Conservative Management of Distal Caries in a Maxillary Premolar with Class II Composite Restoration: A Case Report

Restoring a posterior tooth which has proximal caries along with it is of a great clinical challenge. The long-term success in restoring such teeth is based on achieving proper contact and contour. This case report describes the diagnosis and management of distal caries in tooth #15 (maxillary second premolar). The management of such case is done using a direct Class II Composite restoration with a sectional matrix band system. A 32-year-old male patient presented with food impaction and sensitivity in the upper right posterior region. Clinical examination and radiographic evaluation revealed a carious lesion on the distal surface of tooth #15 without pulpal involvement. The carious tissue was removed, following isolation with rubber dam. This was done to preserve maximum sound tooth structure. Removal of carious tissue was done, followed by use of a sectional matrix, to achieve proper proximal contour and tight contact with adjacent tooth. The choice of material for restoration was nanohybrid composite resin. Nanohybrid composite resin was preferred on the basis of detailed restoration of occlusal anatomy. This material was placed in incremental layering technique. The incremental technique was done to avoid polymerization shrinkage stresses. For confirmation of success of treatment, a postoperative radiograph was made. The radiograph confirmed adequate marginal adaptation and contact integrity. The prognosis of the treatment was done by advising a follow up at 1 and 3 months. On follow ups, it was revealed that the restoration was intact, functional and symptom-free. This case highlights the clinical effectiveness of sectional matrix bands and adhesive composite restorations in the conservative management of proximal caries in premolar.