The embrasure. I don’t think most clinicians give enough thought to the embrasure. It’s the contact in three dimensions. It is dictated often by tooth position and or restorative. As long as there is sufficient embrasure space, the contact can be elongated, broadened, and shifted bucco-lingually. In order for both teeth to have convex curvatures an embrasure space of 2-3mm is necessary. In some instances root proximity sets the tooth up for failure as a proper embrasure is almost naturally impossible. In many instances the embrasures provided by implants are dangerous for adjacent teeth.
The bottom line is that good embrasures are important for proper function and longevity. And in some instances the space required for a proper embrasure has been lost.
Here’s a recent case where the embrasure space is negative, probably negative 1-2mm. Gingival ingrowth can be seen.
The caries was removed and a band placed. From the occlusal, we can seet the proximal convexity of the distal tooth was over the distal cavosurface. Fuji core is great in this indication. It sets completely and immediately, and comes in a blue color that’s clearly visible but not ridiculous. The canals were instrumented medicated and the access closed with cavit. Then an orthodontic spacer was flossed into place.
After 3-4 weeks, the patient returned. We had recaptured 2-3mm of space, which is typical. The endodontics was finished, an amalgam core was placed, and after it had set we placed another spacer to recapture another couple of mm’s.
I think this really stacks the deck for the restorative dentist, and as such exemplifies Restoratively Driven Endodontics.
Here was an early case from 14 years ago. We used Luxacore blue back then. I think the Fuji core is an upgrade. Might be the first one performed, at least by me.
Here’s another embrasure space recapture from almost 10 years ago. You can see in the upper right picture how much space was regained from the spacer.
It may not get a lot of play, but I think it’s a nice one to have in the bag of tricks.