Case Report by Karen Grace C.

Frias of DP41
Dental Specialty: Operative Dentistry
Case: Class II Composite Restoration
Description:
A composite restoration is a dental restorative material used to restore the
function, integrity and morphology of missing tooth structure. The structural loss
typically results from caries or external trauma.
Upon mouth examination on the patient, you can see that caries are
evident on different teeth and in different surfaces. The one I restored is tooth
number 36, which has a Class II disto-occlusal caries with ICDAS 4 because
there is localized enamel breakdown with dentin show.

OPERATION PERFORMED: Class II Composite Restoration

PREOPERATIVE DIAGNOSES: Pulpitis
POSTOPERATIVE DIAGNOSES: Reversible Pulpitis
DURATION OF PROCEDURE: 1hr 30mins
CASE HISTORY:
The patient, Hazel D. Amad is a 28 year old female complaining of
moderate sensitivity on her lower left arch. She does not exactly know where the
pain is coming from. The pain was moderate and usually caused by cold
beverages and relieved by warm beverages. Her last visit to the Dentist was last
December 25, 2016 for tooth number 46 extraction. After percussing different
teeth, we concluded that levels of sensitivity varies and it is greater on tooth
numbers 35, 36 and 37.
OPERATIVE PREPARATION:
Before operative procedures, first of, I prepared and accomplished some
in the ME form including basic information of the patient, the chief complaint,
history of present illness, medical history, and dental history. I presented a
treatment plan that is composite restoration and had the patient accomplished
and signed the consent. Also, prior to operative procedure, dental instruments
(basic instruments, shofu burs and others) were sterilized, PPE, disposable
items, enamel tray, cotton dispenser, waste receiver, bib holder, disinfecting
materials and cleaning materials were set and prepared. Since the patient has no
medical issue, no pre-medication was given. Before proceding, I and the patient
made sure we were wearing our personal protective equipment. I prepared my
materials on the dental chair bracket table, put water beside the patient. Then I
started the initial oral survey and finished the remaining checklist of the ME form.
OPERATIVE PROCEDURE:
I first let the patient be comfortable on her sitting. I positioned
myself on an eight oclock operator position. Using a small pear shaped bur, I
started to prepare the tooth number 36s cavity on the occlusal going to the distal
and went deeper between middle third and gingival third. I made sure there are
no weak enamel left and any questionable structure that may future lead to
recurrent carries. After having the preparation checked, I looked for the right
composite shade for the patient using the shade guide while the tooth is wet. She
has an A2 shade. After that, I isolated the prepared tooth to prevent
contamination of saliva and for easier and clearer working area and then I put the
matrix band assembly.
I then, dried the cavity area. Using a microbrush or micro
applicator, I applied 37% acid etch and let it sit for 15 seconds. After that, I dried
the cavity again using only the micro applicator. I put bonding agent and cured it
for 10secs. To make sure all areas of the cavity prepared are filled with
composite, especially in cases of deep and cavity with undercuts inside, I first
use the flowable composite. Cured it for 20secs. And the followed by packable
composite put incrementally and also light curing it for 20 secs per increment.
During packing of composite, I am already shaping the anatomy. And then I
polished the surfaces, checked her occlusion using articulating paper to detect
premature contacts and removed it.
After leaving the clinic, I disposed materials to be thrown, cleared
the bracket table, remove my ppe as well as the patients and the escorted her
outside the clinic.
FINDINGS:
I found out that the patient is prone to food impaction between
teeth. This is evident not only on tooth number 36 because most of her caries are
class II. During my tooth preparation, the mesial of 37 also has class II caries and
it is the same with her tooth number 35 with distal class II caries and 36 as well,
with mesial class II caries.
CONCLUSION: The other treatment to be done are class I restoration on tooth
numbers 15, 16, 17, 26, 27 and class II restoration on tooth number 14 and 37
since 35 and 36 were already restored. I would also recommend an orthodontic
treatment to correct alignment of teeth.