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How to Place the Cement Filling

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HealthWiki > Where There Is No Dentist > Chapter 10: How to Fill a Cavity > How to Place the Cement Filling



Lay out on a clean cloth:

DENT Ch10 Page 146-3.png
A
B
C
D
E

A: your syringe, needle, and local anesthetic (in case a tooth hurts)
B: your instruments: mirror, probe, tweezers, spoon, filling tool, mixing tool
C: oil of cloves (eugenol) and zinc oxide
D: lots of cotton: cotton rolls, gauze, or cotton wool
E: smooth glass to mix cement



rolls of cotton placed next to the cheek and under the tongue.
  1. Keep the cavity dry. The cavity and the area around it must be dry so you can see what you are doing. Just as important, cement stays longer inside a dry cavity. Place cotton between the cheek and gums to keep the area dry. Put some cotton under the tongue when you work on a lower tooth.
    drying the cavity with cotton held by tweezers.

    Use whatever kind of cotton you have: gauze, wool, or even rolls.

    Change the cotton whenever it becomes wet.

    Keep the cavity dry while you work. Wipe the inside of it every now and then with a bit of cotton.

    Then leave a piece of cotton inside the cavity while you mix the cement.

  2. Lift out the decay. You do not need to remove all of the decay on the bottom of the cavity. If you try to clean out all of the decay, you might touch the nerve.
    using the spoon to remove decay.

    However, you must remove all of the decay from the edges of the cavity. Otherwise, germs and food can go between the cement and the cavity and keep the decay growing inside. For ART, it is especially important to remove all the decay from the edges so the filling will stick well.
    the filling tool.

    Use the spoon tool to scrape clean the walls and the edge of the cavity. If you find that the part of the tooth at the edge of the cavity is thin and weak, break it deliberately. That makes for stronger sides to hold onto the cement. You can use the end of your filling tool to break the edge but it is much easier with a dental hatchet, which is less likely to bend.

    a tooth with decay.
    CAVITY
    NERVE

    Use the spoon tool to lift out soft decay from inside the cavity. Be careful not to go too deep and touch the nerve at the very bottom of the cavity. This takes practice. If the tooth hurts when you do this, stop and inject some local anesthetic.

    Use cotton gauze to collect the bits of decay so that the person does not swallow them. Use your mirror and look closely around the edges of the cavity for any decay that you may have missed. Put some cotton inside the cavity and leave it there to keep the area clean and dry while you mix the filling.

    These first two steps are also used in placing a filling using ART.

  3. Mix the cement on a piece of smooth glass. Place separately onto the glass a pile of zinc oxide powder and a few drops of eugenol liquid. Pull a small amount of the powder to the liquid with the mixing tool and mix them together. Add more powder in this way, until the cement mixture becomes thick.
    illustration of the above: mixing the cement.
    DENT Ch10 Page 148-2.png
    Suggestion: Practice with the cement ahead of time. You can then find out the time it takes to become hard.


    DENT Ch10 Page 148-3.png

    Cement is much easier to use when it is thick and not too sticky. Roll a bit between your fingers. If the cement sticks, it is not yet ready. Add more powder and then test again.

    Now take the cotton out of the cavity. Check to be sure the cavity is dry. If the cotton around the tooth is wet, change it.

  4. Press some cement into the cavity. Put a small ball of cement on the end of your filling tool. Carry it to the cavity. Spread it over the floor of the cavity and into the corners.
    illustration of the above: putting cement in the cavity.
    spreading the cement.

    REMEMBER: Decay stops growing only when the cement covers it completely and tightly.


    Keep adding cement until the cavity is over-filled. Smooth the extra cement against the
    edge of the cavity.

    a toothpick or stem placed between 2 teeth at the gum.
    the teeth after removing the toothpick or stem.
    space left
    for the gum
    before after

    If a cavity goes down between two teeth, one other step is necessary. You need to take care that the cement does not squeeze and hurt the gum.

    Before you spread the cement, place something thin between the teeth.

    DENT Ch10 Page 149-5.png

    You can use the soft stem from a palm leaf, a toothpick, or a tooth from a comb. Be sure it has a rounded end to prevent damage to the gums.

  5. smoothing the cement.
  6. Remove the extra cement before it gets too hard. Press the flat side of the filling tool against the cement and smooth it towards the edge of the cavity.

    As you smooth the cement, shape it to look like the top of a normal tooth. This way, the tooth above or below it can fit against the filling without breaking it.

    removing the toothpick or stem.

    After you take out the stem or toothpick, smooth the cement.
    Gums are easier to clean, and stay healthier, when the cement beside them is smooth.

    Cement that sticks out and is not smooth can hurt the gums. It can also later break off. When that happens, spit and germs are able to go inside and start the decay growing again.

    It is also important to look closely around the tooth for loose pieces of cement and to remove them before they make the gums sore.

    DENT Ch10 Page 150-3.png

    Use the end of your probe. Gently reach into the gum pocket and lift out any pieces of cement caught there.

    Wipe off your probe with cotton gauze each time.

    Now remove all the cotton and ask the person to gently close the teeth. The teeth should come together normally and not hit first against the cement filling. Too much pressure against the cement filling will crack and break it.

    DENT Ch10 Page 150-4.png
    If you do not have carbon paper, darken some paper with a pencil.

    Always check to see if part of the filling is high:

    1. lf the cement is still wet, you can see the smooth place where the opposite tooth bit into it. Scrape the cement away from this place.
    2. If the cement is dry, have the person bite on a piece of carbon paper. If there is too much cement, the carbon paper will darken the cement. Scrape away that extra cement.

    The person must not leave your clinic until
    the filled tooth fits properly against the other teeth



    This page was updated:19 Feb 2018