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Minimal Invasive Techniques


implant-1This patient presented with temperature sensitivity. Radiographs (x-rays) revealed extensive decay in the Upper Right Second Premolar. The decay had started in the area where teeth touch which is difficult to access with a brush and requires flossing. Once the decay had penetrated the hard outer enamel shell it spread quickly through the soft inner dentine. It was approaching the nerve of the tooth this was  causing the sensitivity experienced as the tooth nerve had now very little protection.


invasive-2The patient was given local anaesthetic to ensure they did not experience any discomfort. A rubber dam was then  placed to prevent contamination of the filling, improve patient comfort and improve visibility. Patients find having treatment with a rubber dam much more comfortable.

Using a bright pinpoint light, I transilluminate the tooth, the decayed area between the teeth shows up as a shadow. Using this information and the radiograph, the decay was  accessed  from the bite surface of the tooth exposing the decay via a small opening.

invasive-3The intention in doing so was to maintain a ridge of intact tooth running around the filling as this greatly increases the strength of the tooth once the filling is placed.

(Normally to restore this type of filling, the back edge of the tooth would be removed to access the decay.  removing a lot of healthy tooth, weakening it and leaving it more prone to decay and possible fracture.)


invasive-5A thin metal matrix is placed between the teeth and they are wedged apart slightly to create some space. Under a  microscope and using very fine drills the decay is removed. The metal band allows  preparation of the back wall of the filling without damage to the neighbouring tooth.

Once all the decay has been removed the tooth is prepared and the filling bonded. The bond is very strong but very sensitive to moisture, using a rubber dam protects the restoration from the mouth’s natural moisture to give the best possible bond.

invasive-4Once the wedge was removed, damage to the surface on the tooth behind was visible but no cavity had formed. This area was treated with a strong fluoride paste and clear varnish placed. This will allow the tooth to re-harden and avoid the need for a second filling. The teeth relax back into their normal position once the wedge and dam are removed

As always time was spent at the end of the appointment explaining to this patient any measures, including flossing, which would help with their preventative regime and maintenance of the restoration.

invasive-6The final radiograph shows the completed filling after two years, the patient had no further problems from this tooth. The tooth behind re-hardened as the patient was much better about flossing and so avoided a further filling.

This type of filling is more intricate and consequently takes longer to complete, it is made possible  using the operating microscope that provides the dentist with unparalleled vision and magnification.

We have great filling materials, however they are a poor substitute for healthy tooth and anything I can do to conserve natural tooth ultimately increases the strength of the final restored tooth and optimises it’s longevity.