Direct Pulp Cap by Dr. Ahmad Fayad

Posted on May 15 2019

Noteworthy use of the Greater Curve technique by Dr. Fayad.

Introduction:

28 year old female with senstive Upper left first molar #26.

No spontaneous pain, no lingering pain, no pain on vertical percussion.

Diagnosis: Reversible pulpitis with normal periapex

 

Pre-Op

 

 

Good isolation is the key

Step 1

After removal of previous leaking composite and caries excavation, I exposed the pulp.

Soaked cavity with full strength bleach for one minute.

Step 2

 

Pulp cap placed

Step 3

After bleeding control, I apply the pulp cap material. I use Theracal, others use Duralon. In my hands, Theracal has a high success rate.

Greater Curve Standard band in place

Step 4

 

Post prime and bond

Step 5

After prime and bond (clearfil se protect), I seal the entire margin with a very thin layer of flowable composite (Majesty flow).

Placing composite

Step 6

Place composite in increments. I don't get carried away by placing anatomical features yet. I find when I try to create anatomy with uncured composite, I tend to stretch it creating voids and weak links between layers (others may have different opinions). A nice solid structure is what I aim for now, all packed nicely. Composite: Exquisite from Apex

 

Completed

Step 7

 

Completed

Step 8

Snap contacts

Post op BW

Step 9

 

Post op PA

Step 10

 

2 comments

  • Nathan Mayo: May 16, 2019

    I’ve always wondered why dentists think that curing in increments reduces shrinkage. 1+1+1=3 every time. I like that you sealed the margin with flowable, but I use 1 blob bulk fill with as many balls of precured composite as I can cram down into the mass. A very thick one like this would get 2 rounds of bulk and balls. Cure it all then cut it back. No one but another dentist cares about the nice anatomy and grooves. Good job, and I like your bleach idea. I do that too, during spoon excavation of deep DK where I know I am close to pulp………softens DK and kills bugs on the way in.

  • Tracey: May 16, 2019

    I noticed you have the tofflemire retainer upside down. Does the greater taper work better that way?

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