MiCD Clinical Techniques
Create BioLogically Beautiful Restorations
MiCD GN aims to provide educational resources to help dentists embrace the MiCD concept and treatment protocols in routine clinical practice.
Case prepared by Dr. Anand Narvekar (IN)
Aesthetic Restoration of Severely Crowded Anteriors
Crowded Anteriors 55 years old female patient visited the dental office with a chief complaint of pain in the upper front tooth. Clinical examination and IOPA radiograph revealed badly decayed tooth 11 with multiple class 3 cavities on tooth #12, 21. This complex case was managed based on a phased treatment approach in 3 stages.
Phased Restorative Approach
Appointment 1 (Blue Rubber dam) – Removal of decay on the distal surface of tooth #11 was done followed by root canal treatment. Due to the extent of the caries lesion the mesial class 3 cavity was left untouched to avoid fracture of the crown during the course of the treatment. Removal of decay from tooth #12 was done both misally and distally.
Figure 1 & 2
Palatal and Labial view of before and after restoration
Figure 3
After removal of caries in tooth #11, 12 and you need patience to invert the rubber dam in such a deep cavity margin.
Figure 4
After careful insertion perfect seal achieved with teflon tape which rolled like a retraction cord before root canal treatment.
Appointment 2 (Black Rubber dam) – Fiber post was bonded using Para core followed by restoration of tooth #11 distal surface and mesial surface of tooth # 12 using a Bioclear matrix.
Figure 5
Cavity walls were prepared for the adhesive procedure before placement of Post & core on tooth #11 after RCT. Post selected due to severe destruction of palatal surface.
Figure 6
Palatal view after air abrasion and acid etching on Tooth #11
Figure 7
After bonding the post, full anatomical build-up on tooth #11 with Beautifil II LS shade A2O.
Figure 8
Palatal view of the free hand build-up of tooth #11 after bonding the post.
Figure 9
Bioclear Matrices placed and Beautifil Injectable X shade A2 injected.
Figure 10
Build-up completed with the convenience of Inject & Shape.
Figure 11
The excess material removed with a fine diamond bur.
Figure 12
After removal of the excess material.
Figure 13
After finishing the restoration on tooth #11
Appointment 3 (Military green rubber dam) – Remaining Class 3 restorations on tooth #11 and #21 were completed with final finishing and polishing of restorative surfaces to achieve the natural aesthetics and enamel luster. The patient was strictly advised to use a water flosser to maintain good oral hygiene which is imperative for the longevity of the restorations specially with crowded anterior teeth. A minimally invasive direct restorative approach was implemented at this stage as the bite was atraumatic and free from interferences in dynamic occlusion.
Figure 14
Cavity preparation on mesial surface of tooth #11 & 21.
Figure 15
Restoration of the mesio- cerical area with Beautifil Injectable X shade A2O.
Figure 16
Bioclear matrices placed and restoration of tooth #11 & 21 were done simultaneously with Beautifil Injectable X shade A2.
Figure 17
Well contoured restorations with minimal excess.
Figure 18
Finishing and polishing all the restored surfaces on tooth #11,12 & 21 with Super-Snap Xtreme disk system and OneGloss.
Figure 19
After removal of rubber dam and super polishing with Diamond Polishing paste and Super-Snap disk.
Figure 20
Recall visit after one week.
Figure 21
Visible healing of the distal papilla after one month post-op.
Preserving Health, Enhancing Smiles
Minimally Invasive Cosmetic Dentistry
(MiCD) is a holistic patient-centric treatment approach
