Dental Filling Procedure Note

Chief Complaint: Sharp pain in the lower left molar (tooth #36) when biting down, present for the last 3 days. History of Presenting Complaints: Patient reports a sharp, intermittent pain localized to tooth #36, especially when chewing or applying pressure. She also notes occasional sensitivity to cold beverages, which subsides quickly. No spontaneous pain or pain at night. Visual inspection revealed a small, dark pit on the occlusal surface, indicating possible recurrent decay beneath an old amalgam filling. Past Dental History: Patient has a history of multiple dental fillings, including an amalgam restoration on tooth #36 approximately 8 years ago. No history of root canal treatment or extractions on adjacent teeth. Regular dental check-ups every 6-12 months. No known allergies to dental materials or anaesthetics. Procedure: Anaesthesia: Inferior Alveolar Nerve Block and Lingual Nerve Block administered using 1.8ml of 2% Lidocaine with 1:100,000 Epinephrine. Patient reported adequate anaesthesia after 5 minutes. Decay Removal: Old amalgam filling on tooth #36 carefully removed with a high-speed handpiece. Extensive caries noted beneath the existing restoration, extending into dentin. All carious dentin excavated using a slow-speed handpiece with a large round bur until healthy tooth structure was confirmed. Minimal pulpal exposure risk noted due to conservative removal. Bonding Process: The prepared cavity was etched with 37% phosphoric acid for 15 seconds, rinsed thoroughly, and lightly air-dried. "OptiBond FL" primer was applied for 20 seconds, air-thinned, and then the adhesive resin was applied and light-cured for 20 seconds. Restoration: A sectional matrix band and wedge were placed to restore contact points. A thin layer of flowable composite (shade A2) was placed as a liner. The tooth was then restored incrementally with universal composite resin (Filtek Supreme Ultra, shade A2). Each increment was meticulously adapted and light-cured. Occlusal anatomy was carefully sculpted to mimic natural tooth contours. Curing: Each increment (approximately 2mm) was light-cured for 20 seconds using a "Valo Grand" LED curing light at standard power. Total curing time ensured complete polymerisation. Finishing: Matrix and wedge removed. Gross flash removed with a fine diamond bur. Occlusion checked in centric and eccentric movements; adjustments made to eliminate premature contacts. Restoration polished with a series of composite polishing points and cups to achieve a smooth, high-lustre surface. Floss check confirmed open contact. Post-Operative Instructions: Patient advised to avoid eating or drinking for at least 30 minutes until the anaesthesia wears off completely. Instructed to avoid chewing hard or sticky foods on the restored tooth for 24 hours. Advised that mild sensitivity to hot or cold may occur for a few days but should subside. Good oral hygiene practices encouraged. Risk Explanation: Patient was advised of the depth of the restoration and the possibility of post-operative sensitivity or, in rare cases, pulpitis requiring further intervention such as root canal treatment. Patient verbally acknowledged understanding. Treatment Options: In the event of persistent pain or complications, further treatment options including root canal treatment or, as a last resort, extraction, were discussed. Prognosis: Good. The restoration was placed successfully with good marginal integrity and anatomical contour. The tooth should function well, and sensitivity is expected to resolve within a few days to weeks. Continued regular dental check-ups are recommended. Review Date/Follow-Up: 1 November 2024 - Routine check-up in 6 months.