Approximal lesions in posterior teeth

• Class II cavity

  
• Class II

  
• minimally invasive dentistry

  
• interproximal lesions

  
• class II composite

  
• Iatrogenic damage?

  • operator damage
  • destroys enamel layer
  • increased plaque retention
  • 3x caries risk?
  • floss wont work
  • alter contour
  • rads misdiagnosis

  
• how do we prevent iatrogenesis?


  wedges
• peripheral caries excavation?


  rose heads

  
• how do we fracture marginal ridge?

  enamel hatched

  
• T.C 1169

  
• end- cutting bur

  
• pulpal caries excavation?

  • never iatrogenically expose
  • stop if hard, scratchy, firm, leathery, mod resisitant
  • avoid heat, pressure, maintain RDT
• pulpal caries excavation

  
• Label

  A) pulp

  B) cavity

  C) rosehead

  D) pulpal excavator

  
• next stages of filling placement?

  • matrix
  • etch/wash/dry
  • adhesive
  • restore with composite
  • placement/shape
• composite finishing

  
• amalgam removal

  
• matrix

  
• issues with traditional matrix systems

  A) contact points too high

  B) stagnation areas

  C) flat proximal contacts

  D) matrix as shallowest box

  E) no cervical seal = poorly condensed excess amalgam

  
• automatrix

  
• pros of automatrix

  • no cross infection risk
  • easy
  • easy to get tight contacts
  • reversible
  • no cusp dlexion
  • wedge either side
  • cost-effective
• class II

  • initial bur mark
  • access caries
  • bur buccopalataly
  • bur parallel to long axis of tooth
  • deepen cavity below contact point
  • clear cervical caries
  • widen box
  • fracture marginal ridge
  • finish with enamel hatchets
  • occlusal lock? amalgam
• OVERFILL WITH AMALGAM
• Bevel marginal ridge!