Rolling in The Deep – A Case By Dr. Manouchehr Kiaei

This clinical case involves a 45-year-old male patient who presented with a fractured tooth. The patient reported a history of a mesial amalgam restoration placed during childhood, approximately when he was ten years old. At that time, the permanent tooth #5 had not yet erupted, and the space left by the loss of a deciduous tooth was not filled. The patient expressed concern about a dark spot associated with the amalgam and requested its removal.

Given that a restorative procedure was planned for the tooth, the existing amalgam restoration was removed, along with any associated decay in the distal and occlusal areas. Additionally, the tooth exhibited an old composite restoration with significant marginal deterioration, resulting in a large cavity. After cleaning and preparing the cavity, a matrix and appropriate wedge were placed to ensure proper anatomical form and tight contact.

The cavity was then filled with Predicta Bulk composite material shade A2/B2 , slightly overfilled to account for polymerization shrinkage. The proximal surfaces were easily shaped, and excess material was polished to achieve smooth and functional restoration. The patient was satisfied with the final result, and the restoration is expected to provide longevity, potentially lasting around ten years under normal functional conditions.

In terms of durability, the primary consideration was minimizing occlusal forces on the mesial and distal ridges, as these areas are particularly susceptible to fracture. By directing occlusal forces more centrally on the occlusal surface, the risk of fractures in the restoration is reduced. This approach aims to optimize the longevity and performance of the filling while maintaining the integrity of the tooth.