1

Orientri actuale pentru refacerea contactului interdentar proximal

la restaurrile directe cu materiale compozite n cavitile de clasa a II-a

Autori:
Dr. Constantin M. Vrlan1, Dr. Bogdan A. Dimitriu2, Dr. Dana C. Bodnar1,
Dr. Virginia Vrlan3, Dr. Cristina D. Simina4, Dr. Mariana B. Popa5
1
Confereniar universitar, Catedra de Odontoterapie Restauratoare,
Facultatea de Medicin Dentar, U.M.F. Carol Davila, Bucureti
2
Confereniar universitar, Catedra de Endodonie,
Facultatea de Medicin Dentar, U.M.F. Carol Davila, Bucureti
3
ef de lucrri, Catedra de Odontoterapie Restauratoare,
Facultatea de Medicin Dentar, U.M.F. Carol Davila, Bucureti
4
Medic dentist rezident, Spitalul Clinic de Chirurgie Oral i Maxilo-Facial
Prof. Dr. Dan Theodorescu Bucureti
5
Profesor universitar, ef al Catedrei de Odontoterapie Restauratoare,
Facultatea de Medicin Dentar, U.M.F. Carol Davila, Bucureti

Contemporary approach for reestablishment of proximal contacts

in direct Class II resin composite restorations

Authors:
Constantin M. Vrlan1, Bogdan A. Dimitriu2, Dana C. Bodnar1,
Virginia Vrlan3, Cristina D. Simina4, Mariana B. Popa5
1
DDS, PhD, Associate Professor, Department of Operative Dentistry*,
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest
2
DDS, PhD, Associate Professor, Department of Endodontics,
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest
3
DDS, PhD, Senior Lecturer, Department of Operative Dentistry,
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest
4
DMD, resident dentist, Prof. Dr. Dan Theodorescu Clinical Hospital for
Oral and Maxillo-Facial Surgery Bucharest
5
DDS, PhD, Professor, Head of the Department of Operative Dentistry,
Faculty of Dental Medicine, Carol Davila University of Medicine and Pharmacy Bucharest
*Correspondence to:
Conf. Dr. Constantin M. Vrlan
Facultatea de Medicin Dentar Tel.: 0040-21-3158537
Calea Plevnei nr. 19 Fax.: 0040-21-3126765
010221 Bucureti - Sector 1 e-mail: office@sser.ro
Romnia
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Orientri actuale pentru refacerea contactului interdentar proximal

la restaurrile directe cu materiale compozite n cavitile de clasa a II-a

Rezumat

Subiectul lucrrii abordeaz un aspect nc problematic n restaurarea adeziv direct cu

materiale estetice a cavitilor de clasa a II-a proximo-ocluzale, i anume realizarea

corespunztoare a suprafeelor interdentare la nivel proximal i conformarea corect a punctului de

contact.

Rezolvarea corect a acestei probleme este dificil datorit mai multor cauze, dintre care

enumerm: profilul convex n sens cervico-ocluzal i vestibulo-oral al feei proximale, necesitatea

unei matrici perfect adaptate care s conformeze peretele dentar absent, accesul i vizibilitatea mai

dificile, necesitatea separrii dinilor pentru a creea spaiul necesar compensrii grosimii matricei.

Autorii ncearc s prezinte aspectele teoretice corelate cu soluiile practice utilizabile

actualmente, care pot fi luate n consideraie, privind rezolvarea unora dintre problemele menionate

mai sus.

Cuvinte-cheie: restaurri directe, rini compozite, caviti cls. a II-a, contact interdentar

proximal, tehnici de realizare.

 3

Contemporary approach of reestablishment proximal contacts

in direct Class II resin composite restorations

Abstract

The topic of the present paper represents a still problematic aspect for the direct esthetic

adhesive restoration of Class II (proximo-occlusal) cavities, which is adequate contouring the

interdental proximal area and accurate re-establishing of the proximal contact.

The appropriate approach of this matter is quite difficult due to several problems, like: the

convex emergence profile (both occluso-gingival and bucco-lingual) of the proximal coronal wall,

the need for a perfectly adapted matrix system in order to contour the missing proximal coronal

part, rather complicated access and visibility in the operating area, the need of separating the

adjacent teeth for creating the necessary space to compensate the thickness of the matrix band.

The authors try to present the theoretical issues related to the clinical techniques, which are

currently available nowadays, as therapeutical options to be taken into consideration for solving

some of the mentioned problems.

