Journal of Clinical and ISSN: 2640-9615 Medical Images Case Report Contribution of Ceramic Restorations to Create an Optimal Interproximal Area 1 1 1 2 2 2* Besrour A , Nasri S , Hassine N , Harzallah B , Cherif M , Hadyaoui D 1Qualification Resident, Department of Fixed Prosthodontics, Research Laboratory of Occlusodontics and Ceramic Prostheses LR16ES15, Faculty of Dental Medicine, University of Monastir, Monastir, Tunisia Faculty of Dental Medicine, Tunisia 2Qualification Professor, Department of Fixed Prosthodontics, Faculty of Dental Medicine, Tunisia Volume 2 Issue 4- 2019 1. Abstract Received Date: 30 Sep 2019 Amalgam has been a longtime, a very common procedure to restore decayed teeth. However the Accepted Date: 15 Oct 2019 demand for esthetic look of natural teeth pushes our patients to seek replacement of these restora- Published Date: 17 Oct 2019 tions. In the present paper, we report the case of a 28-year-old patient who was complaining about continuous food impaction between teeth number 46 and 45 because of the presence of aII class 2. Keywords restoration not respecting interdental area. The patient expressed also his desire to replace these Amalgam; Composite resin; old restorations by esthetic ones. Lithium disilicate inlay /onlay was placed in tooth number 46 CAD /CAM; Periodontium; next to a zirconia based ceramic crown on tooth number 45 in order to achieve esthetics and the Gingival diseases; Dental inlay; creation of optimal interproximal area. Dental porcelain 3. Introduction So, the appropriate restoration of proximal contact with recon- struction of correct anatomic contour as well as the provision Dental caries is a significant oral health problem worldwide and of appropriate proximal tightening is essential for periodontal nowadays, it is largely admitted that its treatment should focus health allowing self-cleaning process and also to maintain denti- on management of the carious process with a minimally inva- tion stability and occlusal harmony. sive approach[1, 2].Over 100 years ago, Dr G.V Black proposed a classification system to categorize carious lesions based on the Whether to restore directly with filling materials or to realize an type of the tooth affected and the location of the lesion. Cavities indirect restoration with composite or ceramic inlay-onlay is still on proximal surfaces of premolars and molars were defined as a challenging question for the practitioner. Class IIcavities [3]. It is largely admitted today that dental amalgam restorations have This type of cavities is characterized principally by the damage little place owing to their unesthetic appearance notwithstanding that it brings to the interdental area that consists of: the contact the issues around the Minamata convention on mercury). In fact, surface, the interdental papilla and four pyramidal embrasures: in 2013, the United Nations Environment Programme (UNEP) cervical, occlusal, buccal and lingual [4].The shape and the health reached a binding agreement to decrease dental amalgam use re- of interdental papilla are important in esthetics and in functions, garding its environmental impact. including the prevention of food impaction. Resin-based composite materials meet patient’s esthetic demand. The loss of the proximal walls leads to the loss of contact surface However, there is some evidence[6] contra-indicating the use of and open gingival embrasures which contributes to retention of resin composite materials via adhesive direct techniques in large food debris and can negatively affect the health of gingival papil- size cavities or to recreate contact area and proximal adjacent la. It has been proved that inappropriate restoration of proximal walls. This because ofmany disadvantagesdescribed including contact leads to retention of food debris resulting in tooth decay considerable polymerization shrinkage [7] depending on depth or periodontal disease and possible pathological movement[4, and location, in addition to high occlusal wear. It has also been 5]. proved that proximal contact of composite restorations may de- teriorate overtime. *Corresponding Author (s): Dalenda Hadyaoui, Qualification Professor, Department of Citation: Hadyaoui, Contribution of Ceramic Restorations to Create an Optimal Interproximal Area. Journal Fixed Prosthodontics, Research Laboratory of Occlusodontics and Ceramic Prostheses of Clinical and Medical Images. 