Lingual Wall on Class III's

[Vicviper]

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Just a quick question, we've been doing Class III's in composite, and I'm hearing 5 different things from 5 different bench instructors. The course director says that having a lingual wall is important, but my bench instructor says to open it up, and then go in with a 56, which seems like it would more or less take out the wall, and that he doesn't care too much about the wall. I know to go with the big brother rule here, but my question - is a lingual wall actually clinically significant?

Thanks 🙂

 

[tinman831]

Just a quick question, we've been doing Class III's in composite, and I'm hearing 5 different things from 5 different bench instructors. The course director says that having a lingual wall is important, but my bench instructor says to open it up, and then go in with a 56, which seems like it would more or less take out the wall, and that he doesn't care too much about the wall. I know to go with the big brother rule here, but my question - is a lingual wall actually clinically significant?

Thanks 🙂

Are you talking about making an ML prep into an MFL ?

 

[Streetwolf]

Are you accessing from the facial side?

In operative preclinic our class IIIs were always accessed from the lingual so there was never a lingual wall...

 

[The Hammer]

I'm confused as well. Are you accessing from the facial like a DF or a MF and they want you to take out the lingual as well?

 

[Vicviper]

Sorry for the confusion and not updating quickly, I'm studying for a fun fun pathology test tomorrow. 🙂

I should have been more detailed, I mean a ML Class III - and they "lingual wall" they want us to make is more or less just a "step" in the prep made if you go in at a 45 degree angle with say a #2 round, and then straighten out the bur, and it wouldn't cut the spot on the lingual because the shank doesn't have a cutting surface. More or less, there's just kinda a lip on the lingual that's raised from the axial wall, it makes the prep seem more bowl shaped. This, compared to how my bench instructor wants the prep to be more or less rectangular.

I hope that makes sense, if not, I could take a picture maybe. Thanks!

 

[puncho]

Your course director is teaching you this? From what you describe, seems like you'd have unsupported enamel.

The outline form of a Class III doesn't vary...the lingual (or facial) is removed and it looks like a box. This is how the boards (all of them) view it so I would get used to doing it that way.

 

[omaralt]

I remember during dental school they would teach all these rules about preps. Afterwards u learn that all these rules are for amalgam preps and that there really aren't much rules for composites (just remove all caries and leave no un supported enamel).

 

[HupHolland]

It seems like your professor that is stressing preserving the lingual wall is going to an extreme to conserve non-carious tooth structure.

Real world dentistry: ya just enter with a 330/245 perpendicular to the long axis of the tooth, at the level of tooth contact, extending the prep to remove the caries. Generally this produces a prep with well defined internal angles and no unsupported enamel. In this scenario, the lingual wall is completely obliterated.

Hup

 

[jay47]

I know exactly what you are talking about. Even at the most extreme entering angle, I find it exceedingly difficult to create that lingual wall. Most of the time, I just opened it up and had more of a "DL" wall, and not a true lingual wall. I don't think that the wall is that important as long as you try not to leave unsupported enamel and make sure to bevel all the way around for secure bonding.

 

[SeattleRDH]

I almost never see box shaped preps with composite. All the dentists I work with remove as little tooth structure as needed.

p.s. You will never please all your instructors. They each have their way, the right way, the ONLY way to do things. It's very frustrating.

 

[mmasurf]

buy a burr called 329 its the cousin of the 330 and shape up the box with that u will see how easy life becomes.

 

[Vicviper]

buy a burr called 329 its the cousin of the 330 and shape up the box with that u will see how easy life becomes.

I was trying to look at some pictures online to compare - is it just a bit wider near the shank than the 330?

Oh, and for my practical I just used a spoon excavator to make a nice "Lingual wall" haha, worked like a charm.

 

[mmasurf]

329 is smaller than a 330 so u can shape the walls better. try it it only costs $1 if u buy it from your schools store.