Subgingival prep and restoration

[TXftw]

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I’m a 3rd year who doesn’t have a ton of experience in restorative dentistry yet. Tomorrow I am doing a class V restoration on extensive caries that are located completely under the gingival margin. I know I’m gonna be packing a retraction cord to improve visibility and access. Does anyone here have any advice? Anything helps, please and thank you!

 

[ysrebob]

- tentative outline form w high speed hp
- prep out caries w slow speed (eg 4 round)
- check w a caries indicator dye if you have access to that
- adjust prep as needed; don’t worry about nicking tissue
- retract w cord (soak w hemostatic if bleeding)
- an RMGI like Fuji II (or ye olde fashioned amalgam) will hold up better than composite in this situation

If way way subgingival, can reflect a small flap if needed.

You’ll do great!

 

[lemoncurry]

+1 to the RMGI. If you have access to a soft tissue laser or electrosurge, you could use that to trim back the gingiva to expose the caries. I usually find that going in with a #4 or #6 round slow speed bur is sufficient, especially if restoring with RMGI.

 

[Faux]

I agree with everything but I'd pack a cord in the beginning.

 

[yappy]

Infiltrate the tissue with LA that contains epinephrine as needed to control bleeding.

 

[cooliyak]

You could also use a clear mylar strip to create a subgingival matrix and restore it using an injection molding technique. I tried that the other day and it worked like a charm. I slid the mylar strip interproximally on both sides with it looping the buccal, pulled it tight from the lingual, and placed wedges to hold it in place. The cord held the matrix in subgingivally and it came out at an angle to make sure it was flush with the tooth at the gingival margin. I injected composite and cured through the strip. It was way over contoured, but at least it wasn’t a subgingival problem anymore. Two second of recontouring with a flame or needle finishing bur and it was done.

 

[TXftw]

Thanks everyone! The patient actually canceled the first appointment and rescheduled for this morning. Everything went well, packed a retraction chord, excavated the caries and restored the tooth using Fuji and a Mylar strip! Definitely would not have gone as smoothly without y’alls advice