Food impaction and its role in making teeth prone to periodontal disease and interproximal decay?

 While all dentists strive to do fillings with good interproximal contact areas, it still is not uncommon for fillings to end up with less than ideal contact areas that can allow food to get stuck in between teeth that . While flossing can remove this food, sometimes the food gets lodged in the gingival sulcus that contact a tooth and this can lead to recurrent decay or periodontal bone loss.

One of the most frequent complaints I hear from new patients involve food getting stuck between teeth. Sometimes the solution is replacing some of their fillings since redoing them can eliminate this problem. In some situations, where significant tooth structure is missing in the restored tooth, a crown maybe the best solution.

Proper contacts are not that difficult to achieve , especially if the dentist uses a contoured metal band in conjunction with a V-3 ring ( a spring that pushes teeth apart and helps adapt the contoured band). Even when using this system, care must be taken to ensure that the matrix is positioned in a way that ensures a proper contact area. Sometimes a second or third attempt should be made in order to ensure the development of an appropriate contact. Also wedging ( a small triangular wooden or plastic wedge that is placed a the gingival portion of the matrix that helps ensure that the band is well adapted at the gingival margin of the restoration.) is important as well. 

In my dental practice, I schedule a generous amount of time for doing fillings, so I can take the care that is needed to predictably achieve an optimal result. My fees, although reasonable, may be higher than those allowed by some dental insurance plans. This allows our practice a proper level of compensation for the time and effort spent performing excellent restorative dentistry. 

It is because proper choice and placement of a contoured band with the V-3 band can be technique sensitive, dentists need to take the time to check their placement prior to placing their restoration. Sometimes (due to time constraints) a dentist may end up placing a filling and after removing excess filling material they may end up with a filling with a loose or open interproximal contact. One solution is to have the patient come back and at a subsequent visit "do a filling inside the filling". A small proximal box is prepared in the proximal of the filling , but much of the new filling is not removed. Then the matrix is applied to this smaller filling and a good contact can be easier to achieve on this second attempt. Although this solution requires a second visit, it is probably a better solution than leaving an open contact that may cause future problems that could be prevented with a proper contact.