Geriatric repair with pulp cap- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

This is one of my 86 yo ladies not doing too great health-wise with an old onlay on #18 that did not include the mesial 1/3 of the tooth. Of course that area had been repaired with amalgam years ago and the repair eventually broke away. What to do? Thank God for my world class assistants who isolated 18 with a dam, and away we go.

Thomas W. Mitchell, DDS, FAGD
#18 well isolated. I can see the gingival margin which makes this a lot easier.
Thomas W. Mitchell, DDS, FAGD
Just some basic prepping and decay removal with a small exposure. This tooth has been asymptomatic, so we can do a pulp cap.
Thomas W. Mitchell, DDS, FAGD
After cleaning with diluted bleach I placed Durelon over the exposure. We add a drop of water to the mix to make it set up faster.
Thomas W. Mitchell, DDS, FAGD
Then Clean and Boost, Surpass 1,2,3 and co-cured Titan Flowable A2 with the Valo light set on "plasma mode" for 3 seconds. Note there's no matrix yet. I did about 4 layers of Titan before attempting a matrix.
Thomas W. Mitchell, DDS, FAGD
This is a Getz Dixieland Band in a Toffelmeyer Retainer. The next step is to squirt in Injectafil, but obviously I've got to hold the matrix against 19 while the Injectafil sets up. So I injected it, forced the matrix against 19 with a composite instrument and waited for the Injectafil to reach it's gel stage (took about 30 seconds), then Karen zapped it with the Valo light on "plasma mode" for 3 seconds. Then I did need to place a thin layer of Exquisite on top of the Injectafil to complete the occlusal surface.
Thomas W. Mitchell, DDS, FAGD
After removing the matrix we can see we've got enough of a contact to proceed with polishing.
Thomas W. Mitchell, DDS, FAGD
And the end result should be ok for her. The proximal contact is a bit on the light side, but the surface flosses smoothly (and I doubt she's able to floss anyway)

Conclusion: 

Geriatric dentistry is certainly different from the fine restorative dentistry we usually do. Here our goal is to keep her comfortable without stressing her out. She slept thru the procedure (we started her case at 8 AM which was very early for her). Building up the gingival before placing the matrix and then using Injectafil made this go easily and quickly.

Case by: 

Thomas W. Mitchell, DDS, FAGD