About the Case
This 30-year-old male presented with irreversible pulpitis on tooth #18. Significant recurrent decay was present underneath a poorly done Class V composite. He was a new patient emergency referred by a staff member.
With the Coronavirus Pandemic looming, I was compelled to provide a long-term endo-restorative outcome that did not involve the multiple appointments required for an indirect restoration. In addition, these “pumpkin shell” type caries may be poorly served with a traditional full crown because the “outside shell” of the tooth is nearly all that remains.
The ability to adapt flowable deep in the tooth is more predictable than trying to pack or inject traditional paste composites. The problem, until now, was that bulk fill flowable composites have been particularly prone to bubbles. In my hands the new “low bubble” delivery system from 3M (3M™ Filtek™ Bulk Fill Flowable Restorative) provides a consistently bubble free bulk fill flowable composite.
Endodontic therapy is complete and caries removal is confirmed.
Lateral cuspal overlay preparation protects the buccal cusps, and Clark Class I preparation splints the lingual cusp
After 3M™ Scotchbond™ Universal Adhesive application and 10 second light curing, a layer of 3M™ Filtek™ Bulk Fill Flowable Restorative is placed over the gutta-percha stumps and light-cured with the 3M™ Elipar™ DeepCure-S LED Curing Light.
A 3M™ Filtek™ Bulk Fill Flowable Restorative “curb” is placed and light cured to improve management of the injection phase
Adhesive is reapplied and warm 3M™ Filtek™ Bulk Fill Flowable Restorative is injected, followed by warm 3M™ Filtek™ One Bulk Fill Restorative.
A 3M™ Sof-Lex™ Extra-Thin Contouring and Polishing Disc is key during sculpting of the cuspal areas, margination of the infinity edge, and pre-polishing.
Simple occlusal anatomy is carved with the Q-Finisher® from Komet®.
A TruContact Saw (Bioclear®) is used to clean and groom the unrestored mesial contact.
Magic Mix (Bioclear®) is worked over the entire tooth-restoration complex to achieve stain resistant infinity edge margins.
The RS Polisher (Bioclear®) is used with light pressure in the dry phase, heavy pressure and steady air-water spray during final polishing.
3M™ Filtek™ One Bulk Fill Restorative Composite, Shade B1, is used for a balance of esthetics and performance, plus 4mm depth of curve.
Pre- and post-operative radiographs of the completed endo-restorative procedure.
