CATEGORY AUSTRALASIAN DENTIST71 CLINICAL It is important to note that the protective coverage of MTA vpt can occur immediately or anytime up to three minutes after placement. Prior to adhesive application, selective enamel etching was performed using 35% phosphoric acid (Ultra-Etch, Ultradent) for 15 seconds, followed by thorough rinsing and gentle air-drying. Subsequently, a universal adhesive system (Futurabond U, VOCO GmbH) was applied according to the manufacturer’s instructions (Figs.1112). The cavity was restored using VisCalor bulk (shade A1, VOCO GmbH), a lightcuring, radiopaque nano-hybrid restorative material. Prior to application, VisCalor bulk was pre-warmed to 65°C using the VisCalor Dispenser (programme 1). The temperature increase reduces the material’s viscosity, facilitating effortless insertion of VisCalor bulk into the cavity and ensuring optimal adaptation to the cavity walls. In this case, VisCalor bulk was applied using the bulk-fill technique. Care was taken not to exceed the recommended increment thickness of 4 mm to ensure complete and effective light polymerisation (Figs. 13-15). Given the extent of structural tooth loss, VisCalor bulk served as a biobase to support the subsequent preparation of an indirect ceramic restoration made from lithium disilicate (IPS e.max CAD, Ivoclar Vivadent). In addition to the benefit that VisCalor bulk is applied in a flowable state, another advantage is that, once placed in the cavity, the material has gradually cooled down, increasing its viscosity and providing the properties of a sculptable composite. This facilitates anatomical contouring and sculpting prior to the final 10-second light-curing. VisCalor bulk therefore combines the handling advantages of a flowable composite with the mechanical performance of a sculptable restorative material. At a follow-up visit after ten days, the patient reported no pain or discomfort and showed positive pulp sensitivity. Given the absence of symptoms and favourable tissue response, the tooth was prepared for the final indirect restoration (Figs. 16-18), and impressions were taken. A temporary crown was not placed, as the biobase offered sufficient protection and function until luting of the final e.max restoration. The final crown was adhesively luted under absolute isolation using a dual-cure resin cement (Allcem Core, FGM) (Fig. 19). At the follow-up visit two weeks after luting, the tooth remained asymptomatic and continued to respond positively to pulp sensitivity testing. This indicated that pulp vitality had been successfully maintained (Fig. 20). No periapical radiolucency was observed on the follow-up radiograph (Fig. 21). Fig. 1 Pre-operative radiograph of tooth 47 showing deep caries without periapical translucency. Fig. 5 Caries removal in progress. Fig. 9 Application of MTA vpt onto the exposed pulp and dentine in close proximity. Fig. 2 Pre-operative buccal view of tooth 47 after rubber dam isolation. Fig. 6 Caries removal in progress. Fig. 10 Coverage of MTA vpt with light-cured glass ionomer (Ionoseal). Fig. 3 Pre-operative occlusal view of tooth 47. Fig. 7 Application of caries detecting dye (Caries Finder, Danville). Fig. 11 Adhesive procedure showing selective etching with 35 % phosphoric acid. Fig. 4 Caries removal in progress. Fig. 8 Completed caries removal showing pulp exposure at the distobuccal base of the cavity. Fig. 12 After application of universal adhesive (Futurabond U).
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