2019; V2(3): 1-6. LR16ES15, Faculty of Dental Medicine, Tunisia, E-mail:dalendaresearch@ gmail.com clinandmedimages.com Volume 2 Issue 4 -2019 Case Report Bottenberg et al (2007) concluded on their study that quality of instruction and scaling which improved the gingival condition. surface, margin and contact point decreased significantly over 5 The removal of amalgam was realized under dental dam and years. followed by the excavation of recurrent caries subjacent to the Restorations generated with CAD /CAM technology ensure ideal restoration. occlusal morphology and ideal proximal contouring to restore Then the tooth 46 was prepared respecting the guidelines of decayed posterior teeth and to overcome some of the disadvan- inlays’ preparation. The unsupported and weak enamel was re- tages of direct resin composite.A wide collection of composite moved. The cavity walls were made divergent with rounded in- and ceramic materials are actually available for CAD /CAM tech- ternal line angles. As the axial wall was nearer to the pulp cham- nology. Ceramics are widely used as an indirect posterior resto- ber, a protective base of glass ionomer cement (FUJI I GC®, GC ration material because of their proved physical and mechani- CORPOSATION TOKYO JAPAN) was applied on the axial wall. cal properties. Current classifications divide ceramics into three types according to their composition: CAD /CAM glass ceramics, At the same time, the tooth 45 was prepared to receive a zirconia- CAD /CAM polycrystalline ceramics and CAD /CAM resin ma- based all ceramic crown using round diamond bur (#6856-014). trix ceramics[8]. It required a bevel shoulder preparations for labial, lingual, mesi- al and distal margins. All the line angles and point angles should Lithium disilicate CAD /CAM ceramic (like IPS E Max®, Ivo- be rounded off. The taper should be 5 to 15 degree. The prepara- clarVivadent) was introduced in 2006. It possesses high fracture tion was finished using multilayered carbide burs and finishing toughness which is higher than that of composite materials. and polishing discs (Figure 3). In this article, we will present a clinical situation in which a direct After final tooth preparation, the tooth 45 was cleansed and amalgam restoration was replaced by an indirect Lithium disili- dried. A simultaneous double-mixed impression was made with cate inlay, next to a non-vital tooth that was covered by a zirconia a polyvinylsiloxane material (Virtual, IVOCLAR VIVADENT, crown to ensure optimal recreation of interdental area. Schaan, Liechtenstein) after a double gingival cord retraction 4. Case Report (Figure 4). Shade selection was done using A-D shade guide®, IVOCLAR VIVADENT (Figure 5). A healthy 28-year-old man was referred to the department of fixed dental prosthesis, the dental clinic of Monastir, Tunisia. He In a clinical session, one week later, the zirconia coping (AM- was complaining of repetitive food impaction between the teeth MAN GIRRBACH®, Zirconia Disc, IVOCLAR VIVADENT) was 45 and 46 because of a restoration of the contact area causing him tried in and internal fit and marginal adaptation were assessed in pain and discomfort. The patient reported also an esthetic con- the prepared tooth (Figure 6 and 7). cern about the greyish aspect of amalgam restoration on the tooth A second impression was made with the framework placed on 46. the preparation (Figure 9). Clinical examination revealed a medium oral hygiene, a class II amalgam restoration on the tooth 46. This tooth responded nor- mally to cold thermal testing of pulpal vitality. The tooth 45 pre- sented also an extended class II resin-composite restoration. It responded negatively to cold thermal testing (Figure 1). The pre-operative radiograph showed an adequate endodon- tic treatment on the tooth 45 with absence of any radiographic changes. Clinical and radiographic examination revealed second- ary caries nearing pulp on 46. At inter-proximal probing, bleed- ing was observed (Figure 2). The Patient was interested in esthetical durable restoration. So, af- ter comprehensive evaluation of and collection of data regarding the patient’s complaint, a treatment plan including the replace- Figure1: Initial Situation ment of the amalgam filling in 46 with a lithium disilicate inlay a- An occlusal view and the application of a layered zirconia crown on 45, was devel- b- A buccal view demonstration the absence of interdental papilla be- oped. It had begun by an initial therapy consisting of oral hygiene tween the teeth 45 and 46. Copyright ©2019 Hadyaoui et al This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and build upon your work non-commercially. 2 Volume 2 Issue 4 -2019 Case Report Figure 2: Teeth preparation Figure 8: Final restorations Figure 3: Shade selection Figure 9: Final result Figure 4: Simultaneous double-mixed impression This impression was used to perform the ceramic inlay and to veneer the zirconia coping with porcelain layer (AMMAN GIR- RBACH® E MAX CERAM A1, IVOCLAR VIVADENT). These steps are realized at the same time