Key words: direct composite restorations, Class II cavities, proximal contact, clinical

techniques.
 4

TEXT

To the current hour, the aesthetic dental materials in the range of direct composite resins and the

adhesive techniques represent an indisputable clinical solution for the posterior restorations. These

materials and techniques allow crown reconstructions using much more conservative preparations

with respect to the sound dental tissues and the final restorations present excellent qualities, from the

viewpoint both of practitioners and of pacients. Therefore, these therapeutic methods are more and

more replacing the classic solutions of directly restoring posterior teeth using dental amalgams.

The present work proposes to approach the numerous problems this subject still raises

when restoring proximal contacts in Class II esthetic direct restorations.

The importance of this area is indisputable. Correct proximal contacts provide a multitude of

benefits:

- proper proximal coronal outline restoration;

- protection of the papilla against food impaction, which represents a conducive factor for

periodontal disease;

- prevention of horizontal migration due to lack of proximal contact, which leads to premature

contacts and interferences (implicit reason for occlusal trauma);

- physiological stimulation and gingival protection provided by correct food deflection on

crown surfaces;

- favours accurate hygiene in proximal areas.

There are some reasons for the difficulty of correct contouring the proximal contacts: the convex

outline in both cervical-occlusal and buccal-lingual direction of the proximal surface, the

requirement of a perfectly adapted matrix for contouring the missing dental surface, more difficult

visibility and access, the necessity of teeth separation in order to obtain the space required by the

thickness of the matrix.

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Obtaining an adequate proximal contact involves a correct cavity, a well-adapted matrix, a

proper positioned wedge and an appropriate insertion and modeling of the direct restoration material.

Every clinical case implies to deal in a specific manner with all these - otherwise well known -

issues. We therefore considered to be useful taking into account a series of observations related to a

subject very frequently encountered in everyday direct adhesive restorative dentistry.

The different methods of restoring proximal contacts in class II cavities are strongly related to

the type of matrix and wedge used.

Interdental wedges are used to adapt and maintain the matrix in contact with the tooth in the

gingival wall area. The wedges are made of different materials, such as wood or synthetic resins,

have standard lengths and triangular cross section and have thickness, taper and profile designed to

best adapt at the anatomical tooth outline. The wedges may be rigid or flexible.

Some rules have to be respected when using wedges (wedging):

- The wedge must not prevent the matrix to be properly contoured; an oversized wedge

generates a far too large embrasure

- All the wedges have to be adapted to the tooth outline because a universal wedge fitting all

clinical cases does not exist

- The wedges are generally introduced in a lingual-buccal direction because the proximal

contact that has to be contoured by the thinnest part of the wedge is buccally-oriented. The

wedge has to be placed slightly gingival with respect to the gingival margin of the preparation, in

tight contact with the tooth. If the wedge is placed coronal to the gingival wall of the cavity the

matrix will be pushed into the cavity and an abnormal concavity will occur at this level of the

restoration. On the other hand, placing the wedge too apically will prevent the tightening of the

matrix to the cavity margins, with subsequent material excess in the gingival area due to the slight

matrix displacement during placement and condesing of the restorative material.

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Occasionally - when the cavity has a large width - two wedges may be applied, one from the

gingival and the other from the buccal (double wedging). This allows correct condensation of the

material in the proximal angles and prevents overflow at the gingival margin.

Placing the wedge should sufficiently move away the two teeth from one another in order to

compensate the thickness of the matrix and therefore facilitate a proper proximal contact once the

matrix will be removed. This aspect can also be verified during the previous stage of cavity

preparation, during which dental separation proves to be favourable (pre-wedging).

The tensions induced on the rubber dam when placing the wedge frequently tend to separate the

wedge from the tooth. In order to prevent this problem the rubber dam in the proximal area should

be pulled in opposite direction when placing the wedge. Lubricating the wedge may also help it glide

and prevents cathing on the rubber dam.

Conclusively, in order to be efficient, the wedge has to be placed apically and as close as possible

of the gingival margin of the cavity. The pressure induced by the wedge has to tightly press the

matrix on the surface of the tooth sufficiently enough to adapt it to the tooth outline and thus prevent

overfilling the cavity, particularly in the gingival wall area. The same pressure also slightly moves

away the two teeth from one another, enabling a correct proximal contact once the matrix is

removed.

