455H
Fig. 9.22 A deficient glass ionomer
restoration seen after a year.456H
Fig. 9.23 The operator simply adds more
glass ionomer to the deficient restoration.9.9 APPROXIMAL CARIES
In children caries occurs more often occlusally than approximally, but as they
progress to adulthood, the relative level of approximal caries increases. The authors
advocate managing occlusal caries immediately by sealing or PRRs. They also
support remineralization techniques as an early intervention approach in approximal
caries, where the lesion has not reached the dentine. Whichever way the clinician
chooses to restore approximal caries, it will always entail loss of some sound tooth
tissue. In approximal restorations, sufficient tooth preparation just to gain access to
the carious dentine is necessary. Shape the outline form only to include the carious
dentine and to remove demineralized enamel. Finish the cavo surface margins to
remove unsupported enamel.
Amalgam works well in these situations but clinicians are equally using composite
resins more frequently in approximal restorations of young permanent teeth. Although
there are some studies reporting good success rates, the overall consensus seems to be
that tooth coloured restorations are prone to earlier failure than amalgam restorations.
Operators should inform parents of this proviso when discussing the choice of
restorative material. (See 457HFigs. 9.24, 458H9.25, 459H9.26, 460H9.27, and 461H9.28.)