Caries in retained deciduous teeth can be a challenging problem. Interproximal root caries is tricky, to say the least. If you combine both in a patient who has never had a filling before you have a major restorative conundrum!
Typically, the first news you get is a bitewing like this. You’ve almost said goodbye to the patient in full expectation that the radiographs will be clear. Then, you have to tell them there’s a problem and you might not be able to resolve it. This lady has been functioning on her E for 30 years plus, and she’s not happy to be talking about losing it.
The chances are it’s already non-vital and has been comfortable that way for years. If you can fix the caries then the problem will probably go away for the foreseeable future, but how to go about restoring it? Occlusal access and destroy the distal third of the tooth and struggle to create a contact point? Buccal access and struggle with moisture and bleeding and visibility?
I decided to go the conservative buccal route and cleared the substantial caries without an obvious pulpal exposure. Then I just had to restore the cavern I’d made!
A rare brainwave led me to this solution. Place a Tofflemire as if you’ve got occlusal access and use a turbine to cut an access hole buccally to place your restorative material. I packed a spherical amalgam through the access and then removed the band and finished as usual.