Class II Kissing Lesions and the WREB????

[Shark007]

I have heard that kissing lesions can be a blessing or a curse on the WREB. I have a patient with two great lesions (one on the mesial of #4 and one on the distal of #5). I thought that the one on #4 was a little deeper and was going to restore it this week and just use the #5 lesion. One of our instructors saw both lesions and thought they would be great for the WREB. I know that in this situation you must restore one completely before submitting the other lesion to qualify. But his contact between the two teeth is light when using floss. According to the WREB "there must be no break in the proximal tooth structure of the adjacent tooth either before or during treatment." So I am left with two options; fill one and do only one or submit both and hope both qualify with the WREB examiners, while only having to use one patient. If anyone has had experience with this, please let me know.

---

Members don't see this ad.

 

[Prosthoman]

If the contact is light with a regular floss, then I am sure they will reject your patient with the floss that they use. Don't risk it, unless you don't care about 3 points. If you think you can do everything great and 3 points would hurt it, then take the risk.
good luck

 

[Boardassistant]

Use "Floss and Go" to check your patients contact. This is the floss the WREB uses.

 

[Shark007]

Use "Floss and Go" to check your patients contact. This is the floss the WREB uses.

I brought my patient back in today to have some more instructors check the contact. We used the "floss and go" and they said it should be golden, so i'm good to go. Because i'm not so sure how set the amalgam will be if I do that restoration first, i'm planning on doing the composite first and then tackle the amalgam. Thank you for your replies and wish me luck.

 

[Prosthoman]

please read this:
don't rush in your prep
take your time
use caries indicator.
don't leaver any dimineralization ( wet it, dry it, chucky color disappear when wet, appears again after drying)
send your pt. on friday if you can and if you don't have endo in the morning
have a great assistant
best of luck

 

[Shark007]

I would like to thank everyone for their advice. I will remember it while i'm taking the exam. Because the WREB is this Friday i'm starting to feel more and more nervous.
A couple of things I have realized while practicing on #4 and #5 is that the contact is far to the facial and to open it up facial, because if I leave a bulky contact to the lingual I will have a hard time opening up the contact on the adjacent tooth (which may lead to failure). I'm fairly sure that re-contouring your previous restoration will be a big no-no unless anyone knows otherwise.
I am also planning to start with my composite on #5 because I worry about starting with an amalgam that won't be completely set. Any other advice is appreciated.

Wish me luck.

 

[Prosthoman]

Ok, one more thing that might help, on number four or five, biggest mistake people make is that, they open the lingual site alot, be conservative and carefull in the lingual site of both teeth. Before your prep, this is the advice from the wreb' look at your tooth several time, remember where the contact is, or mark it with something. when you drop into your box, use as much hand instrumentation as you can, you have planty of time.
take care and I wish you the best of luck.

 

[alaa]

I have the same situation as you have,DO 0n#12 and MO 0n #13, I need to know how you did in the exam, please let me know in details because I still feel unsafe to work with....Can you send me a private message with details..thanks

I have heard that kissing lesions can be a blessing or a curse on the WREB. I have a patient with two great lesions (one on the mesial of #4 and one on the distal of #5). I thought that the one on #4 was a little deeper and was going to restore it this week and just use the #5 lesion. One of our instructors saw both lesions and thought they would be great for the WREB. I know that in this situation you must restore one completely before submitting the other lesion to qualify. But his contact between the two teeth is light when using floss. According to the WREB "there must be no break in the proximal tooth structure of the adjacent tooth either before or during treatment." So I am left with two options; fill one and do only one or submit both and hope both qualify with the WREB examiners, while only having to use one patient. If anyone has had experience with this, please let me know.

 

[futurdentist]

i was thinking of doind a do on 13 and mo on 14. please snd your coments and advice here so everybody can benefit.
thanks!

 

[futurdentist]

my problem is that I see the xray once and i think , yes it's a qualifying class II and then I see it again and i think no it's not. Is there any clear way of being sure the ptient is not gonna be rejected?

Thanks!

