Michal Ganowicz shares a case of deep caries using the Bio-Bulk filling technique with Biodentine to restore health and tooth function.
“I am an expert in conservative dentistry and endodontics with 20 years of experience working in Warsaw, Poland. My daily practice includes the treatment of complex issues such as obstruction and temporomandibular disorders. I am particularly passionate about the use of complex materials and the use of biological treatment methods. I fully support the power of attachment and the regenerative abilities of the pulp. During my lectures and workshops, I support the simplified dental treatment processes, as I firmly believe that it is the best choice for both dentists and patients.
Michal Ganowicz
The current method of choosing to treat teeth decomposition is to prepare the cavity and fill it with complex material. Proper execution, complex fills effectively restore teeth function and their effectiveness has been proven in millions of cases. However, this treatment is essentially addictive. Each filling, even the smallest, is prosthetic.
At the same time, we know that healthy enamel, dentin and pulp are valuable. A vital pulp produces dentin, nourishes hard tissues, performs stimuli and participates in immune response. A tooth with vital pulp is always better than a non -vital. Therefore, dentists should store the hard tissues of the tooth and pulp at all costs and use materials and methods that minimize the need for intervention.
Clinical signs and symptoms
The patient was hypersensitivity of tooth 16. The tooth had been treated two months earlier for a deep mod-paste with zinc-edgery oxide paste. Due to the bad mechanical properties of such a temporary fill, parts of the dentin were exposed, hence the symptoms of hypersensitivity. The pause test was negative. The answer to cold stimuli was normal.
Diagnosis
Deep caries, simple.
Process and treatment
After anesthesia and application of a rubber dam, the cavity was prepared. The dentin remained remarkable on the walls of the cavity chamber. A minimum of 2mm of hard tooth tissue remained fully prepared and hard around the margin of the cavity to ensure the waterproofing of future recovery.
The proximal walls were restored with the A3 Universal Composite after the engraving and using a universal welding system on the sidelines of the cavity. The rest of the cavity was filled with biopentine to the surface of obstruction. After 12 minutes of initial biopentine adjustment, the rubber barrier was removed and the patient was sent home. The next appointment was scheduled for two weeks.
Among the visits, the patient had no toothache and the sensitivity was reduced. The sensitivity to the cold was still normal. As a result, a rubber barrier was placed and removed 1.5 mm of the outer layer of biopente. In this case, it was not necessary to discover the tooth.
After selective enamel engraving with a universal welding system, the cavity was filled with a layer of A3 Universal Composite, prepared and polished.
Follow up
One year after the last visit, the patient is not sensitive and the tooth responds properly to stimuli.
Discussion
Untitled caries ultimately leads to the destruction of tooth tissues, inflammation and even the necrosis of the pulp. Therefore, the methods of selection must be those that can postpone the need to treat root and maintain the structure of the teeth and pulley of the pulp. Indirect biodendine cardboard coverage fulfills these criteria, as biopentinin has a positive effect on the pulp, promotes the restoration of mixing and dentin and acts as a rehabilitation material.
In addition, according to the author’s clinical experience and the observations of other authors, Biodentine works well in immediate pulp coverage in cases of irreversible polypros.
After filling the entire cavity with biopentine and wait 12 minutes, we can send the patient to the house. Unfortunately, biodentine is not appropriate as a permanent filling due to its voltage and color. According to the manufacturer’s recommendations, it can be used as long -term temporary filling for up to six months.
However, if we use the method of filling bio-bolts and cover biopentine with a layer of complex material 1.5-2mm, we eliminate the friction problem and aesthetics of filling while maintaining the positive properties of bioactive cement. In this case, the biodotine acts as a dentin substitute and the complex as a substitute for enamel. Together they can act as a permanent rehabilitation for many years.
Theoretically, we can cover Biodentine with 12 minutes after application. However, it is best to wait at least two weeks to completely heal the material if possible. After this time, it will have a micro-hardship such as natural dentin. It also achieves a stronger bond between the welding system and its surface. Another thought is the ability to control the vitality of the pulp over time. This will be particularly important in the case of immediate pulp coverage in a state of irreversible pulp.
Conclusion
The Bio-Bulk filling method with biopentine works well in the treatment of deep caries. Applying the bioactive cement to savory dentin maintains as hard as possible and significantly reduces the risk of pulp.
Biodontine as a dentin substitute, in combination with an outer layer of universal complex, works perfectly as aesthetic permanent filling.
This article is funded by Septodont.
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