief complaint of discolored anterior teeth giving unesthetic appearance.
The clinical findings of the detailed diagnostic evaluation revealed crowding in upper & lower teeth due to which, interproximal hygiene maintenance was difficult, leading to class III caries in 12, 11, 21 & 22.
The patient’s dental needs were explained to her & she was offered the option of restoration of upper anterior teeth 11, 21 & 22 with Activa™ Pronto, followed by orthodontic treatment for alignment of upper & lower teeth for better esthetics and maintenance.
Restoration of rotated and overlapped 12 was planned during the 2nd / 3rd month of orthodontic phase, once it was in a better position to get good access & accurate contacts.
In this case report, the esthetic restoration of teeth 12 and 11 with warmed Activa™ Pronto after tooth blasting has been presented.
Restorative Approach
After the teeth were anesthetized, oral prophylaxis was done. Appropriate shade of the tooth was determined. After this, under rubber dam isolation, caries were excavated from mesial surface of 12 and distal surface of 11. (Fig 2)
Bevel refining was done with disc for smooth transition of the bevel with normal tooth surface which aids proper blending of composite. After that, tooth was blasted with aluminium trihydrate (Esthetrix Blaster) to remove biofilm for predictable bonding to fresh tooth surface (Figure 3.)
The preparation was etched with 37% ortho-phosphoric acid (Etch-Rite, Pulpdent) several millimeters past the bevel for 15-20 secs then washed with water (Fig 4). Enamel was air dried to check for frosty white appearance. Dentin was blotted leaving it slightly moist and a 5th generation bonding agent was applied (DenTASTIC UNO, Pulpdent) and light cured for 20 secs.
For this case I have used warmed Pronto to improve flow of its adhesive properties. Activa™ Pronto syringe was directly placed in a composite warmer (Esthetrix composite softener) for appropriate duration (Fig 6.)
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