Restoring Cervical Decay on Molars- By Thomas W. Mitchell, DDS, FAGD

Introduction: 

There's lots of posts these days about restoring cervical areas. I believe the glass ionomers are just a temporary solution and we routinely see 20+ yo composites (We're a trituator-free office). So here's a way to restore these areas with predictable success using routine procedures that we're all skilled at.
From yesterday, cervical decay at 15 DO and 16 MO. 65 yo long term pt. We've found this to be a very successful technique. Isolation is the key and this shows a simple way to get that.

Thomas W. Mitchell, DDS, FAGD
15 DO and 16 MO cervical decay. We're seeing him next week to deal with the PARL at 14
Thomas W. Mitchell, DDS, FAGD
Initial isolation with the dam (done by one of my world class assistants). You can see the breakdown at #15 DMR. If your assistants aren't skilled at placing dams for you, teach them. We use dams on virtually all procedures and I have to place one at least once a month.
Thomas W. Mitchell, DDS, FAGD
We completed isolation with a floss tie. Here's the final prep for 15. We checked for decay with decay stain. I actually used my slow speed for the final decay removal, something I rarely do. Usually I just use my high speed diamond.
Thomas W. Mitchell, DDS, FAGD
This picture shows the decay at 16. Both areas of decay were on the lingual 1/2 of the gingival embrasure.
Thomas W. Mitchell, DDS, FAGD
The final prep on 16 is just a big slot prep. No need to extend the proximal margins. Just a great way to maintain as much strength in the tooth as possible. As always I started with a 330 bur (the only carbide I own, single use only) and finished a long tapered diamond. Here you can see the value of the floss tie as the gingival margin is isolated and easy to visualize.
Thomas W. Mitchell, DDS, FAGD
Knowing I would use a greater curve band for 15 in order to seal the gingival margin without a wedge, I finished 16 first using a Getz Dixieland contoured band. In this photo I've done Clean and Boost, Surpass1,2,3, A2 Titan flowable on the gingival margin.
Thomas W. Mitchell, DDS, FAGD
The next increment is Apex Dental Materials dual cure bulk fill Injectafil, allowing it to reach it's initial cure and then zap it for a couple of secs before the occlusal increment of pulse cured composite.
Thomas W. Mitchell, DDS, FAGD
16 finished. You can see the 3 layers we used.
Thomas W. Mitchell, DDS, FAGD
Here's the greater curve band on 15, sealing off the gingival with the proximal contact cut thru the band. I crimped the band on the lingual to reduce the lingual contour I would have to polish.
Thomas W. Mitchell, DDS, FAGD
This is my first layer of Clean and Boost, Surpass 1,2,3, and White Opaque Titan Flowable cured for 15-20 secs with VALO light on standard setting. I use the white flow on all of these deep areas so if we have to re-restore it's easy to see where the margins are.
Thomas W. Mitchell, DDS, FAGD
Bulk fill Injectafill placed almost to the occlusal and allowed to reach it's initial cure, then add 1-2 secs of light.
Thomas W. Mitchell, DDS, FAGD
And the occlusal layer of composite.
Thomas W. Mitchell, DDS, FAGD
The basic contouring is done
Thomas W. Mitchell, DDS, FAGD
And the occlusion adjusted and the restoration polished.
Thomas W. Mitchell, DDS, FAGD
Final x-ray shows good gingival margins and a good contour on 16 mesial, but a little flat on 15 distal which I often see with greater contour bands. There is contact clinically but often it looks open on our digital x-rays. It's interesting to see the variation in contrasts between the 3 materials. Looks like the Injectafil is the highest filled of the 3.

Conclusion: 

Yes these are in the difficult category. No they're not impossible. Isolation is the key and rubber dam with floss ties are a must. Bulk fill Injectafil really helps speed it up. Once isolated the rest of the procedure should be routine. This took me 1hr 15 mins from injection to finish. We'll see him next week to evaluate the proximal contact and to review the PARL at 14. Hope this helps

Case by: 

Thomas W. Mitchell, DDS, FAGD