01. Greater Curve vs. Standard Tofflemire
At the top is a standard tofflemire band.
At the bottom is a Greater Curve tofflemire band.
You will see that this technique of restoring teeth takes advantage of the peculiar properties unique to composite.
02. Band setup
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
03. Tighten band
You will notice that the band will pull very tight around the cervical, thus providing a better seal.
04. 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.
05. Finishing burs
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.
06. Plane away the matrix at the contact position
Do not use water spray and go easy on the rheostat.
Just barely remove metal - Keep the RPMs low with the bur against the matrix the entire time and do not lift the bur.
It is a "rubbing, smoothing in" side-to-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. Do not be heavy handed. Magnification makes this easy.
07A. Shape the contact
Pictured is a third molar removed from a 33 year old patient.You will duplicate this with your composite. You have the ability to shape the contact to any size desired.
Note how nature over time creates a broad oval contact.
07B. Assure the metal feathers against the adjacent tooth
Double check to assure the metal feathers against the adjacent tooth without gaps around the periphery.
The circumference of the opening is guided by the flatness of the adjacent tooth's contact surface.
The opening does not need to be large.
08. Place the flowable composite
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.
09. 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.
10. Slide band out of contact area
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.
10A. Finish as normal
Finish out the composite and adjust occlusion as you normally would.
Contacts will have depth as well as width, and will be very tight and smooth.
No food impaction here!
Sealing the contact opening
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 easy to hold in position while curing the flowable composite.
The arrow shows the position for the condenser.
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.
Uncomfortable making openings in the matrix?
Use sectional matrix rings with Greater Curve bands. The 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.