Friday, March 23, 2012

distal decay on 2nd molars.

I hate distal caries on 2nd molars caused by impacted 3rd molars: difficult access, close to pulp, post-op sensitivity, periodontal problems, etc. Just few problems that I know it will be hard to deal with.

I followed Pascal Magne's advice on this one, and it turned out really nice and easy. Check out the sequence:

pre-op taken 11/2011
decay exposed after #32 extracted
matrix band placed, caries detector used

pulp capping and primer
immediately after band removal, prior to finishing or polishing
pot-op x-ray, no finishing or polishing on distal
The martrix band can be purchased at

Cut a second piece and slide into the first band to even go deeper and to protect gingiva during caries removal. Discard it prior to placing composite. Voila!

If an indirect restoration (onlay) is needed on 2nd molar with distal decay, this technique can be used for margin elevation.  check out the next case:
#18 MO composite DO amalgam with open margin on distal
amalgam removed, found base
base removed, found decay
different angle to show the DL wall
MO composite removed
still removing more decay
I was really dreading seeing pulp, did not want to end up in RCT
fortuanately, no pulpal exposure! I placed a composite to elevate the margin, IDS done

CAD/CAM onlay cemented with composite as cement
immediately after cementation
In this case I did not use greater curve matrix, did not know about this technique. It was hard to place rubber dam and have a good seal on distal, I thought removing it and replacing for tofflemire band will be even worse for fluid control. I cemented the onlay with resin cement, the little "puff" on distal is the cement, indicating where the junction between composite for margin elevation and the onlay. I removed it later with finishing strips. I wish I had used the greater curve bands for margin elevation and cementation, it would have made my day so much easier.

Next case the decay was smaller, 3rd molar was extracted, crown lengthening done, and I used distal access instead of occlusal access. it was deeper than it looked. 

pre-op bite-wing

after extraction of #32

clinical view after crown lengthening, I thought it will be small...
Wrong, it was almost to pulp11
 Fortunately, the tooth is till "alive" and asymptomatic today, I am glad we did not need RCT.


  1. Just learned about greater curve matrix in CE class when building subG gingival margin up and thought of your blog on it. Just giving you a shout out! :D

  2. Hi Dr. Nien, glad to see more cases posted up here. We just had a patient with very similiar situation and I just shared your blog with the office! -Mary