Lower 1st molar with old bad amalgam filling restored by direct composite restoration that reinforced by Ever X posterior for dentin replacement and moer strength to the filling
When the patient can’t tolerate the cost of indirect lithium disilicate we should think of direct or semidirect restoration that afford an alternative solution with less cost than the indirect restoration
Here I choose to do direct restoration with composite and reinforced it with fibers that prevent cracks and fractures through the filling and so decrease the failure of the restoration, and with the evolution of adhesive system the fear of debonding become nothing if the steps of bonding done correctly, so I have great bonding system and I have fibers to reinforced the restoration so that should be the best alternative urgent treatment 😀
Here some steps for long life bonding system
Immediate Dentin Sealing (I.D.S) is a concept by Pascal Magne that describe the infiltration of newly cut Dentin with Dentin adhesive to create the hybrid layer that mimic the dentino-enamel complex protecting it from bacterial leakage
Resin coating (RC) placing a thin layer (0.5)mm of microfilled flowable composite to protect the underlying hybrid layer and also let the adhesive resin to complete the polymerization reaction ((Jayasooriya et al .,2003))
IDS+RC will enhance the dentin bonding strength, the two protocol will increase the strength of dentin bond about 400% ((Magne et al .,2005 , Jayasooriya et al .,2003)
DWT (Decoupling with time) is anew concept by David Alleman that mean after curing the dentin bond we should wait for some minutes (decouple) to allow dentin bond get mature ((Alleman, 2021))
This importance of this time out time is very critical, it gives the resin monomer to convert into oligomers then finally small polymer , the rate of this conversion will completing 80-90% of monomer conversion ((Davidson et al ., 1984));((Feilzer et al .,1987))
So , IDS was done with gold standard clearfil SE bond , RC with flowable composite and the final restoration was direct composite
References
1- ALLEMAN . Decoupling with time.
2- Immediate Dentin Sealing: A Fundamental Procedure for Indirect Bonded Restorations (PASCAL MAGNE) . 2005
3- Efficacy of a resin coating on bond strengths of resin cement to dentin (Jayasooriya et al). 2003
Initail state showing the old defective amalgam ,distobuccal wall fracture
Isolation with rubberdam by using active wing clamp for subgingival placement of clamp
Old amalgam removed, all soft caries removed , trummatic pulp exposure occure ,going to direct pulp capping
Application of NeoMTA putty after 2 minutes of stopping of bleeding
MTA covered by RMGIC ,Sandblasting the cavity prior to bonding
_IDS with gold standard Clearfil SE bond from kuraray
_RC with flowable composite
_Proximall and buccal walls buil up by tukoyama composite
Ever X posterior fiber reinforced composite for dentine replacement , Can stop the cracks propagation through the filling which is consider one of the main cuases of composite failure
Immediate result
Slight finishing and polishing
Immediate after rubberdam removal
Checking high spots
After removing a slight high spot that present
Final result after finishing and polishing
Post operative X ray
12 months follow-up
12 months follow-up
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