Subgingival fillings

[Tony932]

1. How does a dentist fill subgingival caries? Does he cut gum tissue in order to get exposure to the cavity?

2. Is it still possible to have healthy tight gums next to a subgingival composite filling? Or will there always be an unhealthy pocket next to the filling because the gum is not as compatible with the composite material as much as it is with real tooth material?

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[cbizzle7994]

1. Fill or drill? For drilling you just hold the bur to the caries so that your bur is only on tooth structure. Are you still going to traumatize the gingiva? Yes. Is it gonna heal? Yea. You have to excavate the caries and there is no good way to do it without some trauma to the gingiva.

In terms of filling, if it's amalgam you don't have to worry about moisture so you're fine. If you're doing a class 2 just make sure your matrix band and wedge are below the gingival margin of your box. If you're using composite, for class 2 it's the same where just make sure you get the matrix band and wedge below the gingival margin of the box. If it is a class 5, you will likely have to pack some cord +/- hemodent to control the bleeding. Just make sure it is dry and well isolated

2. You can definitely have healthy gums next to sub gingival composite. Composite itself won't cause unhealthy gingiva. Just make sure your margins are smooth, no overhangs, and your restoration is contoured properly. This is assuming of course your composite isn't violating the biologic width, in which case you will get inflammation and recession and you need to think a little bit about crown lengthening.

 

[Contach]

I did a few extensive Class V (almost circumferential), sub gingival composites in dental school on non-molar teeth, and I must say that it is way harder than it initially looked. It looked good clinically at the time.

But I took some new x-rays many months later, and there were overhangs galore. I had to re-numb the pt and I spent lots of effort refining those margins with diamond burs, sand paper strips and finishing discs.
I violated the biologic width many times, and the pt was warned that we expected some recession. Luckily the pt had lots of attached mucosa in the area.

If I could do it again, I would strongly consider extractions and a different treatment plan.