Some of the most frequently used matrix band systems are still the classic ones: Ivory and

Tofflemire matrix bands and matrix retainer (the latter in Senior, Junior and Contra Angle variants).

The Automatrix and Palodent systems are also being used.

The Ivory system consists of segmental matrix bands - reconstructing only one of the tooths

walls and the matrix retainers.

The matrix band is straight, with a corrugated gingival margin adapted to the gingival contour

and which can reach subgingivally when the gingival wall is placed far more apically.
 7

Due to the facility of placement this kind of matrix band is frequently used in everyday practice,

but - as for the Tofflemire system requires careful shaping in order to correctly remodel the

proximal outline of the tooth.

Fig.1

Tofflemire universal matrix bands system is advised to be used for restoring teeth with

mesioocclusodistal cavities because the matrix surrounds the tooth more tightly at gingival margin

than at the occlusal level. This system is also used for single proximal surface class II cavities.

Tofflemire has become the most popular system because of its adaptability and ease of use.

One of the advantages of this system consists in the possibility of the angled type to be

positioned both buccally and lingually. Once put in place the matrix band and matrix retainer have a

good stability, the matrix is easy introduced and removed from the retainer. There are different band

profiles, but all of them need to be adapted to the tooth outline. The matrix is also available in

small size for temporary dentition.

Though remarkable versatile, the Tofflemire system is not ideal. The specific disadvantages of

this system are:

- the matrix band is flat and has to be contoured to remodel the anatomical outline of the tooth

and the correct proximal contact;

- the resuting surface requires many adapting maneuvers;

- if rebuilding cuspids is necessary the matrix does not offer the rigidity and adaptability that

automatrix system presents.

To overcome these drawbacks of the classic Tofflemire system anatomical bands for Tofflemire

matrix retainer have been developed. These bands do not require adaptations before beeing

introduced in the matrix retainer, but are, naturally, more expensive.

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If a flat matrix band is used it has to be accurately adapted to the tooth outline. This can be

achieved by using an amalgam burnishing egg-shaped instrument. The matrix band is placed on a

sheet of paper and burnished in such a manner hence to obtain the double convex profile specific to

the proximal surface of the tooth. The matrix thus formed is introduced in the retainer with the

handle preferably buccally directed and the retainer grooves always facing gingivally, in order to

allow an easy removal.

The matrix will be put in place once the matrix introduced in the retainer and fastened by means

of the screw. Inspecting the gingival area proves if the matrix encompasses the limits of the cavity. If

the flat matrix does not fully encompass the gingival margin, it has to be replaced with a corrugated

one, with an extension applied apically of the gingival limit of the preparation. The bands height is

then verified and reduced if it goes 2-3 mm beyond the occlusal surface, in order to facilitate

placement and modeling of the restorative material.

Using the screw, the matrix is tightened without deformation around the tooth and then the

wedge is beeing applied. The gingival area is examined to find out if the rubber dam or gingival

tissue has been caught between the tooth and matrix. Cavity cleansing follows. The wedge and

matrix are beeing kept in the same position so that interdental separation is maintained and the

restorative material sets. After the restorative material has set the retainer is first removed, then the

wedge and eventually the matrix, which is moved in a lateral direction in order to avoid

displacement of the restorative material.

The Automatrix system includes four kind of bands which can be adapted to any tooth,

regardless the perimeter and do not need a matrix retainer. The bands are in four sizes, with height

between 4,7mm and 7,9 mm and thickness between 0,038 mm and 0,05 mm.

This system is recommended in extensive class II cavities, especially when one or more cusps

have to be restored. The Automatrix system naturally has its own advantages and disadvantages. One
 9

of the advantages consists in the possibility of positioning the matrix retainer both on the buccal and

the lingual side. The major disadvantage for these bands is that they are not preformed and

contouring them to reestablish the anatomical profile of the proximal surface turns out to be difficult.

The most suitable band is selected and applied. The clamp is positioned in the preffered position:

buccally or lingually. The band is then tightened around the tooth using the special designed device

from the kit and the wedge is applied. After the restorative material is placed, adapted and set the

clamp is cut off and the matrix is removed using a oblique direction.

The Palodent matrix systems used for class II occlusoproximal cavities in posterior teeth

includes a range of sectional matrix bands and elastic metallic rings which fasten the matrix to the

tooth (fig 2).

