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resulting restoration is as durable and long

lasting compared to amalgam.

Tis article aims to review the technique-

sensitive steps involved when placing a ClassII composite restoration and provides to

enable more predictable restorations.

isolation/moistUre Control

Te use of a rubber dam is recognised as the

optimal way to ensure adequate moisture

control when restoring a posterior tooth. One

of the common problems experienced when

using the rubber dam is the ability to place the

matrix band system of choice. However, the

use of an active sectional matrix system can

oen overcome this problem.

Ideally, the tooth distal to the tooth to be

restored should be clamped, as this will aid

the placement of the matrix band (Figure 1).

Pre-WedGinG

Studies have shown that 89% of experienced

and inexperienced operators will cause some

iatrogenic damage to the adjacent tooth when

preparing a tooth interproximally. Here, a

WedgeGuard (riodent) is used to help protect

the adjacent tooth (Figure 2). Te WedgeGuard

has a dual function as the interproximal metal

strip will prevent the bur from causing any

damage to the adjacent tooth and as a result,

will oen facilitate the speedier removal of the

old restoration (Figure 3).

Secondly, the interproximal gingiva is part

protected by the wedge. It is vital that this area

today, patients are seeking a more

aesthetic alternative to amalgam

when having posterior teeth restored.

eaching trends within the UK and Irelanddental schools are moving toward the

placement of composite when restoring Class

I and Class II cavities.

Adhesive posterior composite restorations

oer many advantages over traditional

materials such as amalgam, but undoubtedly

require a higher skill set to ensure the

Kerrs Sonicll allows a simpler approach to Class II restorations, putting aesthetic

posterior restorations within reach of all clinicians

toP tiPsCOMPETENCE BREEDS CONFIDENCE

40 January 2012 PPd

ProdUCts Used

Figure 1: The tooth distal to the tooth to be restored should be clamped

Figure 2: WedgeGuard in situ

Figure 3: WedgeGuard, medium (Triodent)

Figure 4: The V3 Ring Sectional Matrix System (Triodent)

WedgeGuard (Triodent)

Siqveland (Dentsply)Toffl emire (Produits Dentaires)

The V3 Ring Sectional Matrix System (Triodent)

Sonicfll (Kerr)

Oxyguard (Kuraray)

Jon Swarbrigg BChD MFGDP qualied from

Leeds Dental Institute in 1992. Followinggraduation he joined Farsley Dental Practice, a

mixed NHS/Private general practice in Leeds, as

an associate and became principal in 1999 . Dr

Swarbrigg enjoys complex restorative work in-

cluding Implants and undertakes referral work

for simple and complex cases. He currently

lectures to dentists in the use of anterior and

posterior composite restorations and provides

hands-on training.

www.farsleydental.co.uk

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www.sonicfll.eu

To ask a question or comment on this article please send

an email to: comments@ppdentistry.comppd

of so tissue is not damaged, as if nicked by

the bur, the resulting bleeding can be dicult

to manage and control, which can be an

issue when attempting to place an adhesive

restoration.

Should the gum become traumatised, it can

be dicult to achieve a dry cavity in which to

place an adhesive restoration. Tis can cause an

improper hybrid layer to form, resulting in a

failed restoration.

ChoiCe of matrix system

A widely used matrix system is the traditional

360-degree circumferential band, eg Siqveland

(Dentsply) or oemire (Produits Dentaires).

Tese bands were primarily designed for use

with amalgam and so, were not designed for

placing Class II composites, which would oen

result in a restoration with poor anatomic

form, at-sided or weak contact points that

could lead to food trapping.

Studies support the use of a separationring that is designed to actively separate the

teeth. Te V3 Ring Sectional Matrix System

(riodent) uses a sectional matrix band (Figure

4), a wedge and separation ring to enable the

clinician to produce a predictably contoured

and precise contact point every time when

placing a simple Class II composite restoration.

Class ii beComes a Class i

Problems that clinicians oen report when

placing Class II restorations are the occurrence

of voids or overhangs at the base of the cavity

or, that the restoration is overbuilt and needs

recontouring using a high speed bur to re-

establish the occlusion, all requiring extra time

in the dental chair.

Tese issues described can be reduced by

a technique advocated where, rstly, the lost

proximal walls are established to, in-eect,

make the Class II restoration a Class I.

Secondly, a thin increment of composite

is built and cured into place (Figure 5). Te

separation ring and V3 Sectional Matrix Band

are then removed and the anatomical contour

can be inspected and checked for voids and

overhangs (Figure 6).

A size 12 scalpel can be used to trim away

any excess, and the height of the marginal

ridge can then be established in relation to the

adjacent tooth. Tis is oen a critical landmark

and can therefore be an essential guide when

trying to establish the correct morphology and,

therefore, minimise any occlusal adjustment.

Sonicll from Kerr is initially a very owable

composite that becomes stier as it regains itsinitial properties. Tis means that fewer voids

are formed whilst still being able to manoeuvre

the composite easily to recreate the original

contour of the tooth. Te advantages of using

the Sonicll delivery system can be seen

in gures 5 and 6, as the precise amount of

composite required can be expertly delivered,

adapted and shaped to reform the proximal

walls.

Te Class II restoration has now become

a Class I that can be simply lled using a

stratied or layered approach to complete the

restoration. Sonicll (Kerr) can be used to

bulk-ll the cavity in increments of up to 5mm

(Figure 7). Alternatively, it can be layered in

smaller increments to reduce the conguration

factor, producing a more anatomic form as

required.

anatomiC shaPe

Te nal layers can be contoured to produce

as detailed anatomy as the clinician prefers

(Figure 8). A simple probe and microbrush

can be used to gently manipulate the unset

composite and create a life-like morphology

of the tooth and ultimately create a good

anatomical occlusal surface. A layer of

Oxyguard (Kuraray) to remove the oxygen

inhibition layer will give the nal restoration a

hard surface that requires minimal polishing

(Figure 9).

Amalgam will always be a simpler material

to place, but as a clinician, you always have to

consider which you would prefer to have your

tooth restored with. We owe it to our patients

to be able to place a composite restoration

predictably, and this article will, I hope, help

clinicians to achieve consistency in the eld of

adhesive posterior restorations.

referenCes

1. Lussi, A and Gygax M (1998). Iatrogenic

damage to adjacent teeth during classical

approximal box prepartion,Journal of

Dentistry26:435-441

2. Wirsching et al (2011). Inuence of matrix

systems on proximal contact tightness

of 1 and 3 surface posterior composite

restorations in vivo,Journal of Dentistry

39:386-390

PPdJanuary 2012 41

Figure 5: Re-establishing the proximal walls Figure 6: Proximal walls are expertly reormed Figure 7: Sonicfll (Kerr) in use

Figure 8: Probes and microbrushes can create an occlusal surace

Figure 9: A layer o Oxyguard (Kuraray) creates a hard surace

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