CATEGORY 72 AUSTRALASIAN DENTIST a self-etch adhesive. The distal proximal wall of the restoration on tooth 37 was then built up using the sculptable nano-hybrid composite GrandioSO Unlimited in the A3 Cluster shade, converting the class II cavity into a class I cavity (Fig. 9). The complete restoration was sculpted with GrandioSO Unlimited A3 Cluster Shade, and tints were added using FinalTouch composites in brown and white (VOCO GmbH, Cuxhaven, Germany) (Fig. 10). The occlusion was checked and the composite restoration polished following the polishing protocol, ensuring a smooth and shiny finish using small A.S.A.P. polishers (Fig. 11). A postoperative intraoral radiograph was taken, displaying the very deep restoration with the thin radiopaque layer of MTA vpt (radiopacity 290 %Al) at the base of the cavity, completed with GrandioSO Unlimited, noted for its high radiopacity of 900 %Al (Fig. 12). Overall, an excellent aesthetic and functional outcome was achieved for the patient. Upon review two weeks later, no symptoms or unfavourable outcomes were observed, indicating a successful initial healing. To ensure long-term success and address any potential late-onset issues, the patient will have scheduled follow-up appointments. These will take place at three months, six months, and one year posttreatment. However, the patient has been made aware of more invasive treatment options that may become necessary if symptoms arise in the future. Final remarks Managing a tooth with deep caries approaching the pulp chamber, as with any successful treatment outcome, begins with an accurate diagnosis. The decision to preserve the pulp hinges on clinical evaluations, including symptoms, radiographic data, and pulp sensibility testing [Stangvaltaite et al. 2013]. In this case, since the patient did not display symptoms of irreversible pulpitis, the primary objective was to maintain the CLINICAL vitality of the pulp and prevent further disease progression. Radiographic examination indicated likely pulpal exposure due to caries, making rubber dam isolation essential. The application of MTA highlights a minimally invasive approach, aiming to preserve natural tooth structure and function. Using an MTA block with a thin burnisher, the MTA vpt was successfully applied for direct pulp capping. GrandioSO Heavy Flow was ideal for sealing the MTA plug prior to the bonding protocol with Futurabond U. GrandioSO Unlimited was effectively used for restoring the deep margin of the cavity, noted for its bulk placement capability, short curing time, and high filler content (91 %w/w). This makes it suitable for posterior restorations that are difficult to access and require strong compressive strength, nevertheless, show excellent aesthetics. Confusion frequently arises when defining the difference between pulp capping and partial pulpotomy. Partial pulpotomy removes 2-3 mm of the pulp tissue at the site of exposure; this technique is used for removing the superficial layer of infected or inflamed tissue. Pulp capping does not involve any pulp tissue removal; instead, the biomaterial is placed in direct contact with the pulp tissue [ESE 2006]. This case demonstrates successful pulp capping, facilitated by the ease of material mixing and handling, enhancing incorporation into routine dental practice. Presenting all available treatment options from least to most destructive is crucial. Innovative materials like MTA vpt expand options for vital pulp therapy. To allow for easier placement of the material an MTA block and a thin instrument can be advantagous for neat pin-point placement, ensuring that the material does not contact the amelodentinal junction. Moreover, sealing the material in its entirety prior to commencing the usual bonding protocol is essential. Flowable composites like GrandioSO Heavy Flow WO assist in sealing due to their surface affinity and visibility at the base of a cavity. The patient experienced a successful outcome, with complete resolution of the symptoms at the two-week follow-up, and regular monitoring will continue. The patient was also informed of more invasive future treatment options, should symptoms recur. This approach underscores the importance of conservative techniques and advanced materials in modern dental practice, ultimately providing a beneficial outcome for the patient. u Literature Bergenholtz G (2000) Evidence for bacterial causation of adverse pulpal responses in resinbased dental restorations. Critical Reviews in Oral Biology and Medicine 11, 467–80. Cox CF, Hafez AA, Akimoto N, Otsuki M, Suzuki S, Tarim B (1998) Biocompatibility of primer, adhesive and resin composite systems on non-exposed and exposed pulps of non-human primate teeth. American Journal of Dentistry 11, S55–63 ESE (2006) European Society of Endodontology. Quality guidelines for endodontic treatment: consensus report of the European Society of Endodontology. Int Endod J. 2006 Dec;39(12):92130. Lee SJ, Monsef M, Torabinejad M (1993). Sealing ability of a mineral trioxide aggregate for repair of lateral root perforations. J Endod. 19(11):541-4. Pameijer CH, Stanley HR (1998) The disastrous effects of the “total etch” technique in vital pulp capping in primates. American Journal of Dentistry 11, S45–54. Pitt Ford TR, Torabinejad M, Abedi HR, Bakland LK, Kariyawasam SP (1996) Using mineral trioxide aggregate as a pulp-capping material. Journal of the American Dental Association 127, 1491–4. Stangvaltaite L, Kundzina R, Eriksen HM, Kerosuo E (2013) Treatment preferences of deep carious lesions in mature teeth: questionnaire study among dentists in Northern Norway. Acta Odontologica Scandinavica 71, 1532–7 World Health Organization (2017) Sugars and dental caries. Geneva, Switzerland: World Health Organization. WHO publication no: WHO/NMH/ NHD/17.12. Address for correspondence Dr. Ashish Soneji Queen Square Dental Clinic Bristol, United Kingdom
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