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From: Mark Dreyer
To: ROOTS
Sent: Friday, July 14, 2006 3:23 AM
Subject: [roots]  rct and amalgam core

I'm now doing buildups without asking for permission routinely on all cases from docs not in my
top 10.   I've not had any negative responses and actually a few of them are quite happy to have this service.


I tried and tried but couldn't flush out the amalgam flash from the gingivae.  Advised that perio crown lengthening
surgery may be needed. Would you guys recommend perio sx in this case?

Dang it, placing margins like this is harder than the endo.  I overtapered my prep.  I'm out of practice,
but hope to do a bunch of these in the future and get back in practice.  - Mark




Nice work mark,

What is the  material around the tooth for isolation?

Why don't you try Cermet or Miracle mix instead of amalgam, It reduces the toxicity and I think it has better comp
strength than amalgam plus it has some flouride release and some chemical adhesion. and you can start your crown prep
as early as possible. getting marginal adpatiation is a peice of cake with it. - Ananya

Ananya, I injected dycal into the deep sub-gingival area after excavation of caries, and then trimmed it back with a
high speed chamber diamond using run with water.  Around the rubber dam I've used oraseal caulking from Ultradent.

As for the buildup, I am not a believer in glass ionomer for a buildup material-too weak and prone to recurrent decay.
I'm also not convinced that amalgam has any toxicity issues to be concerned with.  I wouldn't hesitate to use a bonded
resin as a buildup in certain situations, but feel more comfortable with amalgam when I'm working in such a deep
subgingival environment.  - Mark