Sometimes, your afternoon goes pear shape – you learn what failure is about, or about unexpected ambushes in treatment. Tooth #3 (1.6) was planned for exodontia due to perio-endo lesions and coronal decimation from past caries and failed restorations. Tooth #4 (1.5) was adjacent and the entire coronal structure was a very poorly placed blob of composite which rightly displaced during light elevation force. The residual tooth structure was extremely minimal, with a treatment bias towards extraction and implant replacement therapy. The patient wanted to “hold on” to the tooth and did not want to leave without a replacement. Isolation initially was impossible but gained using a combination of laser diode gingivectomy and #1 retraction cord soaked in AlCl3 (aq). The buccal and lingual walls were freehanded before placement of an Omnimatrix to rebuild the D wall and a Garrison sectional matrix (Compositight 3D Fusion) on the M aspect. Rubber dam was placed mid-procedure and the restoration layered to full contour and finished in intentional infraocclusion.
