Recurrent caries under crown - "Thinking outside of the box" by Dr. Ahmad Fayad
Posted on March 22 2023
This case was completed by Dr. Ahmad Fayad of Lessard Dental located in Alberta, Canada.
Food impaction area that caused massive carious lesion at the distal of the lower first molar (36) - tooth is asymptomatic.
Patient refused a new crown and cannot afford it.
He gave me verbal consent to try to save it for some time.
Notice massive distal caries at the crown margin.
1. Drilled a slot prep to reach the cavity
2. #8 slow speed round carbide followed by a spoon to clean up the cavity, reached hard tooth
3. Then placed a Greater Curve matrix band
4. The mesial part of the matrix band was cut shorter allowing the distal portion of the band to sink beyond the cavo surface margin.
5. Applied a thin layer of Panvia V5 cement to bond my amalgam
6. Packed amalgam
Notice I didn't place a wedge (I go gentle with my first layer of condensation when I use the matrix band - I tend to use more force of condensation towards the walls and deep inside the cavity instead)
What you see is not an overhang, its just amalgam particles that will dissolve in a few days with flossing. The floss runs smoothly with no catch anywhere.
I was also having thoughts on using Equia Forte as the initial layer then topping off with composite, but I ended up choosing amalgam for its better long term properties and less chance for recurrent caries in the future - I also bonded it with Panavia to get a more coherent mass and for the amalgam to bond to crown and tooth.
I know this case is a bit extreme and pushing it a little too much, but sometimes we have to think outside the box.