Heroic Dentistry: Saving the Day for Judy

By Dr. Matthew Gilchrist

The Heroic Dentistry series celebrates oral health care providers who, like PULPDENT founder Dr. Harold Berk, have made it their mission to save teeth and help patients live in comfort and smile with confidence. 

Judy was distraught. The loss of a large composite filling on her upper right lateral incisor left a gaping hole in her smile. She didn’t want her students, or anyone else, to see her this way, and she wanted an immediate repair before returning to school to teach her afternoon class.

Judy was concerned that same-day treatment might not be possible for this tooth. I shared her concern, but I had to find a solution, alleviate her emotional stress, and let her get back to work and life as usual.

Upon examination, I could see some secondary decay and a sub-gingival distal margin with a small amount of bleeding. We discussed several options. We could perform root canal treatment followed by a post and core and a crown, which might require crown lengthening. This would take one to two months at a cost of several thousand dollars or more. Another approach would be extraction followed by either an implant and crown, at considerable expense, or a more affordable removable partial denture. A third option would be a direct composite build up and restoration, and although the long-term prognosis might not be as favorable as for the other options, it could be done immediately.

Judy did not want to wait, so we seated her and got right to work. After administering anesthesia and cleaning out the decay, I chose to use ACTIVA BioACTIVE-RESTORATIVE over a traditional composite for several reasons. Isolation was difficult, especially at the distal margin. I needed to be able to hold the matrix in place with one hand and place the material with the other. ACTIVA’s injection delivery system would allow me to accomplish this very easily. I could also bulk fill quickly with ACTIVA in large increments, and not have to rely as long on the less than ideal matrix placement. This would be a great benefit.

I etched and bonded, and I built up the distal wall with ACTIVA and light cured the material. The material flowed nicely and seems to have an affinity to stay on the tooth and in the area where it is placed. I then continued to dispense ACTIVA to fill the tooth, and again light cured. There is no need for condensing, and the delivery system and the way the material handled allowed me to complete the procedure quickly and without an assistant.

Judy was thrilled when she looked in the mirror. In one short same-morning visit, she was smiling with confidence and was ready to walk back into the classroom without embarrassment.

ACTIVA is my material of choice for many restorations, but this particular case really demonstrates the ease-of-use and versatility of the material.  In addition to using the material for routine fillings, it provides me with a go-to material for the more heroic restorations that I attempt for my patients.

Figure 1. Pre-op periapical radiograph shows the extent of the decay and the sub-gingival nature of the distal margin.

Figure 2. Shows the tooth after caries excavation. Note the sub-gingival margin and bleeding on distal. A facial bevel was added for better seal and retention.

Figure 3. Another image of the tooth after caries excavation.

Figure 4. Shows MIDBL restoration with ACTIVA prior to doing a final polish. The tooth was etched and bonded prior to placing the material.

Figure 5. Another view of the ACTIVA restoration. To protect the large restoration, it was taken out of occlusion. Note the articulating paper marks on the adjacent teeth.

Dr. Matthew Gilchrist is a general dentist at Avenue Dental in Charlottetown, Prince Edward Island, Canada.  He graduated from Dalhousie University, Faculty of Dentistry, in 2008 and holds a Bachelor of Science degree from St. Francis Xavier University (2004).  Dr. Gilchrist resides in Stratford, PE with his wife and two children.