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Dealing with deep margins - Many ways to skin this cat!

Dental caries can occur sometimes in the most unfavorable locations for the restorative dentist. In order to restore and obtain a predictable outcome, it is necessary to execute a planned series of steps to ensure a clean field to work during the endodontic treatment and a seamless restorative procedure following completion of the root canal treatment.

This case presented with distal caries with exposure of the dental pulp. A split rubber dam application by clamping the most distal tooth might also allow for easier access. A composite reservoir can facilitate isolation and contain endodontic irrigants within an aseptic field. Cut-trol is a concentrated form of ferric sulfate, utilized for control of hemorrhage from gingival tissues. An Opaldam matrix can be used to create a custom matrix against which composite or amalgam restoration is placed. The matrix can be easily trimmed away from the composite or amalgam. Patients can be instructed to use an interproximal brush dipped in Chlorhexidene mouth rinse to allow healing of irritated interproximal gingival tissues.

Deep margin elevation is another approach to dealing with deep margins, where there are 2 interphases created between the tooth structure and a direct restoration in the deeper portions of the preparation and then followed by an interphase between the prior restoration and an indirect or direct restoration placed over it.

Fire on!
Stay calm and practice ZENdo!

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