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FILL AND DRILL TECHNIQUE: CASE REPORT

ARTICLE: VIKTOR
SCHERBAKOV
4727 Views - Jan 2016

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Operative field isolation is a very important step in endodontic and restorative treatments. Hard-toisolate teeth are no excuse for not using the rubber dam.
In complex cases the isolation ought to be carefully planned. Experience teaches us that the more
difficult the tooth, the more the dentist will appreciate the advantages of using it.
Indeed, once the field has been isolated, a complex clinical case will become simple, with significant
benefit for all subsequent procedures.
In this article I will describe a case where I applied the FILL and DRILL Technique, an approach to
simplify the leakage control in complex cases.
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ANAMNESIS
The patient was a 37 year old man who had suffered anterior tooth trauma when he was a teenager.
In 1999 he received from another colleague root canal treatment and restoration of his right maxillary
central incisor due to external cervical resorption. In 2002, the treatment failed and the tooth was

extracted and replaced with an adhesively cemented Maryland bridge in fiber-reinforced composite.

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In 2010, he came to my observation after noticing a pink spot in the left maxillary central incisor,
which was Maryland abutment.
The clinical examination revealed an erosive defect containing soft tissue on the vestibular surface of
the incisor. Clinically the palatal surface was intact and a careful exploration of the defect with a
probe confirmed that it involved only the vestibular aspect. There were no symptoms associated with
the lesion. The tooth responded to the vitality tests and there was neither clinical nor radiographic
evidence of periapical pathology.

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Invasive Cervical Resorption (ICR) class II according Heithersay has been diagnosed. Regarding the
prognosis, we know from the literature that the ICR class II according Heithersays classification, has
positive outcomes close to 100% if the vitality of the pulp is maintained and if they are treated as a
subgingival carious lesion. So, to ensure the highest chance of success, the therapeutic choice has
been to preserve pulp vitality. Treatment plan therefore included: Removal of the Maryland, Surgical
exposure of the defect, Removal of the soft granulation tissue, Isolation of the operating field, Cavity
preparation, Obturation of the defect with direct adhesive composite resin and flap suture.

Walter Devoto
Dr. Walter Devoto Born in
Chiavari on 29/03/1965
graduated in Dentistry in 1991
at Genova University.

Angelo Putignano
M.D. degree and D.D.S. post
graduate certificate from
University of Ancona-Italy.

FOUNDERS ENDO

PATIENT REQUEST
When I explained the treatment, the patient asked me whether it could be applied without removing
or redoing the Maryland bridge, both for cost reasons and because he was pleased with its function
and its aesthetic appearance. Considering that the defect affected only the vestibular aspect and
that it did not involve the palatal aspect, where the wing of the Maryland was cemented, I tried to
meet the request of the patient. This is why applying the rubber dam and sealing the operative field
were the most difficult treatment stages. These stages were nevertheless critical to ensure the best
possible seal in a critical area for adhesion such as the cervical area, where the risk of a microleakage
is very high.

Pio Bertani
Pio Bertani is a full member of
the prestigious association...

Fabio Gorni
Fabio Gorni is an active
member of the Italian Society
of Endodontics and the Italian
Academy...

ISOLATION PLANNING
The isolation of the operating field was carefully planned and was achieved using two sheets of
rubber dam that were previously disinfected by immersion in 0.2 chlorhexidine.
The sheets were perforated from first bicuspid to first bicuspid, excluding the hole at the level of the
missing tooth. At the level of teeth 1.2 and 2.1, and perpendicular to them, the first sheet was cut in
vestibular direction; these cuts were then joined through a third cut. The same cuts were also made in
the second sheet, but in palatal direction, and another hole was made close to the free base of the
newly-made dam peduncle.

MEMBERS
Monaldo Saracinelli
Ive been a student of prof.
Fabio Toffenetti and
Riccardo Garberoglio.

Jordi Manauta
Was born in Mexico City,
where he graduated cum
laude. in dentistry from
UNITEC.

Gaetano Paolone
My passion is aesthetic
direct and indirect
adhesive dentistry in
anterior and posterior
teeth.

Daniele Rondoni
Born in Savona in 1961
where he lives and has

worked in his own

laboratory since...

Vincenzo Musella
Vincenzo Musella
graduated in dental
technician. Proud friend
and student of...

Giuseppe Marchetti
Giuseppe Marchetti was
born in Parma (Italy) in
October of 1972 and
graduated from...

Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Giovanna Orsini
Giovanna Orsini is a well
known researcher in Italy
and internationally.

Paulo Monteiro
My passion for esthetic
dentistry began when I
attended the last year...

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

FLAP RAISING
After administration of local anesthesia the flap raising exposed the defect, then a aqueous solution of
trichloracetic acid has been applied to induce coagulation necrosis of the granulation tissue.

Patrizia Lucchi
Patrizia Lucchi Graduated
in Dentistry cum Laude in
1995 at the University of
Verona

Anna Salat
Dr Anna Salat graduated
with a degree in dentistry
from the International
University of Catalonia

Giulio Pavolucci
After graduation magna
cum laude in Dentistry, I
started focusing my daily
work on...

