A Case of Resin Build-Up for Secondary Caries Beneath an Inlay Restoration

A dental clinic said I needed root canal treatment,

and another dental clinic said I needed resin treatment.

So I had resin treatment,

but I wanted to check

whether that was really okay,

so I came here~

Among the people who come to me, there are occasionally cases like this—after receiving diagnoses or treatment at several places, they come in at the end to have things checked one last time.

(If you come to me last.. I can give it meaning, right? hehe)

They said they had finished treatment, but for some reason they still didn’t feel at ease. So in the end, they came with the thought of “let’s at least get it checked.”

It was in a state where only resin had been added on.

After checking, I immediately understood why they had felt uneasy..

A gap had formed beneath the existing inlay restoration, and it was said that secondary caries had progressed along that gap.

So the clinic recommended treatment, but.. only that area had been built up with resin.

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In cases like this, the principle is to

remove the existing inlay entirely.

It is similar to knowing the door frame is warped, but leaving the door as it is and just filling the side gap with silicone.

At first glance, it may look like less wind is coming in, but the fundamental problem remains.

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You can see the white build-up in the middle of the tooth, right?

Even the area that had been filled with resin didn’t look intact..^^;

Even when checking with Qray, it shows that there is a problem in red along the boundary of the inlay restoration.

Qray uses a specific wavelength of blue visible light on the tooth, and areas with a high amount of bacteria show a red fluorescent glow.

(*As a side note, the company that makes Qray, IO Bio, is giving a lecture for dentists at the end of next monthㅎㅎ)

After removing the inlay, a resin build-up

Many people ask, “Can resin be used again after inlay treatment?”

It is absolutely possible.

Because resin is based on the principle of “bonding,” it can be done as long as there is a surface left to bond to.

To be more specific, it is possible if the tooth wall remains and enough tooth structure is left to bear chewing forces.

A resin build-up is closer to the process of ‘rebuilding.’

First, the inlay was removed.

It looks fine on the surface, right? Let’s check once with Qray.

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You can still see that caries remain, right?

If caries are not removed carefully, healthy tooth structure can also be removed, so they are taken out little by little, with Qray checks performed in between.

So patients often say, “The resin treatment time seems much longer than at other dental clinics.”^^;

(Because my treatment principle is to remove only the caries accurately and preserve healthy tooth structure, please understand in advance that treatment time may be a bit longer.🙏🏻)

After removing all of the caries, I checked again with Qray.

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Now the red glow has almost disappeared, right? Even the tiny remaining area was removed cleanly.

Next, the surface was treated to allow mechanical retention, and then an adhesive was used so that the resin could bond well.

Finally, the tooth shape was built up piece by piece with resin.

Using the shape of the upper molar that contacts the tooth and the opposite molar, I recreated the actual shape of the patient’s tooth as closely as possible.

It is not a method of filling everything at once,

but a process of building it up

little by little.

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I adjusted the bite so that the force would not concentrate on one side and so that only a specific area would not hurt when chewing.

Molars are teeth that work thousands of times a day during meals, so this process needs to be done carefully in order to prevent problems from recurring later.

I also paid close attention to make sure it did not look aesthetically like “this tooth was treated here~.”

For molar resin, it is important whether it can withstand chewing force.

Only after sufficient adjustment with chewing force in mind was the entire process completed.

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I still remember what the patient said after the existing inlay restoration was removed and retreatment was done.

“This time I don’t feel anxious, and I feel relieved.” I think that one sentence shows the result of this process.

I believe that the real completion is not the shape that is visible on the outside, but the sense of stability when chewing and the confidence that it can be used for a long time in the future.

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Molars are hard to see, so it is not easy for patients to know how they were treated.

Removing an inlay restoration that has already been placed is burdensome for the patient and is not an easy choice for the dentist either.

Still, covering up a problem while knowing it will cause trouble later only ends up bringing back a bigger and more complicated process.

If you had inlay treatment or any dental treatment and still keep worrying about it, it may not be because you are being overly sensitive, but because the tooth is sending a signal.

Even if it looks fine on the outside, you need proper treatment all the way to the inside in order to use a treated tooth for a long time.

As I have always done, I will continue to follow the principle of thoroughly checking even the areas that are not visible, beyond just the results that can be seen on the surface.

This has been So Hyun-su, chief director of Jaejulgou Dental Clinic. Thank you.

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