The original Palodent system (Darway Inc. now manufactured by Dentsply / Caulk) includes

a kit of sectional matrix bands with double convexity (both buccal-lingually and lingual-buccally

oriented), which are fastened in the adequate position by means of the BiTine rings. These rings are

available in both round and oval shapes, suitable to be used single or in pair (for mesioocclusodistal

cavities).

Some of the advantages of this system are:

- the anatomical contour helps obtaining proper proximal contact and embrasures;

- the facility of use;

- good visibility of the operating field;

- smaller tension on the tooth and thus greater comfort for the patient.

Some authors consider the curvature of the Palodent band to be too strong and in some situations

to be pressed in a too tight proximal contact against the next tooth.

Fig. 2
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Properly placing the precontoured matrix requires enough space in order to avoid forcing and

distorting the band. This separation can be obtained either interdental placing the BiTine ring before

and during preparation, or introducing a wedge during preparation.

A special forceps (similar to the one used for rubber dam clamps) is used to place the ring into

position; the arms of the forceps are placed diametrically opposed on the ring and opened to spread

and position it with the ends of the rings arms placed interdental.

Standard Palodent bands are usually beeing used; the Mini type is applied in cases of partially

erupted teeth and the Plus type in the situation of extensive under gingival cavities: the bands are

longer and have a gingival extension (fig 3).

After cavity preparation and wedge or ring removal the matrix is rolled for adapting it at the

circumference of the tooth and is placed in the interdental space. The wedge is then introduced in

order to perfectly adapt the matrix to the gingival area and the ring is positioned, the wedge beeing

placed between the matrix and the ring. The ring must not lean against the wedge (fig 3).

The matrix may be slightly burnished from inside the cavity (taking care not to warp it) to an

intimate contact with the next tooth.

After the restorative material is inserted and polymerized, first the ring, then the wedge and

eventually the matrix are removed and the finishing of the restoration can take place.

Fig. 3

In course of time similar systems of sectional matrix bands have been introduced in general

practice, with likewise features, properties and indications; the best known Palodent type systems

are:

- ComposiTight (Garisson Dental);

- Contact Matrix (Danville Materials) ;

- Sectional Matrix Retainer (3M ESPE);

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- Hawe Adapt Sectional Matrix (Kerr Hawe).

The methods of reestablishment of proximal contacts in Class II occlusoproximal

restorations represents without any doubts one of the most important steps in achieving an aesthetic

composite restoration; the main issue is the choice and proper placement of the matrix. Unlike

amalgam, which can be laterally condensed to obtain an optimum proximal contact, aesthetic

materials fully depend on the contour and position of the matrix. This makes restoring proximal

contact with aesthetic materials difficult and requires much care in adapting the matrix and wedge.

As above mentioned, it is recommended to place a wedge in the interdental space corresponding

the proximal surface that is to be prepared (pre-wedging), one of the reasons beeing to obtain an

enough teeth separation to compensate the thickness of the matrix. In situations where the clinical

situation imposes this two (double wedging) or even more wedges (multiple wedging) can be

used in the same interdental space. The matrix will be positioned in tight contact with the next tooth.

A thin metallic band is recommended to be used because it occupies a smaller space and is

easier to contour and maintain in place than a celluloid matrix. At the same time the metallic band

has a greater resistance when condensing the restorative material, particularly when a firmer one is

used.

No problems usually occur with the polymerization of the restorative material when using

metallic bands, as far as limited quantities of the material are successively placed in the cavity and

polymerized before adding new increments.

If a Tofflemire-type matrix is used when restoring a cavity extended on two surfaces, its (double)

thickness has to be compensated by placement of an adequate thick wedge. It is preferably to use a

ultra-thin band (001) in order to obtain a correct proximal contact. The band has to be burnished

prior its insertion - in the same manner it is done for amalgam restorations - for the future restoration

to be appropriately contoured.
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Similar systems of matrix bands have been developed to be maintained by Toffelmire-type

matrix retainers, using preformed ultra-thin bands. The usual thickness of a standard Toffelmire

band of 0,0015 inch (30 m) is replaced by 0,0010 inch (20 m) and 0,0006 inch (12 m). Such

systems are:

- HO Bands (Young Dental) - fig. 4;

- Microbands (Dental Innovations).

Fig. 4

A good matrix used for restorations in class II cavities with two surfaces is the preformed semi-

matrix, fastened to the tooth by means of thermoplastic points and special designed devices (rings).