Marcos Vargas
Dr. Marcos Vargas
attended Cayetano
Heredia University School
of Dentistry in Lima...

Stefan Koubi
Dr. Koubi graduated from
University of Marseille
where he...

Engin Taviloglu
Dr. Taviloglu graduated
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Dimitar Filtchev
Co-founder of the Laser
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Angie Segatto
My commitment to arts has
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Kilian Molina
Kilian is required as a
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Gregory Camaleonte
I was born in 1980 in
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graduated in 2006 from...

Caroline Werkhoven
Caroline Werkhoven
graduated in 2002 at
ACTA, the dental faculty in
Amsterdam..

Ajay Juneja
Ajay Juneja finished his
BDS in the year 1995...

CAVITY PREPARATION AND OSSEOUS RECONTOURING

After removing the granulation tissue, the deep cervical margins of the cavity has been prepared
with a bur and the osseous recontouring has been performed.

Carlos Fernndez
Villares
Member of SEPES Spanish
Soc...

Next, the first sheet of the rubber dam has been applied. The pedunculated portion of the rubber
dam has been made slid under the Maryland, in labial direction.

Sulivan Leite
Sulivan Leite graduated
from the Ribeirao...

Maciej Zarow
Author of book edited by
Quintessence: EndoProsthodontics: guidelines
for clinical practice ...

Dan Lazar
Dan Lazar, graduated from
the Faculty of Dentistry in
2005 in Cluj-Napoca...

Murad Akhundov
Dr. Murad Akhundov
graduated from the
Faculty of Dentistry in
Baku...

Janos Grosz
Graduated summa cum
laude in 2006 from the
University of Szeged,
Faculty of Dentistry,
Hungary...

Then the second sheet has been applied. Superfloss has been passed through the hole of the
pedunculated section to ease sliding of the dam peduncle under the Maryland in palatal direction.
When this has been done, the dam peduncle was moved towards tooth 2.1 by pulling the floss, and the
traction was maintained by blocking the floss in the interproximal space between teeth 2.2 and 2.3.

MEMBERS ENDO
Simone Grandini
Chair of Endodontics and
Restorative Dentistry,
University of Siena, Italy.

Louis Hardan
Head of Restorative and
Esthetic department in
Saint-Joseph University
in...

Filippo Cardinali
Graduate in Dentistry and
Dental Prostheses at the
University of Ancona in
1992. Active Member of...

Riccardo Tonini
He is active member of the
Italian Academy of
microscopic Dentistry and
Active member of...

Paolo Generali
Doctor Generali was
graduated from Pavia
University in the year...

Calogero Bugea
Graduate in Dentistry,
Certificate in Oral Surgery.
Active Member of the
International
Piezosurgery...

Clifford Ruddle
Internationally recognized
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Pierre Machtou
Pierre Machtou was the
first scientific director and
general secretary of the
French Endodontic
society...

Marga Ree
Primary author of several
articles published in
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Marco Martignoni
Marco Martignoni leads a
private clinic in Rome Italy
and dedicates his practice
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pre-prosthetic...

Massimo Giovarruscio
Massimo Giovarruscio
works in Rome, Bristol and
London, specialising in
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and...

OPERATING AREA EXPOSURE

The operative area has been exposed by applying as a retractor a sectioned 212 clamp, stabilized
with a silicone for bite registration.

LEAKAGE CONTROL
To seal easily, quickly and effectively the operative field, I used the FILL and DRILL Technique, that is
merely a logical operating sequence that involves specific materials and allows operating in the
easiest and most effective way, ensuring the best possible seal and the best possible comfort in
complex situations such as the one of this patient.
In these cases to seal the operative field, I like to use a purple flowable composite because after
polymerization its consistency is harder than that of a liquid dam and because of the strong contrast
with tooth colour. The purple flow was applied quickly and abundantly without worrying if it FILL a
little bit the cavity that we have not yet finished preparing because we can DRILL and remove the
exceeding material with a bur during final cavity preparation.

It has been removed some purple flow apically to the cavity margin in order to perform the
restoration in ideal conditions and to ensure better management of the emergence profile during
composite layering.

At this stage, any pulp involvement requiring endodontic therapy was investigated. If treatment was
required, the condition was ideal, because of a perfectly isolated surgical field. Fortunately, the pulp
was not involved, so a glass-ionomer cement was applied to protect the pulp from cavity sandblasting
that it has been done to maximize adhesion.

After having polished the enamel margin whit a brown silicone point, etching, adhesion and
composite layering have been done.

Finally the rubber dam was removed and the restoration was polished.

SUTURE
After taking a control x ray, the flap has been replaced and sutured.

SUTURE REMOVAL
The suture has been removed after 1 week.

1 YEAR FOLLOW UP
Tooth vitality is evaluated at each control visit. The patient is not a floss and toothbrush lover, but
reported feeling well.

3 YEARS FOLLOW-UP
At 3 years the tooth is still vital without clinical or radiographic evidence of periapical pathology.

After 5 years the tooth is still vital and the periodontal health seems good.

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