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Success With Class V Restorations In Day To Day Dentistry!


Dr Alpa Savla is the winner at 2nd position, the critics award of excellence for DR Pronto Esthetic Challenge 1, 2021-2022

Introduction

Development of different restorative materials presents the modern dentist with several choices when deciding how to best restore cervical cavities on the teeth.

Commonly known as Class V cavities (GV Black), materials considered appropriate for Class V restorations are:

Many Class V restorations are non carious lesions and present with little or no retention form. In such situations, the potential for material to bond to the tooth is most important as it may avoid the need to prepare sound tissue to achieve retention.

When cervical outline of the cavity is placed in dentin, it is difficult to obtain a proper and lasting marginal seal of the restoration (Phair and Fuller, 1985; Pintado and Douglas, 1988; Tortenson and Brannstorm, 1985). The main cause is polymerization shrinkage, which is directed incisally toward the reliable and strongly bonded enamel-composite interface (Davidson et al., 1984; Crim, 1987, Davidson and Kemp-Scholte, 1989).

A possible solution to this problem may be the application of material that renders the restoration sufficiently flexible to compensate for that part of shrinkage that challenges the bond.

Challenges in restoring Class V defects

  • Class V cavities are multi-factorial in origin
  • Polymerization shrinkage/C-factor stress resulting in failure
  • Sealed gaps under the restoration
  • Stress due to biting pressure causing the restoration to fail
  • Cervical outline of the cavity in the dentin resulting in incomplete marginal seal.

Case Report

A 65 year old male patient presented with deep Class V lesions in tooth no 34 & 35.

Cavity preparation

  • 0 no. retraction cord was placed to expose the cervical margin of the cavity.
  • Cavity was prepared by bevelling the margins and air abrasion.
  • Selective etching of enamel was carried out, followed by bonding (3M Adper Single Bond 2) was used.

Incremental layering

  • The first increment of the composite (Activa Pronto, Pulpdent® USA) was placed (less than 2 mm) from coronal to cervical and polymerised.
  • Second increment was placed cervical to the first increment and adapted slightly closer to the cervical margin.
  • The final increment was placed in the cervical region.

Finishing and polishing

  • Contouring was achieved using burs (SS White finishing burs).
  • Restoration was polished (Shofu Super Snap discs).

Discussion

Layering/incremental built up with bioactive filling materials such as Activa Pronto (rubberised resin) in Class V cavities very close to the pulp allows for fewer stresses to develop within the restoration, lesser shrinkage and long term marginal seal.

Restoring the dentin with thin horizontal layers that are 2 mm or less ensures that decoupling with time is properly achieved thereby reducing C factor stresses.

Using a hydrophillic resin like Activa Pronto in subgingival restorations facillitates ionic interaction that binds resin to the minerals in the tooth, forming a strong resin-hydroxyappatite complex and a positive seal against microleakage.

Summary

There is much debate and interest among clinicians as to which is the ‘best’ restorative material for different situations. Occlusal factors are considered to be important in the etiology of Class V cavities.

The use of rubberised resin (Activa Pronto, Pulpdent® USA) which can absorb stress and resist fracture can help the clinician in making highly durable and very esthetic Class V restorations.

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