Airborne Particle Abrasion Saves Precious Tooth | Culver City Dentist | Nima Shayesteh, DMD

Deroofing a type IV (AKA IK type) non-coalesced fissure tract in deep dentin with Airborne Particle Abrasion. 

Treating teeth under the microscope reveals details that one does not usually expect. In this case, a defective silver filling was replaced due to recurrent decay. Prior to acid etching, Airborne Particle Abrasion is utilized to selectively remove remnant caries, decalcification, the smear layer, and to create a better surface topography in preparation for bonding.

The preparation was complete and upon gentle application of the air abrasion, I was taken back as the floor of the tooth instantly vanished and a seeming perforation was observed.

This was unexpected! For a moment it seemed as though a perforation had taken place into the pulp chamber. How could this be 🧐? There was no bleeding. Was the pulp non-vital? It couldn’t be. The previous restoration was not close to the pulp chamber, nor was a radiographic apical pathology present.

With a deep breath, higher microscope magnification, and lower volume particle output, I continued to treat the area very judiciously. I continued to expose the defect by working my way around the periphery of the defect and tried to stay away from the center. I typically take this approach as I want the least amount of particle abrasion to affect the deeper dentin. Fortunately, as I deroofed this “chamber,” the dentin floor was intact and in fact, no communication to the pulp chamber had taken place. Relief! 

Have you come across something like this? What do you think this could be? How do you approach this type of scenario? Do you leave it, or treat it?