Mind the Neighbor teeth: 5 rules to follow

Here are 5 rules to follow if you care about preserving neighbor teeth. Taking care of the teeth close to the one(s) on which we focus our therapy is common sense and dental good manners.

In all of our procedures we use rotating tools;  however, as much careful and delicate we try to be,  the rotation of the tips itself makes it likely that we somehow touch the neighboring tooth.

It is also important to remember that every time a cavity is opened,  we have a special access to the proximal tooth, and that’s unique chance you don’t want to miss!

Here are 5 golden rules for You:

 – Do not touch neighboring teeth with rotary instruments

 – Teflon protection: don’t etch the neighboring teeth

 – Polish existing restorations

 – Seal your old restorations

 – Remember an open cavity is a big opportunity

styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.1

#1  Do not touch neighboring teeth with rotary instruments
…and if it happens, polish them! It is important to leave the proximal wall, that will be in contact with the new restoration smooth, to avoid plaque retention and to help the patient in flossing at home.
You can use wedges that carry an integrated matrix barrier.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.2

Special barrier dedicated to protect neighboring teeth in daily situations. Notice how we did touch the metal protection.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.3

It is not unusual to see scratches in the teeth close to preparations for crowns or overlays.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.4

What we have to do is just notice those signs and remove them: a rough interproximal surface is retentive for plaque and bacteria.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.5

Have a look at the instruments dedicated to polish different  areas.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.6

Discs with different abrasiveness, can be really useful to remove the scratches on the tooth surface and to round the crest.


styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.7

Stripes: the plastic ones can finish and polish the area under the contact point, without changing the anatomy of the tooth.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.8

Spirals comes in two colors – beige and pink – and thouroughly polish not only the occlusal surface, but also the interproximal area which is usually hard to reach with the common instruments.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to

Fig.9

#2  Teflon protection
It helps to not etch neighboring teeth. It is better to use a teflon tape piece not too thin: 0,20 mm thickness  is very good.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.10

Also in the posterior area it is important to protect the adjacent teeth while we etch.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.11

Stabilizing the teflon tape is a key step during adhesive procedures:  we suggest you use the ring you use for second class restorations to gently and firmly fixe the teflon
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.12

#3  Polish existing restorations
This is an easy and fast procedure that can really give a second life to old restorations.
It can also help you achieve a better interproximal contact point if we have a correct shape of existing restoration(s).
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.13

This is the result with EVA handpiece.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.14

Sometimes you will have to reshape a lot, or you will have to give a whole new shape to the restoration.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.15

The restoration replacement of 25 and 26 requires changing the shape of mesial 27 and distal 24.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.16

In purple the  incorrect profiles we want to modify are highlighted.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.17

Cavity prepared, ready for the matrix placement and adhesive steps.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.18

Details of the lines we have changed,   in green the walls of proximal teeth with modified shapes, in pink the cervical lines finished by Eva handpiece molding.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.19

Result of direct restorations 26 (A3 ONE 3M & A3 body 3M) 25 (A3 ONE 3M)
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.20

During the resto on 16  it is possible to improve the shape of 15.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.21

Using an Arkansas stone bur we can finish the cervical margin and modify the mesial profile of 14 at the same time.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.22

Using a Soflex disc is useful to correct the crest margin.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.23

Final view.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.24

# 4  Seal old restorations
When a cavity is opened, a direct view of the composite restoration is available. With a thin explorer like  LM explorer 11f or 12f, you can check the margins and the composite surface.
If there a micro leackage or are bubbles or surface defects are present,  just refresh the surface by sandblasting or with a bur, and do the adhesion again to fill them with new composite.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.25

#5  Remember an open cavity is a big opportunity
This direct vision helps a lot in detecting lesions and in treating them easily respecting crests and healthy enamel.
styleitaliano style italiano adjacent neighbor teeth proximal space untouched restorative dentistry rubber dam wedge matrix isolation protection how to teflon

Fig.26

 

Step by step of a slot preparation using the cavity open on the first molar to  access the lesion, to clean it and restore it.

Conclusions

 

We, as dentists, tend to be really focused on a single tooth we are treating; while it is a good sign that we are concentrated on it, we always must keep an wide view on our patient’s mouths to take the opportunities that certain specific clinical situations give us.

The care of neighboring teeth is one of that moments, and can be a key point to obtain mini invasive treatment, respecting the patient teeth and saving time.

Bibliography

 

Chiodera G, Pavolucci G. 50 shades of teflon – Part 1. styleitaliano.org 2016

Chiodera G. Back to basics: mind the wedge. styleitaliano.org 2017

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