Quality dentistry is the type of care that enables the great majority of patients to keep their teeth and maintain a healthy, comfortable, functioning and good-looking dentition virtually indefinitely. Quality means careful diagnosis and the selection of an optimum long term treatment plan, as well as exerting every effort to prevent future disease. Quality means complete removal of oral disease and it’s causes; Quality means patient education; Quality means most removal of decay and weakened structure from teeth prepared for restoration; Quality means exact marginal adaptation for fillings and castings; Quality means restorations of proper form, function, bite and appearance; and, particularly, quality means the careful planning and meticulous execution of dental procedures to produce these results. 

The following outline summarises the steps to the routine treatment of a back tooth with decay on a proximal (next-to-another tooth) surface.

• Diagnosis
  • This involves a thorough visual examination as well as an examination of the required x-rays.


• Local Anaesthetic


• Placement Of Rubber Dam
  • If removing old amalgam fillings or decay the rubber dam prevents bits of filling and rotten tooth from creeping down to the back of your throat.
  • White fillings are very moisture sensitive. The rubber dam prevents moisture from your breath and any saliva affecting the bond of your new filling.


• Complete removal of decay
  • Active decay left in a cavity (in most instances) will over a period of time spread like cancer.
  • The effects however will only be felt possibly years later, by this time most people would have forgotten the timeframe and consider re-treatment or further treatment inevitable.


• Placement of a matrix.
  • This is what gives shape to the sides of the new filling.
  • It must be perfectly adapted to the tooth, especially near the gum margin.
  • Poor matrix placement results in overhangs (or ledges) where floss and hence also plaque, may get stuck.
  • Poor matrix placement may also result in gaps (open contact points) between the back teeth where food can get trapped.


• Placement of the filling
  • This must be done in small increments due to setting shrinkage of the composite.
  • Placing too large an increment may cause the surrounding tooth structure to crack.


• Restoration of the tooth to proper occlusion, form and function
  • When restoring the biting surface a functional and aesthetic or life like surface requires the reshaping of the natural cusps and grooves. This requires patience and an artists touch.
  • A blob of white stuff will generally be non functional and unsightly.


• Bite Adjustment, Finishing and Polishing
  • Adjusting the bite for the perfect occlusion can be a painstaking process. Ideally the bite is adjusted so that the new filling contacts the opposing teeth at a similar pressure to that of all the other teeth. Great skill is required to provide an ideal shaped biting surface that fits perfectly into the bite.
  • For the ideal bite sometimes the opposing tooth may also need to be adjusted.
  • Lastly the final filling shape is refined and polished to provide a surface that is similar to natural enamel surface.

It should be clear from the above that the ‘simple filling’ of a moderately decayed tooth is a complicated procedure. The slightest inattention to detail will result in a substandard filling.

This attention to detail is just as important, or even more important, in other intricate procedures such as Implant Placement and Restoration, preparation for Crowns, Root Canal Treatment and Periodontal (gum) treatment for example.

If any of these treatments are to be successful the primary goal needs to be to do the BEST job that we can ….. not the fastest, simplest or cheapest.