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Special Issues
July/August 2021
Volume 42, Issue 1

Direct Resin Restorations for Caries Treatment and Maintaining Dentition in a Patient With Dementia

Gregori M. Kurtzman, DDS

Management of patients to preserve what dentition remains can be challenging when the patient has developed dementia issues. Homecare typically declines, and caries due to this and other factors such as dry mouth and high carbohydrate diets take a toll on the remaining dentition. An 84-year-old male patient, who was last seen in the practice 7 years prior, presented at his wife's insistence to address a broken mandibular anterior tooth. The wife indicated that her husband had developed increasing dementia since his last visit and had not seen another dentist over that time. The broken tooth was nonrestorable and caries was noted on adjacent teeth. A new partial denture was recommended to replace the existing poor-fitting flexible denture. Also recommended was restoration of the interproximal and cervical caries with restoration of incisal wear on adjacent teeth with a one-step fifth-generation bonding agent (DiaPlus, DiaDent, diadent.com), flowable resin (DiaFil Flow, DiaDent), and nanohybrid composite (DiaFil, DiaDent). These materials adapt well to the preparation and have minimal polymerization shrinkage and high fracture resistance with good wear properties, allowing their use in areas like the incisal edge or occlusal surface in patients with edge-to-edge anterior occlusion or parafunctional habits.

Key Takeaways

Sealing all enamel on the tooth during direct resin restoration with a fifth-generation adhesive helps prevent future caries due to demineralization, which is especially important in patients with poor oral hygiene.

Incisal wear presenting as "cupping" can be restored with a flowable resin with good wear and fracture resistance that possesses low polymerization shrinkage, minimizing postoperative sensitivity and marginal leakage.

DiaFil nanohybrid composite adapts well to the tooth without slumping, allowing anatomy to be shaped before light-curing without the material sticking to instruments for a strong, natural-looking esthetic restoration.

About the Author

Gregori M. Kurtzman, DDS
Master, Academy of General Dentistry; Diplomate, International Congress
of Oral Implantologists;
Private Practice, Silver Spring, Maryland

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