#18 has deep cervical decay at the distal

Step 1

 Patients chief complaint was food impaction.

All decay has been removed

Step 2

DL margin was flush with the bone at the interproximal.  The DB and DL cusps were reduced 2mm because these cusps were thin and had little supporting dentin.  MB and ML cusps still have ample dentin remaining to provide support.


A bone chisel was used to remove bone 1mm below the distal prep margin

Step 3

A Karl Schumacker bone chisel (ENA6403-3) was used to chisel away bone interproximal to 1mm below the distal prep margin. Be careful not to carve in an intraboney defect. Also used the chisel to sever the epithlial attachment buccal and lingual. I now have room to place the matrix band.

Greater Curve Standard modified at the mesial

Step 4

Greater Curve Standard band was modified at the mesial to allow the distal portion of the matrix to seat down the full length of the tooth. 

Greater Curve Standard in place

Step 5

Distal Contact opening made. Nearly impossible to use a rubber dam on deep preps.  There is a saliva ejector on the lingual, held by a clip. The saliva ejector is positioned to pick up saliva, while simultaneously keeping a very slight steady stream of air across the prep. (Now that the Saliva Ejector Holder is available, I would have chosen it)

Composite placed

Step 6

Ready for finishing

Final composite restoration

Step 7


Tooth # 18 one month later

Step 8

Gingiva has healed well. Pocket depths within normal limits. Patient happy because she can now chew without food impaction.

Bitewing of left molars

Step 9

Sealed composite evident for tooth #18. Same day conservative crown lengthening on the day of composite placement is very practical.
I have resolved my patient’s chief complaint.  Now ready to tackle her remaining dentistry.

Final thoughts

In spite of violating the biologic width at the interproximal, the tissue responded well. Pocket depths are normal with no bleeding. I first noticed this phenomenon on deep cervical preps with Class III's & IV's, and now carry it over to posterior teeth. Why you can violate biologic width with a well sealed composite and not a crown margin is a mystery to me. I'm just glad it works.