Subgingival Class 2 Composite

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I was doing a Class 2 today and the gingival floor was about 1mm below the interproximal gingiva. I had a really hard time positioning the matrix and keeping the tissue out of the preparation. When I seated the matrix and wedge I would still have a sliver of tissue in the preparation. Any tips on how to properly set up a matrix on those preps?

 

[THS]

First, a subG class 2 isn't a great candidate for composite. 1mm isn't too bad, but by the time you get subG, there isn't much cervical enamel left (if any) for good bonding, and you'll end up with leakage and recurrent caries. Even if there is a tiny sliver of enamel left, isolation is really difficult. You probably won't be able to use a rubber dam. I would pack 00 or 000 retraction cord soaked in hemodent, apply hemostat to the papilla, and jam a tofflemire or greater curve band down there on top of the cord. You may need to use an electrosurge/radiosurge unit to reduce that interproximal tissue.

If you're dead set on composite, apply chlorhexidine to the dentin and selectively etch the enamel before restoring.

 

[DocMon16]

I think THS has said a lot of good things. Isolation of the tooth subG is very difficult to obtain. There, you will have to deal with GCF or gingival crevicular fluid, blood, saliva, etc. I think even a glass ionomer may be a good thing to possibly use too, resin modified glass ionomer.

 

[Big Time Hoosier]

I'd use the "open sandwich" technique, if amalgam is a no go. RMGI in the depth of your box layered with composite.

Big Hoss