Approches innovantes en dentisterie restauratrice : une étude de cas

Une étude de cas récente du Dr Enzo Attanasio et du technicien dentaire Daniele Rondoni a abordé des problèmes dentaires complexes dans le quadrant 2, notamment des restaurations d’amalgames infiltrées et une lésion carieuse. Le traitement a nécessité une planification précise et des étapes stratégiques pour assurer une restauration optimale de la santé dentaire.

Le processus a commencé par l’élimination des anciennes restaurations d’amalgames pour évaluer avec précision l’étendue des cavités, tout en préservant autant de structure dentaire saine que possible. Pour la restauration directe des dents 2.5 et 2.7, un composite hautement chargé et thixotrope a été utilisé. Pour des cas similaires, des produits tels que le saremco els composite donnent également d’excellents résultats.

En raison de l’épaisseur insuffisante restante des cuspides sur la dent 2.6, une couverture complète des cuspides a été nécessaire et le saremco print CROWNTEC a été utilisé. Des techniques avancées d’empreintes optiques et de scellement ont été employées, conduisant à des résultats harmonieux et efficaces.

Ce cas souligne l’importance d’une approche précise et individualisée en dentisterie restauratrice. Avec les bons matériaux et techniques, des résultats esthétiques et fonctionnels durables peuvent être obtenus.

Quadrant 2. Initial situation. We observed the presence of two infiltrated amalgam restorations, at position 2.6 and 2.7, as well as a carious lesion at the distal wall of element 2.5.
We decided to intervene by means of two direct composite restorations on elements 2.5 and 2.7. The presence of undermining and pigmented enamel margins, which presupposes the presence of a very generously sized amalgam restoration, suggests the need to manage element 2.6 by full cuspal veneering. For the indirect restoration, a composite-based 3D printed resin is selected.

The removal of the two old amalgam restorations gives the operator the opportunity to understand the extent of the cavities, take note of the softened tissue at charge of the elements subject to treatment and to confirm the treatment plan

Once the mesial box of element 2.6 is opened, the carious lesion at the distal wall of 2.5 is clearly visible. The action space generated by the absence of the mesial marginal ridge of the first molar gives the operator the opportunity to proceed using a slot technique so as to spare as much healthy dental tissue

Removal of all softened tissue. The presence of pigmented reaction dentin from old amalgam restorations is still visible. This is healthy tissue that will not have to be removed, in order to be as conservative as possible

By using a thickness gauge, the thickness of the residual cusps of element 2.6 is assessed so that the therapeutic option of indirect restoration can be confirmed.
The presence of residual thicknesses of less than 2 mm at both walls (V and P) of the element confirm the need to intervene by complete cusp capping

A slot access is performed to remove carious tissue distal to element 2.5. The restoration will be performed in an extremely simple manner using a highly filled, thixotropic flowable composite such as Clearfil Majesty Low Flow

Removal of the vestibular and palatine cusps of element 2.6 is performed

By using a Clearfil Majesty Universal composite mass, the occlusal restoration of element 2 is performed.

Selective enamel etching of the element 2.6

The build up of element 2.6 is performed and finished using a highly filled Clearfil Majesti Low Flow fluid composite

Intraoral view of work’s first phase completion with the direct load restorations of 2.5 and 2.7 completed, and 2.6 ready for optical impression

Vestibular view of the performed build up

A 3D printed overlay is made using a highly filled resin such as Saremco Crowntech by MDT Daniele Rondoni

Reactivation, under isolation, of BU by sandblasting with 53 μm aluminium oxide

Using a heated Majesty Universal Dark composite for cementation

Removal of surpluses and intraoral enhancement of occlusal characterizations

Final result of cemented overlay and integrated composite restorations

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