Clinical Tips 4: Big Cavity (part 1)

Upper premolars are big(er) teeth with large nerves, and small roots! When they get cavities in from the side, or smooth surface cavities, they often get close to the nerve very quickly!

In addition to this, by the time the infected tooth structure or cavity is cleaned out, there is often not much of the tooth left! So indirect restorations such as crowns or inlays/onlays are popular choices to restore the tooth to full-function.

Here we have an upper premolar with a huge cavity!

We start by opening up the tooth by removing the chalky and unsupported enamel to expose the inner tooth structure, the dentin.

Cavity indicator used here to show us what to keep cleaning!

Removal of the cavity hits the nerve tissue. But you can see by the green — we still have more cavity to take out! We did know this going in — that the tooth would need a root canal — so this is all part of the plan!

Here we see the cavity all the way cleaned out, but we have exposed a lot of that nerve tissue. An indirect restoration is indicated here after the root canal, or cleaning and disinfecting of the pulp and canals in the roots, is performed.

The root canal is finished, and the tooth is ready for an its onlay! This visit took about 2.5 hours, and the patient left with a permanent restorations! Stay tuned for the next part – which is restoring the tooth!