The importance of banking natural tooth structure

By David Rice, DDS, DrBicuspid.com clinical editor

November 5, 2019 -- I'm a progressive dentist. However, when it comes to preserving tooth structure, I'm a conservative guy. With 24 years of practice and thousands of restorations under my belt, I've learned that the best dentists bank tooth structure whenever possible.

Banking tooth structure
All images courtesy of Dr. David Rice.

You see, we can do the following:

  • Continue to educate ourselves at places like the Dawson Academy or Spear.
  • Elevate our game (and speed, FYI) with improved isolation like the image above. Oh, by the way, that's a Black line rubber dam clamp by Hu-Friedy if you've never seen one before. Note the floss on it. I've yet to meet a patient who loved retrieving one if you know what I'm saying -- or an attorney who didn't like making your life miserable if, God forbid, your patient aspirates one. I know we all learned to use it in dental school. It's never happened to me but it has happened to others. Don't let it be you. You'll love those BlackLine clamps if you've ever blinded yourself by shining your overhead or headlight off a clamp.
  • Research and use dentistry's finest techniques. I'm a huge fan of sectional matrix systems. The contour we can achieve and the proximal contacts we deliver are amazing. There are several out there that deliver. The one below is from Garrison Dental Solutions. Note the style of the clamp. As you evaluate the best system for you, just make sure it looks like this:
Garrison sectional matric system
  • Optimize our restorative materials. I'm a huge fan of bulk fills in the posterior segment. I'm also a huge fan of our elite industry friends who have taken the time to build the best for us. Note this: Banking tooth structure is an oxymoron if our dentistry doesn't last! I restored this conservative class II with Ecosite by DMG for many reasons.

That said, here my top three points on this particular case:

  1. Single layer at 5-mm depth of cure: Translation? That's low shrinkage stress and less internal porosity due to fewer layers and eliminating the No. 1 composite failure point -- depth of cure. Please don't kid yourself. Your composite, bonding agent, and curing light matter.
  2. Handling: If you've ever prepped a slot prep, you know you don't have any wiggle room. Composites that stick and pull back equal poor restorations for your patient -- and gray hair for you.
  3. Polishability: At the end of the day, we need our patients to take care of these restorations. The higher the polish, the smoother the surface and the more plaque-resistant as well.
Banking tooth structure

So, when you want to deliver predictable restorations, when you want to do it easily and effectively, and when you want them to last, don't take my word for it. Do your homework on dentistry's best. Bank tooth at every turn.

Questions or comments? Drop me an email at david.rice@ignitedds.com.


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