To drill or not to drill..that is the question.

This morning I am encountering a very frequent quandary...tooth colored fillings that have small defects. The question is do I remove the fillings and replace them with nice new ones or are these fillings still functioning and perhaps I should leave them alone? In this case, X rays do not offer any help.
Although it may seem like a simple situation in which I should just re-do the filling..the problem is that anytime you drill into a tooth to replace a filling you might end up with a sensitive tooth afterwards and then I have a patient telling me that everything was just fine until I suggested this!!
Well in this case I decided that I should replace the fillings to prevent this from becoming a larger problem down the road....will report back on this next week.

Drill-etch-glue-fill-polish

I have been away lately due to a death in the family...and have been very busy setting up a blog for the family....
But now I am back and here we have one of my usual cases of bonding an eroded tooth.
In our first figure you can see that this was bonded many years ago but both the bonding and the tooth have eroded even more..

the first step is to drill away the old bonding and prep the tooth to accept a new bonded filling...so i drill away until I am down to clean fresh tooth structure...but that is not all...to get the filling to stick I have to first use a conditioner to etch the surface of the tooth..and that is what this next photo shows...if you look carefully you can see that the arrows are pointing to a frosty surface...that is etched enamel which has micro-porosities...

At this point I take the bonding agent...which is just a fancy term for glue and lightly apply it to our tooth surface....

Once this layer is hardened with my bonding light I then apply the filling material until it blends in with the rest of the tooth...
The filling can now be polished and we have a nice smooth surface ...

Multiple choice...

Sometimes we get choices...take a look at these...
1. New decay on a tooth that never had work...needs a new filling.
2. Old silver filling(amalagam)breaking down..needs removal and restoration.
3. Old crown has the porcelain breaking down...new crown needed.
What do we do first? Well I am going to leave the crown replacement for another day...today we will focus on placing two new fillings.
Step 1..removal of old filling and excavate new decay....

Decay fully removed from both teeth now...

Here you can see the two teeth each with a matrix retainer applied...and then the finished fillings...



Have a happy thanksgiving...