Challenges In Dental Proximal Diagnosis And Treatments Teeth 45-46 Case Report
Makaleler > Tam Makale · 2026
Yazarlar: Lezize Sebnem Turkun, Hervé Tassery, Amel Slimani, CSD Madeleine-Françoise Calais, CHU Montpellier, France. Email: amel.slimani@umontpellier.fr
Journal of Clinical Cases, Uluslararası, 2026, cilt 5, ss 1-6
Özet
This clinical case illustrates the challenges in diagnosing and treating early proximal carious lesions, specifically those affecting teeth 45 and 46 in a 25-year-old female patient. The patient presented with dental sensitivity, maintained excellent oral hygiene, demonstrated strong compliance, and had both a high socio-economic status and normal saliva quality. Notably, her primary risk factor was a past history of eating disorders (bulimia-anorexia), which has been stable for last three years. According to the CAMBRA® assessment, she faces a high risk for caries but benefits from a promising outlook due to her adherence to preventive measures. Radiographs revealed a distal lesion on tooth 45 that spans the enamel and with a dentin reaction, alongside a shallow mesial lesion on tooth 46. Clinical evaluation proved challenging because a lingual gingival papilla obstructed access and visibility of the proximal surfaces, making it difficult to determine whether cavitation was present. Subsequent aero-polishing and enhanced accessibility through tooth separation and laser gingivectomy allowed for improved examination. Employing an intraoral camera and a microscope enabled precise diagnosis: two small active cavitary lesions were detected—one on the mesial side of tooth 46 and another disto-lingual on tooth 45 with no connection to the vestibular white spot lesion. A micro-invasive approach was selected for treatment, incorporating silver diamine fluoride to inhibit caries activity, followed by resin infiltration. Specialized posterior matrices were used to restore the micro-cavities while carefully managing excess material. Post-treatment follow-up indicated favourable tolerance without any complications. This case underscores the critical role of accurate diagnosis, accessibility enhancement, and high-magnification technology in guiding conservative management strategies for complex proximal caries.