Esthetic aspects in the treatment of class V carious lesions

Abstract

Introduction. Dental caries is considered one of the social problems. The gum around the tooth neck promotes the stagnation of microorganisms, eventually turning into plaque. The small thickness of the enamel at the level of the dental neck, 2.0 mm, makes this area much more vulnerable to various factors, such as incorrect brushing, neglect of oral hygiene or excessive consumption of carbohydrates, causing acid formation and demineralization of the already thin enamel. Direct restorations with a high aesthetic result please not only the patient but also the dentist, demonstrating the ability to choose the right material and its shade as well as the ability to model and restore morphologically the tooth. Aim of study. To analyze the esthetic parameters in the treatment of class V carious lesions by Black`s classification. Method and Materials. A study was performed on a sample of 7 patients - 5 women and 2 men, aged between 30 and 55 years, diagnosed with class V carious lesions by Black. The treatment of dental caries was performed according to the therapeutic stages corresponding to the carious lesion class. A major importance was given to the choice of the color of the nanohybrid composite, thus rendering a high aesthetics to the tooth. In the treatment of cervical caries, the stages of the clinical and paraclinical examination of the patients under study were observed, using the following materials: gingival retraction cord, rubber dam, 5th generation adhesive system, nanohybrid (polymerizable) photopolymerizable composite filling material. Results. All patients had class V caries in the vestibular area. Of these, there were 3 carious lesions in the front region and 4 in the lateral one. There were 3 superficial carious lesions and 4 medium ones. Following the treatment, a high aesthetics of the tooth neck area affected by dental caries was obtained. The necrotic and pigmented dentin was completely removed to prevent the composite color from changing (erroneous results), because the composite has a certain transparency. An important step is to undercut the enamel edges, the purpose of this step being to allow a high adhesion of the composite and to avoid the appearance of microcracks between the composite and the enamel. In addition, undercutting reduces the visibility of the boundary between the dental tissue and composite. The study revealed that the theoretical and practical knowledge of the dentist about the anatomy and morphology of the teeth is paramount, the choice of the treatment method being also very important. The choice of the color of the filling material, the type of filling material, good tooth insulation, and the use of gingival retraction cord are very important too. In order to avoid the injury of the gum and dentalgingival junction, the retraction cord was used; thus the gingival tissue remained intact. Conclusion. The clinical study showed that it is very important to obtain esthetic fillings in case of carious lesions of the tooth neck and not only, because patients have high requirements for an aesthetic smile. The carious lesions of the tooth neck have a high frequency. Poor dental hygiene and incorrect brushing are among the main causes. In order to obtain highly esthetic results in placing cervical fillings, it is very important to choose both the type of filling material and its color. Isolation of the tooth affected by the oral environment is of major importance in order to avoid the penetration of gingival fluid and saliva during the treatment, thus reducing the adhesion of the composite to the cavity.