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/

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