message board Any Tips for Working on Caries on the Lingual of #31? Townie "Noolie" is having trouble treating a hard-to-isolate molar in an older patient. Docs chime in with what works for them noolie Member Since: 09/11/08 Post: 1 of 57 Hi. Tough caries on an elder gentleman. Any tips for working on caries on the lingual of #31, mandibular second molar? Thank you. ■ 4/11/2018 seahawk75 Member Since: 07/06/02 Post: 2 of 57 Prep enough to get a band on, but hit it with some SDF (Arrest) first. Always tough to access and isolate with the tongue. That's why I prefer an occlusal approach to seal it. ■ 4/11/2018 bhaarmann Member Since: 01/22/18 Post: 3 of 57 Nicknack Member Since: 02/25/13 Post: 4 of 57 Dry shield or Isolite? ■ 4/11/2018 Rubber dam if you can get it to clamp below level of decay. You can try Isolite or similar but it will be in the way. You can also keep a cardboard-type dry angle between tooth and tongue. If you're right-handed it will be easier. If a lefty you might have to sit in front of patient and retract with right hand. I agree with occlusal access. ■ 4/11/2018 jakewolf Member Since: 02/28/14 Post: 5 of 57 Rubber dam all the way to 22. Isolite access will be nearly impossible. Punching holes to 22 will give you space and take the tongue out of the equation. ■ 4/11/2018 drpsuedonym Member Since: 09/22/08 Post: 6 of 57 Use a round bur so that you can hold the handpiece essentially straight, parallel to the occlusal plane. All you have to do is tuck the round bur into the decay. Use larger burs as necessary to remove all of the decay. And use amalgam to make your life easier. ■ 4/11/2018 tempdentist30 Member Since: 05/06/14 Post: 7 of 57 owensdent Member Since: 06/27/02 Post: 8 of 57 I would do a buildup and a crown. ■ 4/11/2018 Greater curve band does an excellent job. Now that the U band is available it will make access and isolation even better. Today, I would use Activa for its bioactivity and ease of placement. Below is a good example of what is possible: [Editor's note: To view this link, visit this message board online.] ■ 4/11/2018 canslip Member Since: 02/07/02 Post: 11 of 57 Sedation as needed if it will help calm the patient and allow them to relax the tongue. In a patient who fights you, this becomes an impossible restoration. A lot of large, slow-speed round bur (safer than high speed as you never know when the patient may swallow), plastic Svedopter to keep it dry when restoring. ■ 4/13/2018 44 AUGUST 2018 // dentaltown.comhttp://www.dentaltown.com