The wedge for pre-wedging is removed prior to matrix placement, the matrix is introduced and

maintained using a metallic instrument in tight contact with the adjacent tooth. Two thermoplastic

points are softened and used in securing the matrix both bucally and lingually and the ring is adapted

with a special forceps (fig 5). The interdental wedge is then cervically placed and if further matrix

adjustments are still necessary these can be performed by means of a heated Black hand excavator.

Fig. 5

In cases of mesioocclusodistal cavities a ultra-thin, burnishable Tofflemire-type matrix is

recommended to be used in order to properly reestablish proximal contact. The matrix is contoured,

placed, fixed with wedges and then adapted to obtain a correct proximal profile in both the proximal

contact and embrasure areas. Ring bands already preformed and suitable to be used with Tofflemire

retainer are also very comfortable to use.

Polyester bands use have to be limited to very small proximal cavities. The matrix has to be

very careful contoured to the convex profile of the proximal surface. This profile can be obtained by

applying and pulling the band on a round metallic instrument. Polyester preformed bands are

commercially available, both for Tofflemire retainer and as special systems (Translite Auto Matrix
 13

System). The polyester transparent bands are usually thicker than metallic ones, which implies using

thicker wedges to obtain enough interdental separation. It is to be underlined that polyester bands are

not to be used in restoring large cavities, as they can not be adequately adapted and do not have the

necessary strength for condensing dense materials.

Contemporary concerns related to the reestablishment of the proximal contact for composite

resin restorations lead to precontoured instruments specially designed to obtain the proximal

contact (precontoured contact-forming instruments). Such specially designed class II

occlusoproximal systems are:

- ContactPro (C.E.J. Dental);

- TriMax (AdDent);

- OptraContact (Ivoclar Vivadent) - fig. 6 and 7

Fig. 6

Fig. 7

The matrix and the wedge are removed after polymerization and the restoration is examined for

gaps or deficiencies of the proximal contact. If some corrections are necessary they have to be

performed before the field isolation is removed, in order to increase chances for new added

restorative material to adhere to the already polymerized one.

We eventually think - as a comprehensive image of the proper proximal contact reestablishment

in class II occlusoproximal cavities aesthetically restored with composite materials that this

essentially depends on the cotour and position of the matrix. The correct choice, adaptation and

placement of the matrix and wedge decisively condition this aspect, statement that can be illustrated

by means of a few comparative clinical observations.

Clinical observation nr. 1

Fig. 8
 14

Fig. 9

Fig. 10

Clinical observation nr. 2

Fig. 11

Fig. 12

Fig,13

Fig. 14

Conclusions

Some instructions have to be followed in order to obtain a correct proximal contact when using

aesthetic restorative materials of composite type in class II cavities:

1. Ultra-thin matrix bands have to be used, because, unlike amalgam,

aesthetic materials can not be efficiently laterally condensed; the bands need to be

precontoured or adapted by the dentist to the profile of the proximal surface.

2. Placement of the interdental wedges prior to cavity preparation (pre-

wedging), thus obtaining:

- the interdental separation necessary to compensate for the thickness of the

matrix;

- protection for the adjacent tooth and the rubber dam;

- adequate proximal contact obtained after removal of the wedge and return of

the tooth to its normal position.

3. Placement of elastic positioniong clamps for the sectional matrix before

cavity preparation in order to obtain the same effect of teeth separation for
 15

compensating the thickness of the band for Palodent matrix system and the

Compositight, Sectional Matrix Retainer and Hawe Adapt Sectional Matrix systems.

4. Push the matrix toward the proximal surface of the adjacent tooth, taking

care not to warp the precontoured profile

5. Use of the small diameter cones for the light guide during light curing

6. Use of rigid prepolymerized or prefabricated inserts in order to facilitate

the proper proximal contact and to increase the strength of the restoration

The failure to obtain correct proximal interdental contacts with aesthetic material restorations

have the following usual reasons:

1. The matrix does not have an adequate profile for the proximal outline

of the tooth;

2. The matrix is too thick, with the impossibility to be compensated by

the return movement of the tooth;

3. The matrix is incorrectly adapted to the tooth;

4. Change of matrix position during placement and modelling of the

restorative material;

5. Use of a circular matrix when restoring a single proximal contact

without an additional teeth separation;

6. Incorrect use of the wedge which either does not firmly press the

matrix on the tooth in the gingival area, or warps the matrix profile;

7. Lack of interdental separation with wedges or rings prior of and during

cavity preparation;
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8. Insufficient polymerization of the composite material with distortion at

matrix removal;

9. Inadequate finishing of the proximal surface.

REFERENCES

1. Brackett MG, Contreras S, Contreras R, Brackett WW: Restoration of

proximal contact in direct class II resin composites. Oper.Dent., 2006; 31(1): 155-156.

