Herodontics for tooth #27

Posted on November 05 2016

"Elderly patient - Tooth opposed by a denture. Patient desperately wants to maintain remaining lower teeth."

Extensive carries tooth #27

Step 1

 

Deep subgingival prep

Step 2

No pulp exposure. Pulp had recessed into the root.

Caries was flush to the bone level.

Step 3

I used a Karl Schumacher bone chisel to remove bone 1 mm below the prep margin.

Greater Curve Wide Band in place

Step 4

Prep very well isolated. I am holding the matrix with my fingernail to keep the matrix below the prep margin. There is a small gap at the mesial, but no bleeding. I will carve away the overhang with a #12 when I shape the composite.

Bonding Sequence:

Step 5

"Clean and Boost, Etch enamel, Consepsis, Prelude SE Placed a thin layer of A2 Activa along the margin and cured. I can now release my finger hold because the matrix is locked down.

Completing Restoration

Step 6

Layed Filtek Supreme Ultra A2 Body to complete the restoration

Completed Restoration

Step 7

 

I do not want to suggest this was easy, but I believe it would be impossible to do without the Greater Curve band. I violated the biologic width along the mesial border. However, I have observed that a biologic width violation is of no consequence when there is a well sealed highly polished composite in close proximity to bone.

3 comments

  • Spence Bloom: December 10, 2016

    Myself, I’d be carefully reducing the mesial-incisal corner of #27 to get it’s functional contacts aligned with #26. Heavy contact concentrated at #27-MI could spell disaster because it stands tall, all alone…even if it is a denture above.

  • Spence Bloom: December 10, 2016

    I, too, do herodontics…that I couldn’t do without the Greater curve band.

    But it’s funny how often a patient expresses their desperate desire to keep their remaining teeth but it isn’t manifested in reasonable plaque removal/home care or frequent checkups/cleanings to prevent catastrophic dental disasters.

    I hope this pt doesn’t hold it against you if or when this tooth breaks (from lack of strong connection of anatomic crown to the root and lack of enough teeth that causes reliance on this weak tooth for function).

  • Daniel Siriphongs: December 10, 2016

    I do these often as well. The greater curve bands help significantly.

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