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REPA IRISG FILLINGS. 303

in the fissure upon the occlusal surface. The buccal wall is sometimes
the one broken away, sometimes the lingual. In either case the ability
to successfully repair depends upon the stability of the approximal
fillings and the anchorage which can be obtained at the cervical wall
and in the exposed fillings. To restore with gold a buccal cusp or the
entire buccal surface of a bicuspid might necessitate a show of gold
Avhich Avould be objectionable ; and a better plan would be to engraft a
porcelain facing or an entire porcelain crown ; whereas such a restora-
tion on the lingual surface would not be open to the same objections.
Cohesive gold alone is indicated for repairs of this kind. Watts' crystal
gold when used in cases of this description has been most satisfactory.
If the fracture extends above the margin of the giun the operation
is much more difficult because of the danger from a flow of blood, and
the additional difficulty of getting the rubber dam above the border
of the fractured surface. This mav be accomplished by filling for a
few weeks with gutta-percha, when there will be recession of the gum
caused by the pressure of the gutta-percha upon it. When a similar
fracture occurs in a molar, if the fractured surface does not encroach
upon the pulp, and will admit of drilling retaining pits without danger
to the pulp, there is no difficulty in restoring the broken portion with
cohesive gold. Mack's screws are sometimes indicated in cases of this
kind, since strong anchorage can be secured in this way without much
loss of tooth substance.
Fracture of the incisal edge of the anterior teeth is often a serious
accident, because of the difficulty of repair and the unsightly display
of gold when it has been accomplished.
Large fillings situated upon the approximal surfaces of the incisors
but not extending to the cutting edge, yet near enough to weaken the
enamel overhanging, are especially liable to need repairs. The corner
of the tooth breaks away, leaving the surface of the gold exposed, and
the only hold the filling has is at the cervical border and the slight
undercut along the labial and lingual walls of the cavity. In order to
secure retaining hold for additional gold the operator must be careful not
to displace the original filling. Sometimes a retaining pit can be made
laterally into the sound dentin, or, by cutting a little channel through to
the lingual surface and then deepening the channel at its extremity with
a round bur, a secure anchorage may be had for the fresh gold.
Great care should be exercised in packing the gold lest by inadvert-
ence the instrument shouhl slip and push the original filling from its
position. Fractured surfaces should receive prompt attention, for if left
for a period of time disintegration of the dentin will set in and the
caries may extend beneath the filling and thus jeopardize or ruin the
most thorough work.