Class II on #17 (need help)

[easyas123]

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Hello!

I am a dental student and I am wondering if anyone has any tips on preparing tooth #17. As I drill deeper to chase the caries, it is harder to see where I am drilling and I am not able to fit both the hand mirror and handpiece at the same time. Furthermore, I cannot use a rubber dam since I am not able to clamp the tooth so avoiding the tongue is another difficult problem to deal with. I was not able to finish in one session so I had to put IRM in for now. I will finish the preparation later.

I am a third year and this is my first restoration.

Please help!

Thanks 🙂

 

[Faux]

what surface? Can't do single tooth isolation to help with tongue? Could have assistant use the side of suction tube to retain the tongue.



Funny enough, I had a string of posterior root caries as my first operative experience in clinic. Got so fed up I upgraded my loupes from 2.5 to 4.5. Honestly, it helped a lot in terms of seeing what I was actually doing.

 

[PreDentTechySon]

Third molar restorations are just nasty. I have a few in the next week but I think they’re mainly occlusal. I have found if the patient doesn’t open their mouth all the way (closes just a tiny bit) that will cause their cheek to be more loose and will give you better retraction. Cotton rolls and an isolite or a Mr. Thirsty might help with containment.

 

[321931]

Hello!

I am a dental student and I am wondering if anyone has any tips on preparing tooth #17. As I drill deeper to chase the caries, it is harder to see where I am drilling and I am not able to fit both the hand mirror and handpiece at the same time. Furthermore, I cannot use a rubber dam since I am not able to clamp the tooth so avoiding the tongue is another difficult problem to deal with. I was not able to finish in one session so I had to put IRM in for now. I will finish the preparation later.

I am a third year and this is my first restoration.

Please help!

Thanks 🙂

Amalgam, do nothing, extract. Good luck welcome to dentistry.

 

[Vicviper]

Unfortunately, you can often run into situations where you have to drill blind, or by feel. If it's big caries, that's much easier - you just break through the enamel with high speed, and go with slow speed from there. Use the largest round bur that will fit (and thus be the least aggressive), drill for a few seconds, stop, rinse, dry, check with the mirror. Rinse and repeat until you've got the caries out / leaving some over the deepest portion closer to the pulp if needed. Check the x-ray and figure out where the pulp is, so you'll be comfortable drilling where you know it isn't. These are tough, amalgam will be your friend here.

Good luck!

 

[OhioDMD]

They probably won’t let you use it in school but silver diamine flouride could help prolong the longevity.

 

[oralcare123]

Why are you even restoring it? Extract

 

[cooliyak]

Why are you even restoring it? Extract

Exactly. I don’t restore 3rds unless it is an easily accessible occlusal. All others I extract.

 

[oralcare123]

Exactly. I don’t restore 3rds unless it is an easily accessible occlusal. All others I extract.

As far as I remember it, contraindications to a treatment are the inability to access and properly isolate

 

[easyas123]

Why are you even restoring it? Extract

1) patient wants to keep the tooth
2) patient does not have a first molar and the third molar is still partially occluding with the 2nd molar

 

[easyas123]

Unfortunately, you can often run into situations where you have to drill blind, or by feel. If it's big caries, that's much easier - you just break through the enamel with high speed, and go with slow speed from there. Use the largest round bur that will fit (and thus be the least aggressive), drill for a few seconds, stop, rinse, dry, check with the mirror. Rinse and repeat until you've got the caries out / leaving some over the deepest portion closer to the pulp if needed. Check the x-ray and figure out where the pulp is, so you'll be comfortable drilling where you know it isn't. These are tough, amalgam will be your friend here.

Good luck!

Thank you. Very helpful!

 

[oralcare123]

1) patient wants to keep the tooth
2) patient does not have a first molar and the third molar is still partially occluding with the 2nd molar

Patient's desires shouldn't rule you unless you are able to do your job properly. If you can't reach the cavity, can't see it, can't isolate, can't guarantee a quality treatment then you send a patient with all his/her desires to search someone who can.
Why I say such horrible and insensitive things? Because in real life a patient like this will come back suing or accusing you of ripping him off and doing a shoddy work. We all have been new dental students still wanting to help people and save all their teeth, but we had to later learn, that patients can be ungrateful and we need to watch out and stay within professional standards of care