Stacey is an 8-year old twin with congenitally missing teeth, which is not uncommon for twins. She is also my neighbor and the daughter of my wife’s best friend. Four years prior, Stacey had hypocalcified and decayed primary molars restored under general anesthesia due to high anxiety. She presented to my office with a hypocalcified upper right first permanent molar (tooth #3) (Figure 1) which also had deep decay. The molar appeared hopeless, and another dentist recommended extraction, but her parents were rightfully concerned about her losing another tooth.
My concerns were the restorability of the tooth, the status of the pulp, and the potential longevity if I placed a direct restoration instead of a stainless steel crown. Stacey’s mother did not want another stainless steel crown, especially on a permanent tooth.
I did not want to place a traditional inert material in this compromised tooth. Traditional composites are subject to leaking, and preventing microleakage was imperative to ensure long-term success. My materials of choice were MTA, ACTIVA Base/Liner, and ACTIVA Restorative for the final restoration due to its wear resistance, toughness, and release of minerals conducive to sealing and preventing marginal leakage.
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