Restoring proximal caries lesions conservatively

with tunnel restorations

The tunnel restoration has been suggested as a conservative alternative to the
conventional box preparation for treating proximal caries. The main advantage of
tunnel restoration over the conventional box or slot preparation includes being more
conservative and increasing tooth integrity and strength by preserving the marginal
ridge. However, tunnel restoration is technique-sensitive and can be particularly
challenging for inexperienced restorative dentists. Recent advances in technology,
such as the contemporary design of dental handpieces with advanced light-emitting
diode (LED) and handheld comfort, offer operative dentists better vision,
illumination, and maneuverability. The use of magnifying loupes also enhances the
visibility of the preparation. The advent of digital radiographic imaging has improved
dental imaging and reduced radiation. The new generation of restorative materials
has improved mechanical properties. Tunnel restoration can be an option to restore
proximal caries if the dentist performs proper case selection and pays attention to
the details of the restorative procedures. This paper describes the clinical technique
of tunnel restoration and reviews the studies of tunnel restorations.
Status of the marginal ridge
Since fracture resistance of a tooth is closely connected to strength of the
marginal ridge,19 the amount of marginal ridge retained after the tunnel
preparation plays a key role in its success. It was found that the distance
from the marginal ridge had more influence on weakening the ridge than
did extension of the occlusal opening.20 Another study reported that the
amount of marginal ridge retained was related to the strength of the tooth
after placing the restoration. It was shown that 2.5 mm was the critical
amount, and that strength of the tooth with tunnel restoration would be
comparable to that of a sound tooth.19 A brittle layer of enamel would
fracture due to inadequate support from dentine if the cavity preparation
was too close to the ridge, and, if 3.5 mm of marginal ridge is retained,
the preparation would involve excessive removal of dentine. The
resulting tunnel preparation could be more sensitive to fatigue crack
growth.




Fracture resistance in conservative Class II cavity
preparation: box vs tunnel
A total of 40 extracted human maxillary premolar teeth were used in this study. Teeth were
randomly distributed between two main groups. In group A conservative class
II Box preparations were cut in each tooth. In group B the proximal cavity was
prepared through the occlusal surface and the proximal marginal ridge was
left intact (tunnel preparation). Group A and group B were randomly
subdivided into two subgroups (a & b). In groups Aa and Bb a posterior
composite resin material was used to restore the prepared cavities (no base
was used). While in groups Aa & Bb the posterior composite resin was used
with a glass ionomer cement base. The teeth were tested on an Instron
testing machine for their resistance to fracture, force being applied equally to
buccal and lingual cusps. Mean fractures values were: Gp. Aa 285 LB.: Gr. Bb
245 lb. Bb 240 lb. One way analysis of variance showed no statistical
difference between the four groups. The tunnel preparation did not increase
the resistance to fracture of the restored tooth compared to a box preparation


Fracture resistance of class II approximal slot restorations

Statement of Problem. Determination of the fracture resistance of various
restorative materials in Class II approximal slot restorations has not been studied.
Purpose. This study evaluated the effects of retention grooves and different
restorative materials in Class II approximal slot restorations. To explore the
possibilities for further research, the probable effects of preparation size and loading
angle were investigated in a limited manner. Material and Methods. Ninety sound,
caries-free human maxillary premolars were divided into 9 groups. The cavities were
prepared either by hand or in a computer-controlled CNC machine with or without
retention grooves. Four were restored with adhesive amalgam, another 4 with
composite, and a single group with Compomer resin. The gingival floor depth was 1.5
mm. The specimens were loaded at an angle of 13.5 degrees to their longitudinal
axes by using a computer-controlled material testing machine until failure occurred.
For one specific preparation of adhesive amalgam, loading was applied at 0 and 30
degrees to determine the probable effects of the loading angle. For a specific
composite, resin application, the effects of the change in gingival floor depth were
analyzed by assigning the depth to 2.0 mm. Results. Composite and Compomer
resin and composite exhibited better performance than amalgam. The existence of
the retention grooves proved to be effective for adhesive amalgam restorations but
did not have any advantageous effect in composite and Compomer restoration.
Conclusion. For improved fracture resistance in small approximal restorations, the
use of composite was the appropriate choice. Compomer also gave satisfactory
results. Use of amalgam restoration should be accompanied with retention grooves
and an adhesive system to improve its performance.