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a Class III Cavity treatment (procedure, materials)

Isolation Many approximal cavities in anterior teeth are close to the gingival margin. This is because caries develops just apical to the contact area and, unless there is gingival recession, the gingival papilla reaches almost to the contact point. o Often necessary to retract papilla during treatment In order to preserve isolation rubber dam is used in most cases. Access to the caries In most caries, access is through the palatal or lingual surface. When the teeth are in good alignment and the thickness of enamel overlying the caries labially and lingually is roughly the same, it is better to leave the sound labial enamel for aesthetic purposes. If access is gained from labial side, leaving only a thin layer of enamel palatally, there is a risk of fracture. Removing the caries Dentine is removed at low speed with a round steel bur. The enamel-dentine junction is cleared first, and then residual caries is removed from the pulpal aspect of the cavity. In larger lesions, caries spreading along the enamel dentine junction leads to decalcified enamel on the inner aspect of the cavity, although the outer surface is sound. Although this enamel is unsupported if it is on the labial surface it is worth keeping for aesthetic reasons. o It also increases retention of the restoration. Designing the cavity and producing retention Many small and moderate-sized lesions are naturally undercut, thus little more preparation is often needed. For composite sufficient retention is achieved by acid-etching enamel and dentine whether or not undercuts are present. o Usually there is sufficiently large area of enamel, often on the inner aspect. In the absence of sufficient enamel, we can o Cut retentive grooves in dentine cervically and occlusally with a small round bur at low speed o Bevel the outer aspect of the preparation to increase enamel surface area for etching Do not forget to remove vulnerable enamel which has been thinned out and makes contact with opposing teeth in the occlusion Unsupported enamel, which does not contact opposing teeth in occlusal movements, should be left.

Lining Approximal carious lesions in anterior teeth are not usually restored until caries is established in dentine. Pulp horn is often close to the base of the caries and a calcium hydroxide lining may be required in the deepest of these cavities Etching Access to the enamel surfaces to be etched, including the inner aspect, is often difficult o Better to use brightly colored (thus visible) etching gel applied with a syringe. The enamel of the adjacent teeth should be protected with a mylar strip Bonding The bonding resin is painted onto the etched area and then LCed Matrixing and packing A thin, transparent matrix strip is used (straight or curved) It should be well adapted to the cervical margin and a wedge should be used to adapt the matrix in this area. Avoid creating a ledge cervically because it is difficult to remove If access has been from the palatal/lingual side, one end of the matrix is pulled round the labial side and held with a finger The composite is inserted from the palatal/lingual side, the matrix is pulled round, and the composite is LCed from the palatal/lingual side through the matrix and from the labial side through the thin enamel. Finishing If the matrix has been adequate it should not be necessary to finish the labial or cervical margins A small cervical ledge can be removed with a flexible impregnated strip. If there is large ledge, the filling should be replaced. Excess on the palatal/lingual aspect can be trimmed o A composite finishing diamond at high or low speed (e.g. flame) o A white stone at low speed o A multi-bladed tungsten carbide finishing but in the air turbine A final finish is given with a succession of abrasive disc, or, if access is sufficient for them, mounted pumice-impregnated points or abrasive strips.