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This paper describes a technique of placing a semi-rigid cervical matrix slightly past the cervical border of a lesion that extends below (apical to) the gingival crest and inserting the glass ionomer cement through an opening cut in the matrix above the soft tissue level.
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Resourceful efforts of researchers and clinicians have made for an ever-expanding restorative repertoire. The search for improved operative techniques must continue as the objectives of an ideal direct restoration reach beyond natural aesthetics and include pulpal health considerations, occlusal stability, anatomical restitution, marginal perfection, and interproximal integrity. This article focuses on the proximal precinct and provides solutions to the challenge of restoring proximal physiological form to contiguous surfaces when utilizing the direct composite resin technique.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
PURPOSE: To determine, whether different tooth colored materials and application techniques influence the proximal contact strengths (PCS) in vitro. MATERIALS AND METHODS: Standardized MO-cavities for direct restorations were prepared into 360 artificial lower first molars. Eight groups were formed (n = 45) and restored with amalgam (1), low (2, 3), medium (4, 5) and high (6, 7) viscosity hybrid composites and compared to the original contact strengths of the unprepared teeth (8). The restored teeth were mounted into a socket simulating physiological tooth mobility. PCS were quantified by measuring the forces necessary for passing the proximal contact with floss under standardized conditions using a universal testing machine. RESULTS: PCS ranged from 1.32 +/- 0.56 N for the low viscosity composite to 9.90 +/- 1.98 N for the Amalgam restoration. Medium (5.65 +/- 1.08 N) and high viscosity hybrid composites (5.90 +/- 1.45 N) inserted in a multi-layer technique showed no statistically significant differences to the original PCS of the unprepared teeth (5.76 +/- 0.53 N).
BACKGROUND: Contrary to the situation for amalgam restorations, obtaining acceptable proximal contacts with posterior composite restorations can be difficult. Proximal contacts that are less than ideal may permit food impaction and subsequent caries formation and periodontal problems. PURPOSE: The aim of this study was to assess the quality of proximal contacts of posterior composite restorations placed with 4 restorative techniques. METHODS: Seventy-five mounted ivorine teeth with large, standardized MOD cavities were divided into 5 groups of 15 teeth each. The teeth in 4 of these groups were restored with a resin composite and those in the remaining group were restored with amalgam. The restorative techniques for the 4 composite groups were traditional wedge and matrix (Group 1), use of a light-tip attachment (Group 2), use of the Contact Pro hand instrument (Group 3) and use of Beta Quartz glass-ceramic inserts (Group 4). All restorations were completed under simulated clinical conditions. Standards for evaluating proximal contacts were set by preparing 4 dental study models, each model having one type of proximal contact (open, not tight enough, ideal and too tight). All restored teeth were carefully painted with opaque nail polish, except at the contact areas, to conceal restoration type and hence to ensure unbiased evaluation by assessors. Three experienced clinicians independently assessed the quality of the proximal contacts of all restored teeth (total of 150 contacts) relative to the 4 types of contacts exemplified by the dental study models. In cases of disagreement, the clinicians reassessed the disputed contact collectively. RESULTS: Amalgam restorations had 5 contacts that were not tight enough, 20 that were ideal and 5 that were too tight. The Group 1 composite restorations had a total of 25 open contacts and 5 contacts that were not tight enough; the Group 2 composite restorations had 3 open contacts, 13 contacts that were not tight enough and 14 that were ideal; the Group 3 composite restorations had 11 contacts that were not tight enough and 19 that were ideal; and the Group 4 composite restorations had 3 contacts that were not tight enough and 27 that were ideal. None of the composite contacts was judged too tight. CONCLUSIONS: The use of inserts (Group 4) resulted in a better rate of acceptable proximal contacts in posterior composite restorations than the 3 other techniques (90% vs. 0%, 47% and 63% for Group 1, Group 2 and Group 3, respectively).
This study compared excess formation of direct bonded Class II restorations using different matrix systems-metal or transparent. Sixty freshly extracted, non-carious, posterior human teeth were used. In all of the teeth, standardized MOD-cavities were prepared with the gingivoproximal margins located 1.0-1.5 mm cervical to the cemento-enamel junction. The prepared teeth were randomly assigned to six groups. Half were restored using metal matrices and wooden wedges; the other half were restored using transparent matrices and reflective wedges. Three different material systems were used to fill the cavities: 1) a hybrid composite (Tetric) plus an adhesive bonding agent (Syntac Classic), 2) a flowable composite (Tetric Flow) plus Syntac Classic and 3) a compomer (Dyract AP) together with an adhesive bonding agent designed for compomers (Prime & Bond NT). After the specimens were preserved in saline solution, scanning electron microscopy (SEM) assessed the amount of overhang formation at the restoration margins. The data collected indicated the use of transparent matrices resulted in significantly higher amounts of excess material at the restoration margins compared with metal matrices. Moreover, there was no significant difference between the materials when the same matrix was used. All of the dental restorations examined displayed material overhang. Based on these findings, the authors concluded that the type of matrix exerts a major impact on overhang formation, with metal matrices resulting in significantly less excess material buildup.
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Certainly, we could spend more time matching shades, applying characterizations, placing secondary anatomy, and even finishing. However, if posterior composite restorations are to be a viable alternative to amalgam in appropriate cases, we must accomplish efficient and predictable placement so that fees for the two types of restorations are somewhat in line. Contact must be solid, sensitivity must be kept to a minimum, and placement and finishing must be fairly simple and organized. If the problems with posterior composites aren't kept to a minimum, all of dentistry will suffer. Our contacts are excellent most of the time, but occasionally we need to redo a "light" one. Our best estimate is that about one in 100 fillings that had no preoperative symptoms needed some postoperative care after restoring. Usually these complaints are corrected by occlusal adjustment, and very rarely by replacing the restoration. We have not yet made a perfect restoration in our practice--we are still trying.
One of the authors has used this technique successfully for the past three years in various clinical situations that involve both difficult access anterior and posterior teeth. This is a tooth-structure conserving clinical procedure that can provide a simplified approach for restoring otherwise difficult clinical lesions.
This in vitro study examined the relationship of matrix use to microleakage in class 5 Ketal-Fil glass-ionomer restorations. Class 5 glass-ionomer restorations were placed on the facial and lingual surfaces of 40 extracted human molars. The occlusal margin was located on enamel, and the cervical margin was located on cementum or dentin. Each tooth had one restoration placed with and without the aid of a soft metal matrix. Specimens were thermocycled (1234 cycles, 6 degrees C -60 degrees C, 30-second dwell time) and immersed in 5% methylene blue dye for four hours. The teeth were sectioned occlusogingivally through the center of each restoration, viewed with an optical microscope (X10), and each restoration was scored for dye penetration around the cavity walls. The enamel and cementum margins were scored separately for the extent of marginal leakage. No difference in leakage was found between restorations placed with or without a matrix (P > 0.05). Enamel restorations leaked significantly less than nonenamel margins, regardless of matrix use (P > 0.05).
Orthodontic therapy with fixed appliances bears a high risk of plaque accumulation, resulting in demineralization and new carious lesions. Rather than treat incipient lesions in orthodontic patients, most general dental practitioners decide to await future developments. A new concept for comprehensive restorative and endodontic treatment is presented, and its orthodontic implications are discussed.
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Recent developments in amalgam alloys composite resin materials have highlighted the importance of meticulous restoration placement by the dentist. This paper discusses the selection and use of the matrix which is significant in both the quality and longevity of the final restoration.