Posterior Molar 2nd opinion
As this is my first case posting on this forum I will give a bit more of a detailed approach to my workflow for the group. I will be less detailed in the future but I always use the same techniques when restoring with direct composite.
This patient presented to my office for a second opinion after being tx planned for a root canal with build up and crown at his insurance based dentist. Upon testing this tooth, the pulp was dx'ed as reversible pulpitis and healthy apical tissues. I explained to the patient the possible need for root canal therapy in the future but at this time we would restore this tooth properly and keep an eye on the pulpal status.
I used Biomimetic restorative principles as taught by David Alleman and Simone Deliperi to restore this tooth with a stress-reduced direct composite.
I removed all carious tissues according the publication 'A systematic approach to deep caries removal end-points: the peripheral seal concept in adhesive dentistry' by Alleman, Magne. In order to facilitate caries removal I used Caries Indicator dye which is what you see remaining. This was purposefully left over the pulp horn as this was greater that 5mm in depth from the corresponding occlusal surface.
I used hydro-abrasion to treat the dentin prior to my bonding protocols to increase the bond strength of my adhesive layer. I then followed air abrasion with my immediate dentin sealing (IDS)bonding protocol of using a self-etching DBA (Kuraray SE protect bond). I then completed resin coating (RC) of my IDS using a thin layer of flowable composite.
After resin coating, I then use hydro abrasion once again over the entire tooth surface prior to total acid etching. The hydro abrasion removes any accidental bonding agent that was applied to the enamel layer prior to etching and also increases bondability to my flowable layer.
I then build up the enamel replacement portion of the proximal wall according to protocols in the publication ‘Functional and Aesthetic Guidelines for Stress-Reduced Direct Posterior Composite Restorations’ by Simone Deliperi. I used thin (1mm) horizontal layers for my dentin replacement.