Managing deep root decay and a wide embrasure as an unwanted bonus

Posted on June 06 2019

Introduction:

Isolating a deep root decay prep is challenging. This is only the beginning. You must also construct a tight contact while bridging a wide interproximal gap.

 

Double Jeopardy

Step 1

Deep sub gingival Class II prep which typically results in a wide embrasure space. I reshaped the gold on the mesial of #18 to a more ideal contact surface.

Greater Curve band trimmed

Step 2

The Greater Curve Standard was trimmed at the mesial. This will allow the band to seat apically past the deep distal margin.

Greater Curve in place

Step 3


Greater Curve in place. Distal contact opening made. Note the contact opening is not fully against the contiguous #19. There is an unwanted gap at the base. The entire periphery of the contact opening should be in intimate contact with the contiguous tooth.  If it isnt, composite will pass through and lock in the matrix. 

Flowable composite placed

Step 4

Flowable composite is placed along the cervical floor (SureFil SDR flow) Contact opening is secured with a condenser while my assistant cures the flowable.

Contact opening

Step 5


Contact opening is now up against the contiguous tooth. You can see the cured composite dimple left by the condenser. See arrow.

Retainer positioning

Step 6


This view shows the retainer arm being elevated by Blu-Mousse. Elevating the retainer arm pushes the band distally against the neighboring tooth.

Final Class II composite

Step 7

Final Class II composite (SonicFil) crafted on a short tooth with deep subgingival decay and a wide embrasure.

Conclusion:

1)     A contact with depth is an integral part of the Greater Curve technique. A contact with depth enables the dentist to shape a rounded marginal ridge without fear of adjusting through the contact.

2)    A matrix can more easily extended across a wide space when there is no wedge blocking  the way.  

3)    Had an excellent seal against contamination.  The Greater Curve band draws very tight round the base of the tooth in spite of the prep margin being subgingival. 

4 comments

  • Cary Berdy: June 23, 2019

    Hey Robert,
    Try putting the band in “upside down” that way as you tighten it won’t slip out. Works great!

  • robert Belott: June 14, 2019

    Excellent tip and result , I find that the band will track out of the retainer when I tighten it,any suggestions to mitigate this?

  • nathan mayo dds: June 13, 2019

    Nice job, but I thought you usually ground away an ovoid opening through the band to insure a tight contact area. Did you scuff up too many adjacent teeth with that idea?

  • Vance Wascom DDS: June 13, 2019

    Like the way you lifted retainer with blue moose, has been a problem for me in the past, always learn something from your posts, would sure like to meet you someday

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