Re: Deep boxes, filling problems

From: DrSteve (drsteve_at_guessmy)
Date: 03/03/05 

Date: Wed, 2 Mar 2005 20:31:03 -0500

This a great argument for indirect restorations.

By the time you work of the tooth 3 times to get it within acceptable
boundaries, you could have placed a porcelain onlay.

Steve (what's an impression?) Mancuso

"StovePipe" <StovesNewAddy@sympatico.DOTnet> wrote in message
news:1gsrh99.1ynnbdq1h3fu65N%StovesNewAddy@sympatico.DOTnet...
> Bill <dentaldoc@hotmail.com> wrote:
>
>> Nice job on that distal of #14!
>
> Thank You Bill; like JME's comments, that is much appreciated.
>
>>I agree that this fine effort is
>> beginning to look like "herodontics."
>
> That is one of the reasons I decided to Fuji 9 it vs use a flap
> procedure.
>
>>(Do many patients really
>> appreciate how darn hard we work for them in these situations?)
>
> Sure... when they finally lose those teeth....
>
>> Those deep interproximals are such a bear to fill. I hope she gets the
>> crown done before she splits the tooth, after all the work you've put
>> in.
>
> So do I, but her personal values just aren't there. If I _do_ do the
> crowns, the interproximal margins will be on Fuji 9 instead of sound
> tooth structure, as there is none in those boxes, unless we DO do a
> crown lengthening.... and even then....
>
>> Does she wear an NTI?
>>
> No. When I was in the DownTown Kombat Zone, I didn't know about the NTI.
> I didn't have an Internet connection. In fact, it has only been about a
> year since I _have_ known about the NTI, as it was _then_ when I
> connected to the SMD. It is Due ENTIRELY to you folk. ;-)
>
>> What's going on at that mesial margin on #15?
>
> That surprised me. Fuji 9 comes in a capsule with a spout on it. You
> shake it up in your Amalgammator, put it in the pliers, and inject it
> in. I was surprised that I missed the gingival floor of that mesial box.
> It was not the deepest one. I think my technique was off: I might have
> pulled the stuff back out as I withdrew the spout.
>
>>I hope she's not packing a lot of food interproximally.
>
> I'm sure she is at this point. I had planned to let the gum tissue calm
> down and close the contact using composite and a Parkell ring and
> matrix. When I can get the matrix piece well wedged and ringed, I can
> get a very good contact, sometimes even too tight.
>
> FYO: Parkell are now making sectional matrices (for their rings) that
> have a gingival wing on them. This helps with those deep boxes somewhat.
> They look a bit like boomarangs.
>
>>I've seen some patients who fail to > floss, fail to get crowns, and
>>sometimes destroy their interproximal > bone faster than the caries can
>>destroy the teeth. >
>
> Yes, I'm sure gonna try and not let that happen.
>
> What I'm gonna do: Put an AutoMatrix band on the 2nd Molar with a piece
> of Tofflemyer stuck down the mesial to the gingival limit again. This
> time, it should be easier, as there is now filling material to push
> against. Then, I'm gonna go down the box with a # 700 surgical length
> bur on the high speed (for good visibility). I'll measure the depth to
> the floor of the box on the B/W and mark the bur. I'll clean it out in
> Buccal/Lingual direction with the bur, but leave the mesial portion
> (against the matrix) intact.
>
> Then (I should have thought of this before...) I'll take the Danville
> MicroEtch II and blast away the remaining compomer (against the matrix).
> I'll use the MicroEtcher so as not to tear/puncture/displace the matrix
> combination and then fill the thing again. Then after some gum healing,
> we'll talk crowns.
>
> But first, we dance.... [I MEAN....] first, we talk NTI.
>
> If it works out, I'll post the results.
>
> Thanks
> SP
>
>
> --
> Not a real Addy, yet

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