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INTERPEOXIMAL WEAR AND ITS TREATMENT. 213

making a proiniuent contact in finishing, is demanded. If, how-
ever, (2) the contacts are found unworn and in fairly good form,
it may be that the lodgment has been the result of accident which
has strained the teeth apart and may be regarded as temporary.
In that case, the space should be well cleaned and the patient
instructed to be especially careful to keep the space free from
lodgments. The case should be examined at frequent intervals
to see that this is successful. Within a few weeks the fibers of the
peridental membranes should recover their normal tone, and the
teeth be held together with sufficient firmness to prevent lodg-
ments from recurring. Where this fails after sufficient trial, a
cavity should be cut and a prominent contact made. (3.) Often
the examination will reveal the fact that the lodgment has
occurred through the roughening of the proximal surfaces of
the teeth by the beginning of caries of the enamel. This, of
course, calls for fillings at once to prevent further damage of
this nature.
If the form of the contact is at fault, either from (1) an
abnormal form of the tooth surfaces, (2) malposition of the
teeth, (3) abnormal wear of the contact points, treatment should
be instituted for permanent relief. The best form of treatment
in any one of these conditions is to separate the teeth sufficiently,
cut a proximo-occlusal cavity and make a filling with a prominent
contact, such as is shown in Figures 162, 163, or in Figure 220.
In these cases interproximal wear will oftenest be the cause
calling for this procedure. Generally, the cutting of a single
cavity will be sufficient, unless, indeed, decay has actually begun
in the proximal surfaces. These call for somewhat radical
prominence of the contact point built on, for it will probably
wear rapidly and become much reduced. In some eases it has
seemed that the wear of the cusps has been such as to give an
unusual sliding movement of the teeth upon each other in chewing
food. It is well to look for this and, if discovered, correct it by
a little grinding of the surfaces.
The cavity should generally include more surface than
that already worn and have a good and sufficient step in the
occlusal surface. There is no necessity for considerable depth;
it should only be sufficient to insure stability. The whole filling
should be especially well and substantially built and the contact
so malleted as to make of it hard hammered gold in contra-dis-
tinction to solid annealed gold.
After the treatment, it is well, particularly if there has been
much loss of interproximal gum tissue by absorption, to watch