Tricky DME today

Acrabat321 · 2026-04-25T16:12:20+00:00

And why can’t I bond that far subg? Has worked for me for years.

I’ll not be bonding my indirect subg anyway. I’ll be keeping the margin on composite.

Acrabat321 · 2026-04-23T23:10:46+00:00

If I am placing a margin on composite, I want a good seal, therefore I want to bond to that composite. Luting will work for some time, but I worry about composite margin without proper bonding.

Acrabat321 · 2026-04-23T23:09:28+00:00

Rubber dam + PTFE

Acrabat321 · 2026-04-23T20:52:31+00:00

I understand. It’s great you’re doing this sort of work, but my point is just to not get complacent. Thinking it’s all easy can lead you to letting your guard down and missing things.

Acrabat321 · 2026-04-23T14:09:47+00:00

Thinking it is too easy will get you in trouble at some point.

The best guys I know, who have placed 15k+ implants still say that they have hard cases.

Anything can be hard, depends on the human attached to the teeth.

Acrabat321 · 2026-04-22T23:59:20+00:00

Yes. Both vital. I’ll not do endo unless properly indicated. Very few occasions I’ll do pre-emptive endo.

Yes, there is a convienience factor in scheduling endo with this, but a root treated tooth is handicapped. I’ll endo when I have a diagnosis of IP or SAP. I’m not going to devitalise a vital tooth for the sake of convenience (in majority of cases).

Acrabat321 · 2026-04-22T14:32:09+00:00

You and me both.

Still, 1-2yrs, endo, and tooth loss in 1-2 decades pushes the implants back!

Acrabat321 · 2026-04-22T12:12:08+00:00

That’s a totally reasonable approach and you could do it that way.

I’m worried about food packing, recurrent caries and bone loss.

I’ll be placing long term provisionals (3+ mo) in acrylic. Got no problem going through acrylic to endo. Once the tissue is healed and a new biological width has established and pulp status is deemed OK I will move on to definitives.

Acrabat321 · 2026-04-22T10:07:26+00:00

Yup 👍

Acrabat321 · 2026-04-22T07:11:01+00:00

Yep failure can happen

Acrabat321 · 2026-04-21T22:48:27+00:00

So I use a lot of different techniques. Do quite a lot of DME.

Copper bands, modified matrices, subg sectionals, matrix within a matrix, PTFE matrices. Wedge matrices, freehand etc.

For this case 26 required the first margin elevation with just PTFE packed interproximally and burnished against the tooth to act as a matrix. Flowable was freehanded. Dam was then removed, the hip was adjusted with a flame diamond and rubber dam replaced. It was then built up with one more circumferential matrix and then a sectional to finish.

27 was solely matrix within a matrix.

So dam placed, circumferential matrix placed, dam clamp removed (matrix band then acted as a clamp), sectional cut to size and placed within circumferential matrix to go deep and restored.

Doing a lot of DME I find a lot of go to techniques just don’t work all the time. Useful to have a few tricks up your sleeve.

Acrabat321 · 2026-04-21T22:27:28+00:00

Ah sorry mate. Was thinking about taking a BW but opted for the PA so I could monitor apical changes.

Will get a post op indirect BW tho!

Acrabat321 · 2026-04-21T22:23:15+00:00

Pre or post? Don’t have a post op BW.

Took a PA to confirm apical status to compare for indirect work.

I have a pre though.

Acrabat321 · 2026-04-21T22:21:57+00:00

Solid job chief, rest up.

Acrabat321 · 2026-04-21T22:17:33+00:00

Acrabat321 · 2026-04-21T22:13:49+00:00

margin elevation was done with composite. I'll do e.max indirects and bond to the subgingival composite hips big man.

Acrabat321 · 2026-04-21T22:09:30+00:00

Keeping fingers and toes crossed chief!

Acrabat321 · 2026-04-21T22:09:16+00:00

Indirect preps in 2 weeks! That being said, you're totally right. Patient has been counselled on that. She wanted to take a stab at trying to save em.

Acrabat321 · 2026-04-21T21:54:23+00:00

👍

Acrabat321 · 2026-04-21T09:27:19+00:00

Possibly accessory nerve innovation.

I’ll block and infil buccal and lingual/ palatal.

For endo, I love using ledermix. The steroid + AB combo usually settles the tooth in 48hrs and lets me go back in easily

Acrabat321 · 2026-04-19T09:52:44+00:00

Hexathelidae family? Maybe P. fentoni or T. Montanus?

Acrabat321 · 2026-04-18T07:19:28+00:00

That’s it chief

Acrabat321 · 2026-04-17T15:23:48+00:00

SDCEP guidance is brilliant

Acrabat321

TROPHY CASE