Dr Max Pura presents a restorative case that required fast and efficient treatment in order to overcome the challenges presented by an extremely dental-phobic patient.
A 44-year-old female patient attended the practice with pain in the lower left region. She had severe dental phobia and often panicked during treatment. As such, it was a big deal for the patient to try to address her dental issue at all. Consequently, the goal was to provide a quick and highly efficient solution, with as few steps as possible.
Assessment and planning
The patient presented with good oral hygiene, the gingival tissues appeared healthy with no clinical signs of active periodontal disease, and plaque and calculus levels were minimal. A comprehensive assessment was conducted, including visual examination and probing. Clinical photographs and a radiograph were also taken to assess the situation. A mesial-occlusal-distal (MOD) cavity was detected on the LL7. No additional carious lesions or soft tissue abnormalities were noted on examination.
The LL6 was also fractured and required attention.
Due to her dental phobia, the patient could not tolerate a rubber dam, which would make isolation and effective treatment of the LL7 more difficult. To increase speed of the treatment without compromising quality of the outcome, a bulk full composite was indicated to restore the tooth once the cavity had been cleaned.
For the LL6, a crown was recommended. To once again optimise speed and efficiency, a CEREC crown was suggested, which could be fabricated chairside from a digital scan on the same day.
The relative procedures were explained to the patient to ensure informed consent. Sedation was discussed as an option to help her tolerant treatment, however, she preferred to avoid it if possible due to bad experienced in the past and financial considerations. She was also keen to be treated in the practice and not be referred as she had built up trust with the practitioner and professional team. As such, the patient was apprehensive but ready to proceed.
Treatment delivery
On the patient’s return to the practice, the lower left quadrant was sufficiently numbed. The old restoration and damaged tissues were carefully but efficiently removed from the LL7 using a fast handpiece.
The tooth was then restored quickly and easily using the BRILLIANT Bulk Fill Flow from COLTENE. With predictable handling, this product makes faster placement possible with fewer adjustments, all the while ensuring excellent malleability and great shade matching. It can also be cured in up to a 4mm depth in 20 seconds, further supporting a streamlined workflow. For this patient the material helped me to deliver a good outcome despite the limitations faced by the patient.
The LL7 restoration was polished to a high lustre, blending seamlessly with the natural teeth.
To treat the LL6, a CEREC milled crown was placed, using BRILLIANT Crios shade A2 from COLTENE.
Outcome and reflections
The patient was delighted with the outcome achieved. The functionality and aesthetics of both her LL6 and LL7 were restored, using fast and efficient techniques that minimised the time she had to spend in the chair. In this case, a direct composite restoration was placed with satisfactory marginal adaptation, contour, and aesthetics. Although the patient exhibited mild procedural anxiety, she tolerated treatment well following reassurance. After her treatment, the patient was provided with post-operative instructions and she was advised to continue current oral hygiene practices and attend the practice for a routine review.
For more on COLTENE, visit https://colteneuk.com/, email info.uk@coltene.com or call 0800 254 5115.
Author: Dr Max Pura, GDC no. 179927, Principal of Pura Dental Care in London.
