Dr.Bharathi Mahadevaiahis the winner of the Silver award for much appreciated cases in the DR Pronto Esthetic Challenge 2, 2021-2022
Introduction
Dental composites have acquired an unmatchable level of popularity in the world of direct restorative materials in today's era of dentistry. The two main characteristics of composites include esthetic properties and bonding to the tooth structure. The major drawback of traditional composite is bio mineralization. Numerous research for an esthetic material with good physical properties has brought us a step closer to the resin composites with new filler designs, a change in the organic resin component along with fluoride release. The material that cumulates the advantages of the composites and GICs. To make it true in the sense of the term, a new bioactive material Activa™ Pronto (Pulpdent®, USA) has been introduced. The present case report has utilized this material to treat the deep class III caries. Activa™ mimics the physical and chemical properties of natural teeth by combining the strength and esthetics of composites with all the benefits of glass ionomers. The key components of Activa are:
patented bioactive ionic resin
patented rubberized resin and
bioactive ionomer glass.
Bioactive ionic resin is moisture tolerant with high release and recharge of calcium, phosphate, and fluoride ions. Rubberized resin is extremely tough and durable and mimics the physical properties of the tooth. Bioactive ionomer glass bonds to the tooth and has a high fluoride release. Hence, it has a wide array of indication right from conventional Class I, Class II, and Class V caries to the complex carious lesions involving multiple surfaces. It is also indicated in cases where the isolation is compromised and in patients with high caries index due to its fluoride-releasing properties. The present case report has utilized this material to treat the deep class III caries.
Case Report
A 22 year old female patient reported to the clinic with the chief complaint of decay in the upper front tooth, and an unsighty smile. Clinical examination revealed a primary diagnosis of Class III dental caries irt 22 and secondary caries irt 11 21 12. Investigations done were the cold test and EPT test, both yielded positive response. This confirmed the primary diagnosis. Material selected was a bio-mimetic restorative material, the Activa™ Pronto composite material.
Hence, Activa™ Pronto can be a material of choice in restoring deep carious lesions due to their superior physical and mechanical properties.
Diagnosis-led management of deep anterior caries
Depth on a radiograph does not by itself determine pulpal treatment. Combine symptoms, sensibility tests, percussion, periodontal findings, caries activity and restorability. The objective is to control disease and preserve pulp vitality when biologically appropriate.
Operative priorities
Establish isolation and access that preserves facial enamel where possible.
Remove caries to sound peripheral enamel and dentin for a reliable seal while avoiding unnecessary pulpal exposure in the deepest area.
Select matrixing and wedging that reproduce the proximal contour and contact.
Use an adhesive and composite strategy compatible with the substrate, cavity depth and curing access.
Pulpal protection and review
Material choice should follow the pulpal diagnosis and remaining dentin rather than routine placement of a thick liner. If exposure occurs, reassess whether vital pulp therapy, endodontic care or referral is indicated. Review symptoms, vitality and marginal integrity over time.
Aesthetic integration
Control opacity and translucency, place the facial enamel layer conservatively and finish proximal line angles and surface texture. Verify contact, floss passage and occlusion before polishing.
Does deep caries always require root canal treatment?
No. The pulpal diagnosis, symptoms, vitality and clinical findings determine treatment.
What is selective caries removal?
It preserves affected tissue near the pulp when complete excavation would create unnecessary exposure, while obtaining a sound peripheral seal.
Why preserve facial enamel?
It supports bonding, aesthetics and conservative access in anterior teeth.
How is a proximal contact recreated?
Appropriate matrix adaptation, wedging, composite placement and finishing are required.
What requires follow-up?
Monitor symptoms, pulp vitality, proximal health, contact and restoration margins.
References
[1]Young DA, Nový BB, Zeller GG, et al.. The American Dental Association Caries Classification System for Clinical Practice Journal of the American Dental Association. 2015. DOI: 10.1016/j.adaj.2014.11.018. Available at: source
[2]Miao C, Yang X, Wong MCM, et al.. Rubber dam isolation for restorative treatment in dental patients Cochrane Database of Systematic Reviews. 2021. DOI: 10.1002/14651858.CD009858.pub3. Available at: source
Dr. Rockson Samuel is a dental surgeon, healthcare content strategist, and Founder and Chief Dentist of Indira Dental Clinic in Vellore, Tamil Nadu. He provides comprehensive general and family dental care with professional interests in endodontics, implant dentistry, clear aligner therapy, digital dentistry, preventive care and patient education. A graduate of K.G.F. College of Dental Sciences and Hospital under Rajiv Gandhi University of Health Sciences, he also has formal training in management and digital marketing. As Community Leader at DentalReach, he contributes to dental publishing, professional education, international media partnerships and the development of evidence-informed resources for dentists.
