Fast Geriatric Restoration- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

From yesterday 82 yo Mom of long term patients with significant dementia has "broken a tooth". #29 had a large DOL filling which has come out. She's asymptomatic but x-ray shows decay at the top of the canals, although there is no PARL. So we set up for endo + buildup, gave (1) carpule of 3% Carbocaine at the mental foramen, placed a dam and cleaned out the decay. At that point it was obvious that the canals were not exposed, so we did not do endo, just went ahead with the buildup.

Thomas W. Mitchell, DDS, FAGD
X-ray of #29 shows decay at the top of the canals, but no PARL and asymptomatic.
Thomas W. Mitchell, DDS, FAGD
After decay removal the canals are obviously closed at the top, so we decided to not do the endo. I had to remove the dam to get the Greater Curve matrix on. It fit ideally at the margins and I cut a hole in it at the distal proximal contact.
Thomas W. Mitchell, DDS, FAGD
This is after Clean and Boost, Surpass 1,2,3 and co-cured WO Titan Flowable. I like WO Titan in these deep ones in case we do have to go back in then it's obvious when we're getting close to the canals.
Thomas W. Mitchell, DDS, FAGD
Then filled the matrix 2/3 full with Injectafil, waited a few seconds for it to gel and then light cured for a few more seconds.
Thomas W. Mitchell, DDS, FAGD
Then layered Exquisite over the Injectafil, shaped it with Seamfree and composite instruments and removed the matrix. There was a strong distal contact and no overhangs at the gingival margins.
Thomas W. Mitchell, DDS, FAGD
Finished with red 3M Softflex discs and sealed/glazed with Surpass 3 with the final light curing.
Thomas W. Mitchell, DDS, FAGD
From the buccal.
Thomas W. Mitchell, DDS, FAGD
From the lingual you can see the WO Titan at the gingival margin. The restoration is not in occlusal contact necessarily.

Conclusion: 

Total time was 25 minutes from injection to completion. Using Injectafill saves a huge amount of time, and having Exquisite bonded on the occlusal layer insures durability. The restoration is not in occlusal contact necessarily to help prevent fracture and need for more treatment. We take lots of compromises with Geriatric dentistry simply to limit the number of procedures/stress on these patients.

Case by: 

Thomas W. Mitchell, DDS, FAGD