Subgingival distal Class V tooth #29

Posted on September 28 2017

Introduction:

A method to isolate and attain access to an inaccessible location.

Greater Curve Band surrounds tooth #29

Step 1

I failed to take a preopt photo. Decay was at the distal, subgingival and extended toward the buccal. Greater Curve band in place. The retainer was set up from the lingual. Band ready for cut back to provide access to the prep.

Band cut back in order to gain access to the Prep

Step 2

A view of the prep and cut back tofflemire setup. I left some caries in the deeper portions of the prep. I did not want to risk exposure.

Band cut back and Prep

Step 3

Another view of the prep and Greater Curve band setup. Note the excellent isolation the matrix provides.

Fill

Step 4

Clean & Boost (Apex Dental), Consepsis (Ultradent), Bonding agent was Prelude SE (Danville). Prep bulked filled with Activa (Pulpdent).

Additional isolation

Step 5

To further aid isolation, I used Triad Gel to secure a Neodry against the setup.

Final Restoration

Step 6

Buccal view of the final Activa restoration

Final Restoration

Step 7

Distal View of the final restoration.

Conclusion:

I chose Activa for the following reasons:

1) Activa has a bioactive glass. It continuously seals the margins through remineralization. As the bonding agent deteriorates over time the bioactivity will continue.

2) Activa is rubberized similar to dentin. It flexes with the tooth. Flexing keeps it sealed as opposed to a passive hard composite which does not flex. This becomes more of a factor with larger restoations. 

3) Activa hinders biofilm formation. I have observed that Activa is stain resistant. Hindering biofilm formation might be why.

2 comments

  • Cynthia Kibiuk: October 06, 2017

    I always enjoy seeing your cases. I work at a nursing home and we see much root surface decay. Your bands do a great job isolating these areas as well as providing a scaffolding to inject a RMGI such as Fugi II LC capsule. Thanks for sharing your tips…I always pick up some good ideas from your cases.

  • richard cronley: October 03, 2017

    Denny,
    I’ve been using Activa since your lecture in February at P&G- today we did a similar case to your’s above involving lingual decay under an existing crown on #29. We used the Greater curve after elecrosurging some overgrown tissue. worked great!
    Thanks for sharing your tips!

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