Tips and tricks on how to fill deep interproximal cavities

Deep interproximal cavities are tricky to repair for several reasons. So what can you do to make live easier on yourself when restoring deep decay?

Bone removal

Removing some bone in the area of the decay may be necessary. We have found doing a separate crown lengthening procedure unnecessary. With the right tools and training a minor amount of bone re-contouring can be done at the same time as the restorative work. One can do this with equipment any dentist already has, a diamond bur. Higher magnification is very helpful when attempting this, especially if using a closed technique. We have found the Solea to be very useful in these situations. However, if we are talking about less than 1mm, then a diamond bur is much faster way to accomplish the job.

Tissue maintenance for restoring deep interproximal cavities

Cords, paste, and hemostatic agents are best for ensuring that bleeding is kept to a minimum.

Metal matrix strips for deep restorations

The best matrix strips need to be able to go deep. They must be tall enough to get well below the gumline and still reach the occlusal level of the tooth. You will likely need to adjust the matrix so the deeper portion can fully seat. More tips and tricks can be found for sectional matrix systems on our page about that.

Filling material for deep interproximal cavities.

We prefer to use a giomer like Shofu’s Beautiful. The technique we use is just a thin layer along the metal tooth margin then cure that layer. Next we use a snow plow technique with the flowable giomer and our normal composite.

Wedges and sealing the apical margin

Lastly, sealing is the most important step of getting a good deep interproximal filling. Using larger wedges is sometimes counterproductive in deeper areas. Sometimes using multiple smaller wedges works better. One of the best tricks and one that we use all the time is to pack PTFE into areas that do not seal from the wedge. You can see a nice example of that on our PTFE in dentistry page.