Wedges in perio patients

Take care with interproximal wedging for restorative work in periodontal patients. I was restoring a lower 6 in a patient with minimal recession and deep pocketing and required a wooden wedge to hold the matrix band in place. Care must be taken as the pocket represents a potential space for the wedge to be inserted at the wrong angle into and due to periodontal condition, a larger wedge is often needed.

In a cramped space, the wedge often tends to be inserted at an angle too far gingivally. In this case the wedge went deep into the pocket and perforated the lingual gingiva. As the wedge I chose was too small the whole wedge was jammed subgingivally and was very difficult to remove.

My tips here are to ensure that a large enough wedge is chosen. If it ever looks like the wedge is too small and the whole wedge would pass through to the other side without too much pressure don't force the wedge in. Also, when positioning the wedge in place, aim slightly occlusally and the contact against the tooth surfaces will deflect the wedge in the right direction. If you aim too far gingivally then there will be less resistance from the soft tissue and the wedge is likely to go further in the wrong direction.