At this point, something needed to be done to maintain a clean dry field. It became clear very quickly that our normal ancillary use of Oraseal calk was not enough. I had my assistant maintain a steady stream of air on the tooth while I inserted size 6 hand files into the two mesial canals, and a size 30 file into the distal canal. I would recommend lubricating the files with vaseline before placing them. I then maintained the air stream while my assistant mixed up a loose batch of IRM. I placed the IRM and compacted it within the access and around the files before trimming back the material that flowed out beneath the crown.
As the IRM set, I moved the files in a circular patterns to prevent them from locking in and to create a funneled pattern of space. Upon setting, I removed the files and was left with perfect pathways. Through these, I did my cleaning, shaping, and obturation.
Here is the final result
This technique can be applied to any situation in which caries is removed beneath a fixed restoration, and the restoration is to be maintained to hold a rubberdam and act as a temporary.
If you have any questions or clinical tips to share of your own, please post them in the comments below.
Also, if you are new to the blog, you can also see more of my cases on my office's facebook page: www.facebook.com/alpharettaendo