Clinical investigation of dual alloy restorations in teeth with deep subgingival caries

Clinical teeth

investigation with

deep

of dual

subgingival

alloy

restorations

in

caries

Elena 1. Liatukas, D.M.D., D.D.S., MS.* Howard

University,

College of Dentistry,

Washington,

D. C.

A

previous report described a technique for restoring deep subgingival carious areas with amalgam to create a suitable gingival wall for cast gold restorations.’ Since the method required materials of different composition, it seemed that electrolytic action would cause undue effects. This two-year study delineates the minor complications which occurred and establishes the merit of the method.

MATERIALS .AND METHODS The 46 teeth reported in this study presented extensive proximal caries. A cast gold inlay was indicated for each tooth, but the gingival depth and/or breadth of

Fig. 1. An indication for a dual alloy restoration. The subgingival caries (a) will be restored with amalgam; a Class II cast gold inlay will complete the restoration. Presented before the Forty-seventh General Meeting of the International Dental Research, Houston, Texas. *Associate Professor of Operative Dentistry. 242

Association for

Dual

undercuts

alloy

restorations

243

_

e w lith Fig. 2. Diagram

of a cavity

preparation

Fig. 3. Diagram of a gingival a cast gold restoration.

Fig. 4. The distal gingival same tooth seen in Fig. 1.

Fig. 5. The completed

amalgam

wall

restoration

amalgam

for a dual alloy restoration. restoration

of the premolar

for the premolar

to provide

was restored

in Fig. 1.

an acceptable

with

amalgam

gingival

(a).

wa

‘%is

fOl

is the

244

J. Pros. Dent. Au.wst, 1969

Liatukas

Fig. 6. The mesial and distal gingival first molar.

Fig. 7. The completed

restoration

walls were created

showing

the junction

in amalgam

of amalgam

(a and b) on the lower

and gold (a).

the carious lesions thwarted every effort to effect an acceptable preparation (Fig. 1) .* The technique involved restoring the gingival wall to the optimal level of just above the crest of the gingiva with silver amalgam (Figs. 2 and 3). The completed gingival amalgam restoration was then treated as though it were tooth structure (Figs. 4 and 5). In isolated instances, the soft tissues required displacement in order to attain visibility and dryness. Every effort was made to create the gold to amalgam margin above the gingival crest (Figs. 6 and 7). This precaution facilitated clinical evaluation. The salivary pH was recorded before and after placing the restoration. Objective signs, such as corrosion, discoloration and pitting, were evaluated. Subjective symptoms, such as metallic taste and other discomforts, were recorded. Most of the restored teeth were examined 6 to 12 months after insertion; others were observed from 4 to 6 years after treatment.

Table I. Clinical investigation subgingival caries

Patient

/ Saliva pH before / procedure

of dual alloy restorations in teeth with deep

Saliva pH after completion

Type of restorations already present”

1 2 3 4

6.8 7.0 6.8 6.8

6.9 6.9 7.0 6.8

M G/A M G/A M G,‘.4 G

.> 6 7

6.9 6.9 7.1

6.8 6.8 7.0

M G/A 2G M G/A

8 9 10 11 12 1:i

6.7 7.2 6.9 7.1) 7.0 7.1

7.0 7.1 6.8 7.0 6.9 7.0

M G/A M G/.4 G M G/A M G/A G

14 15 16 17

7.1 7.n 7.0 6.8

7.1 7.0 6.9 6.8

M M M M

18 19 20 21 22 23 24 25 26 '7 28 29 30 31 32

6.8 6.8 6.9 7.0 7.1 7.0 7.1 6.7 6.8 6.8 6.9 7.1 7.1 7.0 7.1

6.9 6.8 7.0 7.0 7.0 6.9 7.0 6.8 6.8 6.9 6.8 7.0 7.2 6.8 7.0

33 34 35 36 37 38

6.9 6.9 6.9 6.8 6.8 7.0

7.0 6.8 7.0 6.8 6.8 7.0

M G/A A (few) M C/A G G G

39 40 41

7.0 6.8 6.9

6.9 6.8 6.8

M G/A G/A G/A

*Mixed,

M; gold. G; amalgam,

M M M M M M

M M M

M

_-.Findings 6 mo. to a yean* No C or R No C or R No C oi- R Metallic taste

G/A G/A G/A G/A

afttat

Disappeared 6 weeks

after

For 2 weeks

Remove with pumice

R.

-

Disappeared 1 mri,

Removr with pumice

A G/A G/A G/A G/A G/A G/.4 A G G/A G/A G/A A A G/A

A; change, C; reaction.

Remarks

246

.I. Pros. Dent. August, 1969

Liatukas

Table I-Cont’d

Patient

Saliva pH before procedure

Saliva pH after completion

42

7.0

7.1

43 44 45 46

7.1 7.0 6.9 6.8

7.1 7.0 6.8 6.9

Type of restorations already present* G G G A M G/A

Findings 6 mo. to 4 years* Slight G/A No C No C No C No C

tarnish or or or or

on

Remarks Remove with pumice

R R R R

RESULTS Table I lists the results of the postinsertion examinations of the dual alloy restorations. The before and after salivary pH remained remarkably constant. Six months after insertion, 3 cast gold restorations developed surface discoloration. Brushing with prophylaxis paste restored the original color. Two patients reported a metallic taste which disappeared in 4 weeks. Three patients reported postoperative thermal shock which resolved itself within 2 months. The surrounding soft tissues remained normal.

SUMMARY

AND CONCLUSIONS

Clinical observation of 46 teeth restored with dual alloys established the acceptability of the method. Subjective symptoms of thermal shock and metallic taste disappeared within a matter of weeks. The infrequent presence of superficial tarnish was removed with prophylaxis paste. The soft tissues remained normal. I wish to express my appreciation to Joyce D. Willis and Max E. Taylor, Department of Visual Aids, Howard University, College of Dentistry, for their aid in the preparation of this report.

Reference 1. Liatukas, E. L.: Restoring a deep gingival J. PROS. DENT. 19: 410-412, 1968. HOWARD UNIVERSITY COLLEGE OF DENTISTRY 600 W. STREET, N.W. WASHINGTON, D. C. 20001

wall

with

amalgam

for a cast gold restoration,