CATEGORY AUSTRALASIAN DENTIST75 exposure, an indirect pulp cap would be recommended to promote pulpal health. If symptoms worsen in the future, indicating irreversible pulpitis, the suggested procedures would be orthograde root canal treatment or the extraction of tooth 37. Treatment began with a thorough cleaning of the tooth. e appropriate shade for GrandioSO Unlimited was then determined on the still wet tooth using the shade guide provided with the system, which turned out to be A3. e ClusterShade-System of GrandioSO Unlimited simpli es the shade selection process, utilising just ve shades to cover all VITA® classical shades. Its chromo-adaptive properties enable easy blending with the natural tooth colour gradient, ensuring a seamless and natural-looking restoration. e treatment area was isolated using a rubber dam to maintain a clean working environment. Excavation of the carious defect was performed using a speeding increasing handpiece with coarse-grit diamond and tungsten carbide burs for caries removal. (Fig. 3). e preparation was nished with ne-grit diamond burs following the caries’ course, necessitating the opening of the distal proximal box. Alumina air-abrasion (29 µm, 4.0 bar) was used at the amelodentinal junction (ADJ) to enhance adhesion of the restorative material (Fig. 4). During the nal excavation, initial pulp exposure occurred, either from caries or iatrogenically, requiring direct pulp capping. A wooden wedge was used to seal the distal cervical margin, causing a tear in the rubber dam at the distal proximal area. Upon reassessment, it was deemed unnecessary to replace the rubber dam, as contamination control could be adequately managed using a small saliva ejector. Homogenously hand-mixed MTA vpt (VOCO GmbH, Cuxhaven, Germany) was applied as the rst layer for direct pulp capping following excavation and haemostasis with local anaestheasia to promote mineralised bridge formation. MTA vpt has a bacteriostatic e ect due to its high pH 12 and releases calcium and hydroxide ions that promote formation of tertiary dentine and remineralisation. For e ective caries management, small areas of carious dentine close to the pulp must be tightly covered with MTA vpt. An MTA block with a thin burnisher was used to successfully place the MTA vpt onto the exposed pulp (Fig. 5-7). e mixed paste may have a slight blue tinge, however, this colouring disappears after curing, leaving the material white-opaque. MTA vpt is free of bismuth oxide and ferrous compounds, thus, showing no product-related discolouration of the tooth. Immediately after application, the MTA vpt was carefully covered with a thin, su cient layer of GrandioSO Heavy Flow (Shade WO, white opaque) without pressure and light-cured for 40 seconds without prior conditioning or use of an adhesive (Fig. 8). e cavity was demarcated with a sectional metal matrix, and Futurabond U was applied as a self-etch adhesive. e 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). e 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). e occlusion was checked and the composite restoration polished following the polishing protocol, ensuring a smooth and shiny nish 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 CLINICAL Figure 3: Rubber dam isolation 37 and initial cavity preparation Figure 5: Hand-mixed MTA vpt shown in an MTA block to allow for an easier and measured pick-up of the material with an instrument Figure 7: Accurate placement of MTA vpt over the micro exposure on 37 at the base of the cavity Figure 9: Displaying building up of the distal wall of the restoration on 37 with GrandioSO Unlimited A3 Cluster shade Figure 4: Completed Cavity preparation 37 and clearing of ADJ with air abrasion (Alumina, 29 µm, 4.0 bar) Figure 6: Hand-mixed MTA vpt shown picked up on a narrow burnisher to allow for precision placement Figure 8: Illustrating precision placement of GrandioSO Heavy Flow WO to seal the MTA vpt immediately after application Figure 10: Displaying building up of the full restoration on 37 with GrandioSO Unlimited A3 Cluster shade and FinalTouch brown and white tints
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