Alhassan Muneera Abdulaziz, Bajunaid Salwa Omar
Gen Dent. 2020 Jul-Aug;68(4):e1-e3.
Treatment of a large proximal carious lesion that extends below the cementoenamel junction is challenging. Large defects usually require replacement with indirect restorations (inlays, onlays, or crowns). However, when the gingival cavity margins are deep, procedures such as isolation of the operative field, proper cavity preparation, successful impression-making, and adhesive luting may be hindered unless soft gingival or hard bony tissues are removed to expose the cavity margin. The present case report describes the clinical application of a conservative cervical margin relocation technique for treating deep cavity margins. A patient presented with large distal carious lesions and necrotic pulps in both the maxillary and mandibular right first molars, which were diagnosed with symptomatic apical periodontitis. After root canal treatment of both teeth, the maxillary molar underwent a crown-lengthening surgical procedure and subsequent placement of a zirconia crown. In the mandibular molar, the cervical margin was relocated by placing a composite resin base at the proximal gingival cavity margins under meticulous isolation of the operative field. The tooth was restored with a composite core build-up and bonded ceramic onlay. The satisfactory outcome suggested a promising prognosis for the oral health of the patient.
治疗延伸至牙骨质釉质界下方的大型近中龋损具有挑战性。大型缺损通常需要用间接修复体（嵌体、高嵌体或全冠）进行修复。然而，当龈下洞缘较深时，除非去除软组织或硬骨组织以暴露洞缘，否则手术区域的隔离、合适的洞形预备、成功的印模制取以及粘结固位等操作可能会受到阻碍。本病例报告描述了一种保守的颈缘复位技术在治疗深洞缘方面的临床应用。一名患者上颌和下颌右侧第一磨牙均出现大型远中龋损及牙髓坏死，诊断为有症状的根尖周炎。对两颗牙齿进行根管治疗后，上颌磨牙接受了冠延长手术并随后安置了氧化锆全冠。在下颌磨牙中，通过在手术区域精细隔离的情况下，在近中龈下洞缘处放置复合树脂基底来复位颈缘。该牙齿用复合树脂核堆积和粘结陶瓷高嵌体进行修复。满意的结果提示患者口腔健康预后良好。
