On the topic of aesthetics and function, Anam Sadozai discusses large direct restorations utilising principles of biomimetic dentistry.
With improvements around dental awareness and an increase in life expectancy, a greater number of people are retaining their teeth into older age.
These teeth are most likely heavily restored, due to widespread dental caries in the population before the introduction of fluoridated toothpastes in the 1970s.
In our profession it is not uncommon for elderly patients to present with heavily restored teeth that have fractured. Patients presenting with such situations should be advised to have an indirect onlay to provide cuspal coverage as it reduces the risk of unfavourable fractures in the future.
However, there are a series of clinical situations in which this may not be practical.
This article covers a biomimetic approach to perform extensive direct restorations in compromised teeth (Alleman, Nejad, Alleman, 2017; Dionysopoulos and Gerasimidou, 2020).
Case study: patient presentation and examination
A 62-year-old patient attended with a large amalgam restoration in his UL6 that had recently fractured and was temporised with glass ionomer cement (Figure 1*).
This tooth had been root filled eight years ago. The root filling was only present in two of the three canals, however there was no associated periapical pathology and the tooth was asymptomatic.
Treatment options were discussed, and the patient was advised to have the tooth re-root treated with a specialist before covering it with a ceramic onlay.
As the tooth had been asymptomatic for eight years, the patient was not keen on having the re-root treatment, so we decided to restore the tooth with a composite restoration until the patient could gather funds for possible re-root treatment/onlay in the future.
Treatment procedure
After the patient was anaesthetised, rubber dam was placed, and the old restorative material removed. Caries was evident underneath the filling, which was cleaned (Figure 2*). Caries detector dye was used to check for any residual caries (Figure 3*).
*To read the rest of this article, view the photographs and gain CPD, visit cpd.dentistry.co.uk/courses/restoring-aesthetics-and-function
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