Clinical Tips 7: Root Decay Inlay

Sometimes patients end up with some unfortunate decay, despite their best efforts to maintain and clean their teeth. This particular type of decay, often called senior decay, happens on the root surfaces of the teeth and can quickly cause the tooth to be un-restorable. That is one reason we get bitewing xrays regularly that go between your teeth – to see this stuff as soon as it pops up so we can fix it before it gets huge! These lesions can pop up in just 6 months.

Here we have a patient with root decay under an old amalgam filling on tooth #15. The amalgam itself hasn’t exactly failed, but the tooth needs some help!

We start by removing the amalgam and the decay.

We then seal up the inner portion of the tooth, called immediate dentin sealing, to ensure we have a smooth surface to manufacture our restoration.

The tooth is then prepared for the restoration. We then scan it, design it, and manufacture it. We chose Lithium Disilicate here for its strength.

Unlike crowns, inlays and onlays are chemically bonded to the tooth structure. This is done under a rubber dam with resin cement, Panavia SA, after carefully preparing the tooth structure with total etch using phosphoric acid, and a layer of Clearfil Universal Bond Quick. We then fill the restoration and/or tooth with cement, and cure, and clean it up.

This tooth is now being held together with its ceramic restoration, the same way that crowns can resist fractures, so can bonded ceramic restorations. This tooth is now stronger than it was before we started when it had its amalgam in it!

Stay tuned for more Clinical Tips with Dr. Bishop!