I think it is not an easy task to fill a wedge-shaped defect, the reasons and complications caused by filling.
1, because the defective part has periodontal tissue interference, the defective part – the gingival wall: often under the gingiva or flush gingiva, there may be periodontal blood, gingival sulcus fluid contamination, will cause the filling body to fall off, the patient postoperative discomfort, or filling body overhang.
2. After the resin filling, the gingival sulcus often does not feel smooth when you probe it.
3. It is not easy to make the defective wall or incisal wall to be well shifted and integrated with the tooth tissue, and it is often higher than the original tooth body, making the junction darker after a period of time. Or the wedge-shaped defect filling body does not restore a good protrusion, or in the clinical process of grinding will unconsciously grind away the normal protrusion of the tooth surface on the lip or buccal side of the affected tooth defect.
4., there is a possibility of postoperative sensitivity, instead of post-treatment sensitivity, there is more severe sensitivity. Have you encountered any of these I mentioned? How do you overcome? I initially summarized the operation steps, there are better ways to discuss. Wang Lingxiang, Department of Endodontics, Qingdao Stomatological Hospital
(i) Preparation before filling
1. Check the periodontal tissue, the gums are inflamed and must be treated periodontally first. One or two weeks after periodontal treatment, the gingival tissues return to normal before restoration. The patient is instructed to rinse with mouthwash for 1-2 minutes every day during this week or two weeks, and no more rinsing with water for half an hour after rinsing.
2, the gingival wall of the class V cavity in the subgingival 1-2mm very deep, through the gingival line can not get a good exposure, must be periodontal surgery, if the affected tooth is located in the lower 4, 5 position, attached gingival width is narrow, perform root to reset surgery. After removal of the stitches after surgery, it is also necessary to rinse daily with mouthwash in the same way as above. Re-filling will be performed after two weeks or more.
(ii) Filling treatment
1. Cleaning of the tooth surface
Remove the food and soft scale embedded on the filling surface and around it with a probe, rinse with a triple-use gun, and rinse the patient’s mouth.
2. Tooth preparation
①Select a small ball drill of different sizes according to the size of the cavity, grind all the filling surfaces with a slow handpiece drill, and rinse
②Prepare the incisal wall or labial-buccal wall, i.e., mainly enamel, with a less sharp diamond needle that has been prepared, prepare in an oblique shape, rinse, and obtain a clean and clear filling surface
3.Placement of gingival line
Place the gingival line with a gingival rower, three 0’s or two 0’s.
4.Adopt the self-etching bonding method (if the filling often falls off or has sclerotic dentin, the pre-etching + self-etching bonding method should be used to increase the bonding strength)
① acid etching with 37% acid etching agent only acid etching incisal wall or lip and buccal wall on the enamel wall part, acid etching time: 15 seconds, 30 seconds
②Rinsing with a high-pressure water gun, sucking away saliva and water, not instructing the patient to rinse his mouth
③Dry the tooth surface and then treat the surface with a two-step self-etching bonding system (primer and bond). Apply, wait and blow in three steps. Strictly follow the manufacturer’s recommended instructions.
5, . Placement of flowing resin
Place the flowing resin along the linear line where the two faces of the wedge-shaped defect intersect, so that the flowing resin enters the area and obtains a stress buffer and a good bond. Light curing irradiation for 20 seconds.
6.Placement of composite resin
Place 3M’s Z350 resin material, which can be selected in different colors depending on the near neck and near cut end. Fill in layers and irradiate each layer for 30 seconds with light curing.
7.Remove the gum line
Rinse the tooth surface with water to moisten the gum line, and then remove the gum line.
8.Refine the shape
Check and remove the overhang at the cervical gingival margin, the thin layer of cured and hardened adhesive remaining on the tooth surface around the filling, and any excess material at the intersection of the resin and the tooth at the incisal or labial-buccal wall.
9. Polishing of the filling and the tooth surface
Strictly speaking, polishing should be done after 24 hours. Based on the current national situation, it should preferably be done 5 minutes after filling, so if the patient has more than one tooth to treat, polishing can be done last.
10. Medical advice: If the symptoms of hot and cold irritation appear after filling, it can be observed for 1 week, and the general situation can get better by itself. If the symptoms of pulpitis appear, it is necessary to come to the hospital for pulp treatment in time.