Once in a while we get a permanent molars that takes long time to completely erupt. The gingiva will be covering half of the tooth for long time and we keep waiting, waiting, waiting...
Now I used a cotton pellet ( as big as needed) as gingival retraction, to push away the gingiva and to control fluid. Laser gingivectomy can also be done, but most of time, I find the cotton pellet is sufficient.
I use it from the beginning, if burs are needed to remove caries, it will
keep it away from getting touched by the bur. Sometimes the
sandblasting is enough to remove decalcified enamel.
 |
| pre-op view with decay on occlusal, DB cusp covered |
 |
| cotton pellet on distal, caries removal started. |
|
|
 |
| composite placed and cured |
Waiting for the gingiva to recede can take a long time and the caries only gets worse. These teeth are not in occlusion, and it is difficult to clean for the little ones (7 or 8 years-old). Most of time I find heavy plaque and food debris, especially under the gingiva. Sealant on one of these as early as possible will prevent the decay.
