How to place a class two composite in a tooth with bleeding intraproximal gingiva?

I see this a lot at NYU where I am teaching. The proximal box is long and adjacent gingiva is inflamed. Often I dab the gingiva with Hemadent and then place a layer of retraction cord. I do this so either I or the student can complete the preparation of the filling. It is really difficult to do a decent job when there is continuous bleeding into the preparation.    Electrosurgery  or a soft tissue laser would help as well, but often these tools are not available.

Once the preparation is completed, a well fitted contoured band should be fitted and tightly wedged so there is no bleeding into the preparation. The key is to us a long enough matrix and use the proper shaped wooden wedge to make the gingival of the band adapt to the preparation. Sometimes I have to play around with the wedging to get it to work well. Sometimes I put the wedge in from the buccal and sometimes from the lingual. If a fat wedge is needed than sometimes I use a blacks knife or a scalpel to reshape the wedge so it allows the matrix to achieve a proper contact. Once I fit my band I then place my V3 ring to help ensure a good contact.

The key is to have patience and to take a little more time for these fillings because if there is significant bleeding when the composite is placed there will be an improper seal at the gingiva and the filling may fail prematurely.

from Ask Dr. Spindel - http://lspindelnycdds.blogspot.com/2018/11/how-to-place-class-two-composite-in.html - http://lspindelnycdds.blogspot.com/

Comments

Post a Comment

Popular posts from this blog

Help! My Child is Terrified of the Dentist

Image
If you’re the parent of a young child, you know their brains are similar to sponges that soak up everything around them—especially in their first five years, which neuroscientists say is when they’ll do the most learning and developing in their entire life. At this formative time, your child may amaze you with what they notice: your facial expressions, the different tones of your voice, and your habits. If your habits include regular dental visits and an excellent oral hygiene routine, they’ll notice and want to emulate you. If you happen to feel anxious about your dental visits, or you groan when you’ve got to floss and brush, they may synchronize and feel your dread. This could lead to dental fears that stick with them for years—potentially a lifetime! Kids Can Be Courageous If you’re feeling guilty right now, go ahead and put that away as it won’t serve you or your little one. Everyone has some room for improvement, and Coastal Pediatric Dentistry® is here to help show you an
Read more

Going for the Gold?

Image
On the left is the older allow, on the right the new one that my lab has chosen to use The cost of a penny weight of pure gold is currently $79.53. The cost of a penny weight of pure palladium is $130.6. It used to be that palladium was added instead of gold to the precious metals often used for pfms, but now laboratories are finding that palladium is no longer affordable. The lab that I am using has just changed the formulation of the metal it's using to one that has more gold than palladium. I really do not mind, but metals with more gold are softer and often easier for a dentist to accidentally polish off delicate margins. It is important when polishing "higher gold" formulations to exert less hand pressure when performing the final polishing of the crown's margins. Other wise there should be no problem with this change. Traditionally labs have chosen alloys with higher gold percentages for optimal esthetics, since alloys with higher concentrations of
Read more

Tongue Ties: What Parents Need to Know

Image
For a long time, people just didn’t seem to know much about tongue ties. In the early years of my practice, few of my patients had ever heard of a tongue tie. When I pointed out that they or their children might be tongue tied, I was often the very first practitioner who’d mentioned it to them. When I told them that a tongue tie might actually be the root cause of their oral myofunctional issues, or even their sleep apnea , I’m sure that some of them thought I was crazy. But in the last few years, things have changed so much! Initially, there was a small increase in the number of patients who were contacting me specifically about tongue ties. Dentists and orthodontists also began reaching out more frequently to discuss the application of myofunctional therapy exercises to tongue tie treatment. But in the last year or so, that little bit of interest has become a surge of awareness. Tongue ties and their effects on health and craniofacial development are finally becoming mainstream.
Read more