Direct Restorations
Dentsply SDR - Smart Dentin Replacement
Occlusal Restoration

Occlusal molar caries

What two clues suggest this is an extensive lesion?

Access to lesion

What bur is most suitable for access when planning composite restoration, and why?

Check answer

High speed round bur. It is not always necessary to remove undermined enamel, as it can be bonded to the restoration. A round bur can enter the dentine without removing overlying enamel.

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Peripheral Caries Removal

What bur is most suitable for removing peripheral caries?

Check answer

Low speed round (rosehead) bur.

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Removal of peripheral carious dentine leaves unsupported enamel.

This would require removal for an amalgam restoration
But it may be retained if composite is used as enamel will be bonded to and supported by composite.

A large proportion of the cavity's buccal wall is now pure enamel.

Caries detector dye

Caries detector dye has been applied to reveal caries in undercuts peripherally (Operator preference, not a standard party of the procedure.)

Caries detector dye - peripheral caries

Wash after 10 seconds.

Still a bit of enamel-dentine junction caries left. This is removed with a rosehead bur (slow handpiece).

Caries detector dye - not reliable for pulpal caries removal

Pulpal caries removal is judged by hardness NOT dye penetration

Why do currently available caries detectors promote over-preparation?

Pulpal caries removal completes preparation

What is most suitable for removing pulpal floor caries?
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Hand excavator. Must be sharp, and used very carefully.
How much pulpal caries to remove is a hot topic at the moment - see our page on pulp-capping.

Lining (operator preference)

A thin layer (<1mm) of Resin-modified Glass ionomer has been placed over the pulpal dentine. (Operator preference)

Total etch (15 seconds)

Extended 1mm beyond margins and into fissures due to be sealed

Check etch pattern.

Check etch by washing and drying tooth. Ensure frosty appearance, and all fissures etched.

Apply Adhesive (Dentine Bonding System)

Follow manufacturer's instructions regarding evaporation, timing and curing.

Apply SDR Flowable Composite (max 4mm thickness in one go)

One increment was used, leaving 2mm for "capping" aesthetic composite.

Keep the tip in the material during injection.

Allow a few seconds for the SDR to self-level / adapt to undercuts

Light-cure the SDR - 20 Seconds

Place 2mm ‘Capping composite’ increment

Use your favourite aesthetic posterior composite. Finish shape as much as possible by hand before curing.

The SDR increment will bond in the normal way to it.

Apply Fissure Sealant to fissures and pits

Solvent-free surface sealant applied & light cured. Restoration Complete.

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