Journal of Clinical Cases

Challenges In Dental Proximal Diagnosis And Treatments Teeth 45-46 Case Report

Hervé Tassery^1,2**, Lezize Sebnem Turkun³ , Amel Slimani^4,5

1. Ecole de Médecine Dentaire de Marseille, Université d’Aix-Marseille, 13385 Marseille, France. Emai: [email protected].
2. Institut Hospitalo-Universitaire Méditerranée-Infection, Aix-Marseille Univ, IRD, MEPHI, AP-HM, 19-21 Boulevard Jean Moulin, 13385 Marseille CEDEX 05, France.m.
3. Ege University School of Dentistry, Izmir, Turkey. Email: [email protected].
4. LBN, Univ Montpellier, Faculty of Dentistry, Montpellier.
5. CSD Madeleine-Françoise Calais, CHU Montpellier, France. Email: [email protected].

Corresponding Author: Hervé Tassery

ABSTRACT

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