2. Drfer CE, von Bethlenfalvy ER, Staehle HJ, Pioch T: Factors influencing

proximal dental contact tightness. European Journal of Oral Sciences, 2000; 108(5): 368-377.

3. Drfer CE, Schriever A, Heidemann D, Staehle HJ, Pioch T: Influence of

rubber-dam on the reconstruction of proximal contacts with adhesive tooth-colored

restorations. J Adhes Dent, 2001; 3(2):169-75.

4. Dunn WJ: Establishing proximal contacts with pre-polymerized composite

inserts. Oper.Dent., 2004; 29(4):473-476.

5. El-Badrawy WA, Leung BV, El-Mowafy O, Rubo JH, Rubo MH. Evaluation

of proximal contacts of posterior restorations with 4 placement techniques. Journal of the

Canadian Dental Association, 2003; 69(3): 162-167.

 17

6. Francci C, Loguercio AD, Reis A, Carrilho MR: A novel filling technique for

packable composite resin in Class II restorations. J Esthet Restor Dent. 2002;14(3):149-157.

7. Klein F, Keller AK, Staehle HJ, Drfer CE: Proximal contact formation with

different restorative materials and techniques. Am J Dent, 2002; 15(40: 232-235.

8. Loomans BAC, Opdam NJM, Roeters FJM, Bronkhorst EM, Burgersdijk

RCW: Comparison of proximal contacts of class II resin composite restorations in vitro.

Oper.Dent, 2006; 31(6): 688-693.

9. Loomans BAC, Opdam NJM, Bronkhorst EM, Roeters FJM, Drfer CE: A

clinical study on interdental separation techniques. Oper.Dent., 2007; 32(3): 207-211.

10. Loomans BAC, Opdam NJM, Roeters FJM, Bronkhorst EM, Burgersdijk

RCW, Drfer CE: A randomized clinical trial in proximal contacts of posterior composites.

Journal of Dentistry, 2006; 34(4): 292-297.

11. Loomans BAC, Opdam NJM, Roeters FJM, Bronkhorst EM, Plasschaert AJ:

The long-term effect of a composite resin restoration on proximal contact tightness. Journal

of Dentistry, 2007; 35(2): 104-108.

12. Loomans BAC, Opdam NJM, Roeters FJM, Bronkhorst EM, Plasschaert AJ:

Influence of composite resin consistency and placement techniques on proximal contact

tightness of class II restorations. Journal of Adhesive Dentistry, 2006; 8(5): 305-310.

13. Peumans M, Van Meerbeek B, Asscherickx K, Simon S, Abe Y, Lambrechts P,

Vanherle G: Do condensable composites help to achieve better proximal contacts? Dent

Mater, 2001; 17(6):533-541.

14. Prakki A, Cilli R, Saad JO, Rodrigues JR: Clinical evaluation of proximal

contacts of Class II esthetic direct restorations. Quintessence Int., 2004; 35(10):785-789.

 18

15. Unterbrink G: Obtaining proper proximal contacts. Dent.Prod.Report Europe,

2003; 1(Jan/Feb): 18-21.

Figure legends:

Fig.1: Tofflemire and Ivory matrix bands

Fig. 2: Palodent matrix band with BiTine ring

Fig. 3: The Palodent matrix System

Fig. 4: HO Bands (Young Dental)

Fig. 5: Palodent matrix placed by means of BiTine ring and thermoplastic material

Fig. 6: Precontoured contact-forming instruments OptraContact

Fig. 7: Aspect of restoration material after using the OptraContact instrument

Fig. 8: 3.6.- Cavity aspect after preparation

Fig. 9: 3.6.- Placement of Tofflemire matrix and retainer

 19

Fig. 10: Proximal contact obtained using a flat metallic circular matrix

Fig. 11: 4.4.- Prepared cavity before rubber dam placement

Fig. 12: 4.4 - Automatrix and wedge in place

Fig. 13: 4.4.- Automatrix and wedge in place

Fig. 14: 4.4.- Proximal contact obtained using anatomical precontoured automatrix