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At the top is a
standard tofflemire band. At the bottom is a Greater Curve tofflemire
band. You will see that
this system of restoring teeth takes advantage of the peculiar
properties unique to composite. |
1 |
IMPORTANT!
Set up the band
opening just larger than the circumference of the tooth. This will keep
the band within the prongs of the tofflemire retainer as the matrix is
tightened. |
2 |
You will notice
that the band will pull very tight around the cervical, thus providing a
better seal. |
3 |
Bend the band
against the marginal ridges of the adjacent teeth. Burnish the metal
precisely at the contact position with a condenser.
If necessary, prior to placing the
band, make certain the opposing contact has a flat surface. If it
does not have one, make one. A marble to marble final contact, even if
tight is still a food impaction site. |
4 |
These are the Brasseler
finishing burs you will need. Of course, it doesn't have to be Brasseler, but something similarly shaped. The 7404 small football
is the first choice. If the space is really tight, reach for the flame
shaped MW 7901. Many find that Shofu's FL2 White Stone works well. |
5 |
Plane away the
matrix at the contact position. Use no water spray. Go easy on the
rheostat. Just barely remove metal. Keep the RPMs low.
Keep the bur against the matrix the entire
time. Do not lift the bur. It is a "rubbing, smoothing in" side to
the side motion. Once you have perforated metal, expand
the opening around the periphery until you have arrived at the desired
contact size both buccal-lingual and cervical-occlusal. Don be
heavy handed. Magnification makes this easy. |
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You have the ability to
shape the contact to any size desired by burnishing away metal.
Simply burnish a nice smooth oval. Pictured is a third molar removed
from a 33 year old patient. Note how nature over time creates a broad
oval contact. |
6 |
Double check to assure the
metal feathers against the adjacent tooth without gaps around the
periphery. The opening does not need to be large. The circumference of
the opening is guided by the flatness of the adjacent tooth's contact
surface. |
7 |
After placing the bonding
agent of your choice, begin by placing a flowable composite. Curing the
flowable composite will lock everything in place, and assure the deeper
parts of the prep are sealed and bubble free. Only place flowable
composite into the deeper crevices and sides of the proximal box. Keep
it thin. Remember, flowable composite has excessive polymerizing
shrinkage. After placing the flowable composite, fill the remainder of
the prep with composite of your choice. |
8 |
There
is no need to place a separating agent at the contact areas. Any bonded
contact to the adjacent tooth can be broken cleanly with the blade of a
small mixing spatula. Tell your patient they will hear a little snap as you lightly torque the
spatula. |
9 |
Band removal is easy. The
band will usually slide out of the contact area.
Hard to believe, but true!
If the band does not slide out easily, twist the band side to
side. It will sever at the contact position due to the prior burnishing.
Hemostats also expedite removal.
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Finish out the composite and
adjust occlusion as you normally would. |
10 |
Contacts will have depth and
width, and will be very tight and smooth. No food
impaction here! |
11 |
There are times the
contact opening within the metal band will not seal perfectly against
the neighboring tooth. Use a condenser to hold the matrix band against
the neighboring tooth at the base of the contact area, and above the
first increment of flowable composite. The thinned metal is very
malleable. It is east to hold in position while curing the flowable
composite. The arrow shows the position for the condenser. |
12 |
Wedges
rarely need.
Your contacts will be tight without wedging. If there is a need to
secure the matrix against the cervical portion of the prep, lightly
place a wedge. Trim the belly of the wedge (pictured left) so it does
not distort
your beautifully shaped matrix. |
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Uncomfortable making openings in the matrix?
Use round
separating springs with the Greater Curve matrix. The band's outward
flare places it directly against the adjacent teeth. I recommend
thinning the band with a composite finishing bur at the contact
position. Thinning will make the matrix malleable and adaptable to
the adjacent tooth. Thinning will also acquaint you with the
exercise of "smoothing in" contact openings.
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