Multiple class v case presentation

Dr.Mohammed MorganDr . Mohammed Morgan

Thanks Dr.Ahmed Mossad
For your Great Effort .

Prescribe Mouth Wash
encourage patient for brushing
schedule another appointment
So Lets :
polishing the patient teeth

polishing paste
After 1week
No stains
No or Mild gingivitis
So, Lets
Start

Clinical Note :
before caries removal , Gingiva should be retracted away
To avoid its injury during caries removal .
Injury = Bleeding = bad vision = problem in isolation

Dentech KSK clamp
No. 44Suction
Tip
Cord Shadow
The
Most
Important
Step
IsTeflon
Isolation

To what extent of bevel in class V composite ?
To the Middle third
Of the tooth
WHY

The Problem :
Proximety of
the cervical
1/3 of the
tooth to the
alveolar
bone
( fulcrum )
The gingival
margin of any
restoration
undergo
a considerable
Amount of
flexture during
masticatory
process .
This Stress
concenteration
Is the problem
Especially in
patient who
grind or clench
their teeth .
( Bruxism)
Reference : “Smart” Class V Preparation Design for Direct Composites | Dentistry Today

The Problem :
Without treatment,
these abfraction
lesions can
progress toward
the center of the
tooth, and eventually
weaken the entire
natural clinical crown
Enamel is
brittle but
dentin is
resilient so, The
enamel in this
area can
cleave,
forming a
notch like
abfracted
area
SO,
Long-term
restoration of
this area is
difficult
because of the
continued
stress on the
gingival margin
of the
restoration

benefit of extending bevel
to Middle 1/3 :
3
maximize the amount of
micromechanical
retention to enamel so the
effects of flexural stress on
the restoration will be
minimized
allow the composite
material to better blend
aesthetically with the
natural tooth surface
eliminating the appearance
of demarcation line
between composite and
natural tooth structure.

after
Scheduled in another visit to
encourage patient to complete
After seeing the difference in
the teeth restored before .

What
do you
think ?
Cap
the pulp
or
RCT

No history of spontaneous pain
No Tenderness to percussion
Bleeding from the exposure site is controlled
Contamination control
Size of the exposure is less than 1 mm
Pulpal exposure due to traumatic injuries is more
favorable than carious pulpal exposure.
So, Lets cap it
Factors Aﬀecting Prognosis of Direct pulp capping

Calcium hydroxide Or MTA
Review suggests direct pulp capping
with MTA more effective than
calcium hydroxide
Calcium hydroxide which is regarded as the gold standard for pulp capping
NOW, several disadvantages of
Ca(OH)2 have been reported, including high solubility
in oral fluids and the formation of tunnel defects in
dentin bridges .

MTA induces proliferation of pulp cells
The new dentin bridge that is formed has
thickness and a hardness far
higher than that which is
obtained by dressings with
calcium hydroxide ; also this is
done in a shorter time compared to the
time taken from ca (OH)2
less solubilityMTA forms a superior dentin bridge with less
underlying inflammation than Ca(OH)2

Clinical Notes
Bleeding is normally controlled by placing a cotton pellet
soaked in a solution on the exposed pulp.
A variety of solutions have been used, including
saline, sodium hypochlorite (concentrations ranging from 0.12% to 5.25%),
hydrogen peroxide, ferric sulfate and chlorhexidine .
Saline or calcium hydroxide solutions
are the most benign to the pulp in cytotoxicity tests.
2
A minimum thickness of 1.5 mm
of MTA is recommended
To be placed over the
Exposure site .

Clinical Notes
Control of bleeding from the exposure site is
an important factor , it refer to the degree
of
Inflammation
Of the
Underlying
Tissue .
Ref : grossman endodontic practice 13ed textbook

Clinical Notes
MTA is adapted easily By using A moistened
Micro brush .
PATEL, N. (2014). Comparing Gray and White Mineral Trioxide Aggregate as a Repair Material for Furcation Perforation: An in Vitro Dye Extraction
Study. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. doi:10.7860/jcdr/2014/9517.5046
Ref :
There are two types of MTA available: Gray and White
Gray MTA gives a discoloration to tooth and gingiva So,
Gray MTA is not used where aesthetic is the prime concern .
Because
Gray-coloured MTA contain tetracalcium aluminoferrite ( ferrous oxide)
the absence of signifcant FeO in White MTA causes the colour change from Gray to White
SO , lower iron oxide content used in the White MTA ( less discoloration )

Also, Capped with MTA
as indirect pulp capping

y Remaining dentin thickness: This is the amount of remaining dentin
present between the floor of the cavity and the pulp space. Studies have
shown that a remaining dentin thickness (RDT) of 2.0–0.5 mm has a good prognosis
as the secretion of the reactionary dentin is more in such cases.
When the RDT is between 0.5 and 0.25 mm, the reactionary dentin is reduced
due to decreased odontoblastic activity. This in turn reduces the prognosis.
One of The most important factors determining
the success of indirect pulp capping is :
Ref : grossman endodontic practice 13ed textbook

Then Capping MTA with Theracal

Caries
After caries removal from proximal area
in the next visit
Still have

Direct capping
Of exposure
With MTA
Then Covered
With Theracal
T.F After complete
Caries removal
in the next visit

not in the same visit
Of capping
Is a problem ?
Final restoration

Enamel bonds are
compromised with
most self-etching
primers.
his deficiency
may be overcome
using the
“selective etch”
technique

The same way of isolation
Sectional matrix
Stabilized in place
by

Go for pulp capping if
all conditions of it are
met
But,
Don’t forget to place
final restoration in the
same visit of capping.
2
I think rubber dam
sheets not mandatory
for isolation in
Such cases
You can do it via
retraction cord , Teflon
and clamps
1
Conclusions

Multiple class v case presentation

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Multiple class v case presentation