Page 13 - GP Fall 2020

responded positive to vitality testing with odontal and restorative prognosis once cor-
cold and electric pulp testing, and negative rected, and, thus, cases without secondary
to percussion sensitivity, palpation sensitiv- caries should be recontoured. Lightning
ity, and fracture testing. strips are typically used in orthodontic inter-
proximal reduction, however they provide a
Treatment Concerns minimally invasive and conservative tech-
This case presented with numerous restor- nique that can be used to recontour subgin-
ative dilemmas that made treatment plan- gival restorative overhangs. As such, these
ning challenging. First, as there was no lightning strips could be considered for use
secondary caries and no periodontal issues in a restorative context.
around the restoration, a minimally invasive
approach was preferred. The nature of the References
restoration being completely subgingival 1. Loomans, Bas AC, et al. “Proximal Marginal
would make access, isolation, and recon- Overhang of Composite Restorations in Relation
touring of the restoration with a diamond to Placement Technique of Separation Rings.”
flame bur and establishment of well defined Operative Dentistry, vol. 37, no. 1, 2012, pp.
21–27., doi:10.2341/10-286-l.
margins unpredictable. The use of any dia- 2. Brunsvold, Michael A., and James J. Lane.
mond bur posed the risk of iatrogenic loss of “The Prevalence of Overhanging Dental Res-
tooth structure. The replacement of the ex- torations and Their Relationship to Periodontal
isting restoration with a contemporary class Disease.” Journal of Clinical Periodontology,
II distal-occlusal slot restoration would en- vol. 17, no. 2, 1990, pp. 67–72., doi:10.1111/
tail removal of excess tooth structure and j.1600-051x.1990.tb01064.x.
also be complicated by proper isolation and 3. Millar, Brian J, and Karen Blake. “The Influ-
margination of the restoration. Further, re- Figure 2. Post-operative BW and PA radio- ence of Overhanging Restoration Margins on
moval of the existing restoration could have graphs showing removal of the overhang on Interproximal Alveolar Bone Levels in Gen-
resulted in pulpal exposure due to proxim- tooth #18 and acceptable emergence profile. eral Dental Practice.” British Dental Journal,
vol. 227, no. 3, 9 Aug. 2019, pp. 223–227.,
ity to the pulp. Another option considered doi:10.1038/s41415-019-0530-1.
was to perform a surgical flap with crown Discussion 4. Chan, D. C.N., and A. K-H. Chung. “Manage-
lengthening in order to recontour the over- This case presented a challenge in correct- ment of Idiopathic Subgingival Amalgam Hy-
hang, however, this option was the most ing a subgingival restorative overhang. A pertrophy–The Common Amalgam Overhang.”
invasive. Additionally, the nature of the conservative method to treat this subgingi- Operative Dentistry, vol. 34, no. 6, 2009, pp.
oblique ridge and the consequent bone loss val overhang was explored, and proved to 753–758., doi:10.2341/09-058-t.
inherent in crown lengthening, meant this be beneficial in numerous ways. First, the 5. Loomans, B.A.C., et al. “Restoration Tech-
procedure was not amenable to a predict- nature of the lightning strips having met- niques and Marginal Overhang in Class II Com-
able outcome for tooth #18. al-backing, rather than the plastic-backing posite Resin Restorations.” Journal of Dentistry,
that is usually seen in restorative arma- vol. 37, no. 9, 2009, pp. 712–717., doi:10.1016/j.
jdent.2009.05.025.
Description of Operative Technique mentarium, provided greater rigidity that 6. Reza, Davalloo, et al. “Comparison of the
After discussing treatment options, the pa- enabled ease of strip manipulation around Efficacy of Three Different Instruments in the
tient opted to be treated in NYU College the contour of the tooth. This also provided Removal of Amalgam Overhang: An In Vitro
of Dentistry’s postgraduate clinic. Anes- the additional benefit of not causing iatro- Study.” The Journal of Contemporary Dental
thesia was achieved with topical 20% ben- genic damage to tooth structure in the form Practice, vol. 20, no. 3, Mar. 2019, pp. 335–340.,
zocaine and 2 carpules of 2% lidocaine of grooves and undercuts that are common- doi:10.5005/jp-journals-10024-2519.
with 1:100,000 epinephrine via local in- ly experienced with finishing burs. Further, 7. Roman-Torres, Caio Vinicius Gonçalves, et
filtration. An orthodontic interproximal this technique resulted in very minor tissue al. “A Short-Term Clinical and Microbial Eval-
reduction (IPR) strip with metal backing trauma. Not only were a flap and sutures uation of Periodontal Therapy Associated With
was directed subgingivally and used to file avoided, but a retraction cord that would Amalgam Overhang Removal.” Journal of Peri-
odontology, vol. 77, no. 9, Sept. 2006, pp. 1591–
down the restorative overhang (Lightning otherwise impinge on gingival fibers was 1597., doi:10.1902/jop.2006.050145.
Strips Safe Side Fine Narrow, Miltex-In- also not necessary. Next, the use of light- 8. Spinks, Gary C., et al. “An SEM Study of
tegra 620-81010). The lightning strip was ning strips to recontour rather than replace Overhang Removal Methods.” Journal of Peri-
held with college pliers on the buccal and the restoration using a high speed rotary and odontology, vol. 57, no. 10, 1986, pp. 632–636.,
a hemostat on the lingual, and maneuvered bur avoided the risk of pulpal irritation and doi:10.1902/jop.1986.57.10.632.
in a C-shaped, see-saw motion against the exposure and prevented removal of excess 9. Vale, Jose D. Freitas, and Raul G. Caffesse.
contour of the tooth. Pre-operatively and tooth structure. Finally, this method is also “Removal of Amalgam Overhangs: A Profi-
throughout the procedure, probing depths less subject to the limitation of poor visibil- lometric and Scanning Electron Microscopic
were measured and compared to the apical ity experienced when using a rotary or sur- Evaluation.” Journal of Periodontology, vol.
extent of the restoration as it appeared by gical instrument. It is important to address 50, no. 5, 1979, pp. 245–249., doi:10.1902/
jop.1979.50.5.245.
measurement on the preoperative periapi- that this is not applicable in overhang cases 10. Yasar, Füsun, et al. “Alveolar Bone Changes
cal radiograph. A postoperative periapical with secondary decay, in which the resto- under Overhanging Restorations.” Clinical Oral
radiograph was taken when the probing ration should be replaced. Investigations, vol. 14, 18 Aug. 2009, pp. 543–
depth matched the preoperative periapical 549., doi:10.1007/s00784-009-0334-9.
measurement and the tactile exam with an Conclusion 11. Rodriguez-Ferrer, H. J., et al. “Effect on Gin-
explorer confirmed smooth margins and that Restorative overhangs are common and gival Health of Removing Overhanging Margins
the overhang had been reduced. As the prob- problematic restorative complications that of Interproximal Subgingival Amalgam Resto-
ing depth and radiographic measurement predisposes a tooth to secondary decay and rations.” Journal of Clinical Periodontology,
coincided, no further filing was needed. periodontal disease. While challenging to vol. 7, no. 6, 1980, pp. 457–462., doi:10.1111/
correct, studies have shown improved peri- j.1600-051x.1980.tb02152.x.
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