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Management of Proximal Caries in Right Maxillary Lateral Incisor Using Composite Restoration

Chief Complaint:

Patient reported food lodgement and mild sensitivity in the upper front tooth region.

Medical History:

Non-contributory

Dental History:

No previous restorative treatment in the affected tooth.

Clinical Examination:

On intraoral examination, proximal caries was detected on the right maxillary lateral incisor (Tooth No. 12) on the mesial surface. The tooth was asymptomatic with no signs of pulpal involvement. Periodontal status was within normal limits.

Radiographic Examination:

Intraoral periapical radiograph revealed a radiolucent lesion limited to enamel and dentin, with no periapical pathology and an intact lamina dura.

Diagnosis:

  • Provisional Diagnosis: Proximal caries involving enamel and dentin in right maxillary lateral incisor.
  • Pulpal Status: Reversible pulp condition.

Treatment Plan:

  • The treatment was planned and executed by Dr. Kamlesh Pamnani at Arjun Dental Clinic in Mandsaur was as follows-
    1. Conservative caries removal using ceramic (Cera) burs
    2. Use of caries indicator dye to ensure complete removal of infected dentin
    3. Adhesive restoration using light-cured composite resin
    4. Finishing and polishing of restoration

Treatment Procedure:

  • After obtaining informed consent, the tooth was isolated using cotton rolls and suction.

    1. Caries Removal:

    Carious dentin was removed conservatively using ceramic burs (Cera burs). A caries indicator dye was applied to differentiate infected dentin from affected dentin. Selective caries removal was performed until only sound dentin remained.

    1. Cavity Preparation:

    Minimal invasive cavity preparation was done, preserving maximum healthy tooth structure.

    1. Restorative Procedure:
      1. Acid etching was performed using 37% phosphoric acid, followed by thorough rinsing and drying.
      2. A bonding agent was applied and light cured.
      3. The cavity was restored incrementally using composite resin, ensuring proper proximal contact and contour.
      4. Each increment was light cured as per manufacturer’s instructions.

Finishing and Polishing:

  • Occlusion was checked, and the restoration was finished and polished to achieve optimal esthetics and function.

Post-Operative Instructions:

  • The patient was advised to:

    • Avoid biting hard foods for 24 hours
    • Maintain proper oral hygiene
    • Report if sensitivity or discomfort persists

Outcome and Follow-Up:

  • At the follow-up visit, the patient was asymptomatic.          
  • The restoration showed good marginal integrity, proximal contact, and esthetic harmony with adjacent teeth.

Conclusion:

  • Early diagnosis and conservative management of proximal caries using ceramic burs and caries indicator dye allows precise caries removal while preserving healthy tooth structure. Composite restoration provides excellent esthetics and functional outcomes in anterior teeth.

Clinical Significance:

  • Use of caries indicator dye ensures complete removal of infected dentin
  • Cera burs offer minimally invasive and controlled caries excavation
  • Composite resin is the material of choice for anterior proximal restorations