Page 119 - My FlipBook

APPROXIMAL CA VITIES IN INCISORS.
105
by any system of wedging, and approximal cavities become, of all,
the most to be dreaded by patient and operator. They usually have
their initiation at the of contact.
point Two teeth touch each other at
a limited area, and caries at that After
begins spot. spreading the
teeth, and removing stains, there is seen at this point of contact a
whitish, or chalky, appearance to the enamel. Except in its most
incipient form, it is futile to attempt to remove this by filing or by
The caries
polishing. usually penetrates very deep in proportion
to its circumferential area, and the dentine is swiftly reached. To
eradicate the caries with the file or disk would be to the den-
expose
tine, and at all events to destroy the integrity of the abutments of the
arch by producing a space, which is almost always mischievous. The
best plan is to accept the condition, as a cavity needing a gold filling.
J am speaking of permanent teeth, and advise gold in all teeth at all
ages, where these minute cavities are discovered.
Fig. 1 10 shows such a cavity in a central incisor. It should be pre-
pared with as little extension of the borders as possible, although mak-
FIG. no. FIG. in. FIG. 112.

ing it a point to remove all carious material until strong edges are
reached. There is a temptation in these cases toward enlargement,
because of the fact that by so doing the work is rendered more easy.
The excuse, however, is insufficient, and the practice reprehensible.
Indeed, with me it has been my pride to make perfect fillings of the
most minute kinds, and under the most trying circumstances. To
retain the a rose bur may be used, dipping slightly toward
filling,
the gingiva as indicated at b and similarly toward the incisive edge as
at a. Here at once we find a difference between ' ' general principles' '
and ' ' special cases. ' ' I have in a former chapter argued that no un-
should be toward the incisive or at least that it should
dercutting edge,
not be extensive. But in these tiny cavities, where there is strong
tooth-substance in all directions, we may allow ourselves the most
convenient method and arrange the retaining points opposite to each
other as indicated. Even in these tiny cavities I require two exten-
sions of the cavity for good retention ; yet again this is a rule with an