Proper Caries Removal? No You Can't without isolation.

162 Rating(s).


Posted on By Gerald Benjamin In Composite Resin

The overwhelming majority of dentists believe that they can see caries and completely remove all caries without the benefit of a rubber dam.

No you can't.

A 25 year old male presented with fairly small amalgams with indications on radiographs that caries remained under the restorations.The amalgams were probably placed 10 or more years ago by the same dentist.

Local anesthesia was administered and a rubber dam placed. The maxillary right first and second molars were scheduled for treatment and the small amalgams removed...Signifiant amounts of retained caries were observed (no caries or leakage was noted along the walls of the restoration.) Three times the tooth structure of the original restoration was removed to eliminate all of the caries.

Few dentists can control lips, tongue, cheeks and saliva while maintaining full view of the tooth under going treatment. Even fewer dentists will be able to 100% maintain a dry field at the very posterior of the mouth.

Even if you THINK you can...No you can't.

Very small occlusal amalgam removed
Cavity prep becoming considerably larger than the original amalgam

Relatively small restoration removed
Completed direct resin occlusal restorations in an absolutely dry field
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5 Comments

Great message Dr. Gerald. It's a simple but highly neglected procedure in dentistry. Can you tell me what could be the reason for this. Regards. Dr.Ashok


Reply

Some dentists think that they are omnipotent and can do 'everything perfectly.' I like the 'sure thing'. I can see everything, not rush and place a perfectly placed restoration without chance of leakage. To answer your question:Laziness... It takes under 40 seconds to apply a rubber dam.


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As usual, very nice presentation, Gerald!


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Thank you Dr. Goldstein! Standards of excellence are our (yours and mine) guidelines and considering that you and I have almost 100 years of practice, I doubt that it will change. Always an honor to have your endorsement. gerald


Reply

caries removal is a process that has to be done in a methodical way. The basis of such a process has to allow the clinician a level of success that minimizes the question, “Have I removed all of the decay?” Today the standard evaluation involves instruments, such as explorers and excavators, which predate the turn of the 20th century. These issues become even more questionable when such hand instruments are worn well past their clinical uses and create false negative and positive results. Advancements, such as caries-detection stains, have aided dentists in caries evaluation; however, there can be tremendous variability in outcomes.
As a profession, dentists identify with the need to better evaluate the removal of caries-infected dentin. Future advancements, such as ozone therapy or tooth-decay detection by measurement of increased light-induced fluorescence (NYU Faculty Practice in NY), can have tremendous impacts for patients for years to come. But what about today, tomorrow, or next week? This article describes a technique available today—a technique that preserves dentin in the restorative process and ultimately improves long-term clinical outcomes. This technique is followed by a proven approach on restoring the damaged dentinal surfaces and the enamel with a variety of restorative options.
After high-speed access, the process begins with initial caries removal with a new, unused low-speed carbide bur. A round carbide bur generally works well in its removal of caries-infected dentin. These products are used in a far more conservative low-speed handpiece system, such as CeraTorque .
- See more at: http://www.drismaelkhouly.com/


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Hu-Friedy
360 Imaging