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174 THE TECHNIt'AL PROCEDURES IN FILLING TEETH.

place the buccal enamel margin and is a violation of the rules
for extension for prevention made necessary by extension of
decay within the dentin, not on the surface of the enamel.
Figure 231 is a proximo-occlusal view of the completed fill-
ing, and Figure 232 a view of the occlusal surface in contact
with the cuspid. This latter gives the best idea of its form.
Although this is a large filling, the buccal cusp of the tooth is
abundantly strong and the filling is well supported.
In case it should become necessary to make a filling in the
distal surface of this tooth at a future time, the cavity would
be cut in the ordinary way, cutting out so much of the step por-
tion of the present filling as might be necessary to give it sta-
bility. If it was thought that the removal of the whole step
portion was necessary, the separator should be placed and the
first bicuspid should be i^ressed against the cuspid with as much
force as possible in separating the bicuspids, and the filling
removed to the marginal ridge so that the new filling could be
anchored over it with mallet strokes in the direction of the long
axis of the tooth. Under such conditions the malleting would
have no tendency to disturb its mesial portion. ]\Iuch experience
with this operation has shown it to be safe and eiTective if the
first filling has been well condensed.
Such a cavity as has been shown in this series may receive
a porcelain filling by making such changes as will allow an
impression, or a matrix, to be withdrawn. The step portion,
however, would have to be cut deeper in order to give a stronger
body of porcelain for greater strength. A i:>orcelain filling would
be far better from the esthetic point of view if the shade and
degree of translucency is well matched. Yet, if the color or the
form is ot¥ at all, or so much that it will attract the eye, or a
shadowA' cement line will raise a question, then from the esthetic
point of view a well finished gold filling is to be preferred.
Mesio-disto-occlusal cavities in the bicuspids when the
PULP is alive and when the pulp is removed. In Figures 233-
245, a case is presented for treatment involving several distinct
conditions. In the upper first molar there is an ordinary mesial
cavitj', in the treatment of which there is no special difficulty.
In the second bicuspid there is a decay in the distal surface and
a decay in the mesial surface, both of which have burrowed
deeply in the dentin. A mesio-occluso-distal filling is recpiired.
The pulp is not exposed. In the first bicuspid, the mesial and
distal cavities are deeper and broader; the pulp is exposed and