 

[2006Grad]

my problem is that I see the xray once and i think , yes it's a qualifying class II and then I see it again and i think no it's not. Is there any clear way of being sure the ptient is not gonna be rejected?

Thanks!

No. Just realize you will be sh**ing your pants as you wait for your patient to either be accepted or not from the grading area during the exam.

 

[futurdentist]

so is it better to take a deep cavity ? something that is clearly in dentin?

Thanks!

 

[DesiDentist]

A deep cavity is not a good idea. Keep searching, only use a deep cavity if you have nothing else. I've seen/heard of students undermining cusps and even ending up doing MOD on their composite (contacts are a pain w/ composite). You want a cavity that definately enroaches the dentin, however you do not want it all diffuse once it goes past the DEJ. You will be sitting their all day scooping out stuff.

My cavities were medium sized radiographically. However, my amalgam was much bigger than what I expected. Also, if you can work on a patient before that is good too, that way you will have a chance to see how big their cavities get and also how well they can take anesthesia.

DD

 

[futurdentist]

i didn't really mean a deep cavity , rather ones that is clearlyu into dentin. it's not close to the pulp (enough to classify it as deep) however it definitely does not just reach the DeJ . it is clearly beyond the DEJ. The other one is (i think ) at the DEJ so it's kind of border line. that's y I'm worried if it would accepted or not. the problem is that in the x-ray , the head of the triangle is narrow and sometimes u can't tell if it's exactly at the Dej or just shy of it?!
What do u think?

 

[DesiDentist]

Definately, have a cavity that goes beyond the DEJ. That is your best bet. You don't want to lose points for rejection. Take various xrays and submit the best one.

Good luck,

DD

 

[DesiDentist]

both my class II's they entered through the enamel, stopped around .5 mm from DEJ and jumped into dentin. radiographically they were not straight through, but they skipped. Both got accepted.

DD

 

[futurdentist]

what do u mean by jumped into dentin?were u able to see a radiolucency in the dentin?
Ok, so let me tell what i have cause i'm very confused here. i have a DO on 13 and Mo on 14 , that i should pick 1 of them. The DO on 13 seems to be just at the DEJ , but i'm not able to confirm that. But then i have to open contact which means that almost all the distal wall of the premolar will be blown away to open contact with the big 14.
The other situation is if i pick the Mo on 14. I can see radiolucency in the dentin already so it is clearly beyond the enamel, but the question is :is it too deep? will i need to destry the oblique ridge and keep asking for a modification after the other. It it was just an Mo on 14 like the ones we did on the typodont (preparing for the Rt exam), Then i would have definitely gone for the 14.
what do u think? Both my operative patints have exactly the same situation, that's y i'm double confused.

Thanks!

 

[DesiDentist]

Okay, by jumping into dentin I mean this:

interproximal class II caries being on or near the contact area and they are someone shaped like this: >

Just imagine caries starting and shaped like this } and this is the DEJ | and this is entering past the DEJ > so my caries looked like this:

}|>

I think you are in good shape. However, be careful when you have adjacent caries not to accidentally hit the contact and have some of the lesion come out, it maybe really hard to regain a good contact. I would do only the ones that go into dentin on both patients. I'll tell you why, if you submit a patient with two adjacent lesions and one looks bigger they will have a reference point. Unless they go way past the DEJ (like 1.5 mm) I would choose the bigger lesion.

Enamel is about 1 mm and you technically need to be 1.5 mm (the depth of a 330). So if you are into dentin by .5 you have ideal lesion, and you have room for increasing the size. lesions look smaller on the radiograph, so worst case scenario your box is 2 mm (still in ideal) the examiners are not going to know if you are exactly 1.5 or 2 mm, but they will know if it is 3 mm.

Choose the bigger lesions, make sure that even if your box ends up being 3 mm that you still have ample room away from the pulp. To be safe try to find a patient who has at least 4 mm (after ideal prep) away from the pulp. Take a nice bite wing and use a perio probe to find the amount of space you have to work with.

Good luck,

DesiDentist