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ToothNinja99

You guys are superheroes for wanting to save this tooth. ■

Member Since: 01/07/10
Post: 19 of 82

eeznogood
Member Since: 02/23/06
Post: 20 of 82

1/24/2020

Tooth: It is a simple Class V restoration! Takes less than 20 minutes and costs not much. It
just needs to be designed in a way to allow it to stay. ■
1/24/2020

NORTHBOUNDandDOWN

I place and restore implants, too, but can't help but think it'd be a shame to lose this tooth.
Direct restoration:
*
Improve retention.
*
Meticulous bonding.
*
Reduce occlusal load causing flexure.
If endo is needed:
*
Clean, shape and obturate roots.
*
Preserve tooth structure and reinforce core.
*
Cover cusps.
It would be a shame to transform a simple Class V composite into an implant. ■

Member Since: 03/21/11
Posts: 23 and 25 of 82

1/24/2020

eeznogood
Member Since: 02/23/06
Post: 28 of 82

All you need is an inverted diamond-coated cone bur. Pass it on the gingival and incisal
margins of the defect to create a countersink. Then, scratch the rest of the surface to expose fresh
dentin and do not do that on the area where the pulp seems very close.
Place a cord and your bonding system after that, and build it up. It helps a lot to build it
up carefully, to avoid needing rotary finishing. Using spatulas and an explorer, I would remove
excess composite while still soft, before curing, until it looks perfect, then cure and do not touch
it with a rotary after that. If you want it to, it will work. ■
1/24/2020

smiledochill
Member Since: 03/11/04
Posts: 37 and 41 of 82

Great input and discussion, guys! I really appreciate it and it helps to see a community
of dentists going back and forth with thoughts that mimic my internal monologue in many
respects. I'll try to address some of the things I've read so far in random order:
* In my 25 years of practice, I have seen a couple teeth horizontally fractured at the gum
line from sharp/deep NCLs (noncarious lesion).
* He's coming in soon for a basic filling on other teeth. I'll for sure get some IO photos,
which will help a lot.
* In my X-ray vision software I can adjust the brightness/contrast, and I'm fairly convinced I don't see PA path at either apex of #12. I still think with mild pressure I could
push an explorer into the pulp chamber from the buccal at a height below the crest of the
ridge. It might be secondary dentin that can look different, but it visually looks very thin!
* Also, when viewing in the software, it is more readily apparent the radiolucency above #14
is an alignment of more-aerated sinus areas.
* Clinically, he does have a decent "canine fossa" of sorts in the buccal vestibule that is more
above 12 than it is the canine, so there is going to be less dense bone around the apical
area.
* The buccal root is rather narrow in the M-D dimension at the subcrestal area and the
buccal recession is significant. His hygiene is good, but this area is getting inaccessible to
hygiene, so TB abrasion is not the full story. (Not that I thought anyone thought that.)
* IO photos will show it better, but in terms of direct restorative, I think managing the tight

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