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Dr. Nithin Mathew – Contacts & Contours
Contents
• Introduction
• Contacts
• Contours
• Proximal Contact Area
• Embrasures...
Dr. Nithin Mathew – Contacts & Contours
• Matricing
• Classification
• Types
• Recent Advances
• Conclusion
• References
4
Dr. Nithin Mathew – Contacts & Contours
5
• Presence of proper contacts & contour is important to maintain stability &
occ...
Dr. Nithin Mathew – Contacts & Contours
6
• Benefits of an ideal contact & contour:
1. Conserves the health of peridontium...
Dr. Nithin Mathew – Contacts & Contours
7
• Role of a dentist is to establish the ideal extension so as to perform
optimal...
Dr. Nithin Mathew – Contacts & Contours
8
Food we consume moves in 3 different directions:
• Occlusal surfaces
• Contact &...
Dr. Nithin Mathew – Contacts & Contours
9
• Any decay occurring on the proximal surface is mainly due to faulty
interrelat...
Dr. Nithin Mathew – Contacts & Contours
10
• Time of eruption: only contact point
• Proximal Contact Point Proximal Contac...
Dr. Nithin Mathew – Contacts & Contours
Proximal Contact Area
11
• Area of proximal height of contour of the mesial or dis...
12
CONTACT TAPERING SQUARE OVOID
Between
Incisors
Contacts starts at incisal
ridge & labial, labiolingually
Starts at inci...
13
CONTACT TAPERING SQUARE OVOID
Molars
(mesial
contact)
Buccal periphery almost at
bucco-axial angle of tooth
Same as pre...
Dr. Nithin Mathew – Contacts & Contours
Contours
14
• Convexities on the facial & lingual surfaces of tooth that affords
p...
Dr. Nithin Mathew – Contacts & Contours
Height of Contour
15
• Area of greatest circumference on the facial and lingual su...
Dr. Nithin Mathew – Contacts & Contours
Types of contour
16
OVERCONTOUR
• Deflects food away from gingiva
• Understimulati...
Dr. Nithin Mathew – Contacts & Contours
Embrasures (spillways)
17
• V-shaped spaces between the teeth that
originate at th...
18
• Named for the direction towards which they radicate:
facial, lingual, incisal/occlusal, gingival
Lingual/Palatal
Faci...
Dr. Nithin Mathew – Contacts & Contours
19
• Gingival embrasures filled with papilla – prevents food being trapped in
this...
Dr. Nithin Mathew – Contacts & Contours
20
• Embrassure is reduced: additional stress is created in teeth & supporting
str...
Dr. Nithin Mathew – Contacts & Contours
Marginal Ridges
21
• Rounded borders of enamel that forms the mesial &
distal marg...
Dr. Nithin Mathew – Contacts & Contours
22
• Functions:
• Helps in prevention of food impaction proximally
• Mastication
•...
23
• Marginal ridges with normal occlusal
Dr. Nithin Mathew – Contacts & Contours
24
• Marginal ridges with exaggerated occlusal embrasures causes drifting of
tooth...
Dr. Nithin Mathew – Contacts & Contours
25
• Adjacent marginal ridges are not compatible in height - drives the debris
int...
Dr. Nithin Mathew – Contacts & Contours
26
• Marginal ridges with no triangular fossa, the vertical forces will impact
foo...
Dr. Nithin Mathew – Contacts & Contours
27
• Thin marginal ridges will be susceptible to fracture or deformation
Dr. Nithin Mathew – Contacts & Contours
28
• Marginal ridges with no occlusal embrasures, the 2 adjacent marginal
ridges w...
Dr. Nithin Mathew – Contacts & Contours
Procedures of proper contacts & contours
29
• Intraoral procedures:
• Tooth moveme...
Dr. Nithin Mathew – Contacts & Contours
Tooth movement
30
• Act of separating the involved teeth from each other, bringing...
Dr. Nithin Mathew – Contacts & Contours
31
Objectives:
• To bring drifted, tilted or rotated teeth to their indicated
phys...
Dr. Nithin Mathew – Contacts & Contours
32
• To move teeth to a position so that when restored, they will be in a
most est...
Dr. Nithin Mathew – Contacts & Contours
33
Tooth Movement
Rapid / Immediate Slow / Delayed
Dr. Nithin Mathew – Contacts & Contours
Rapid/ Immediate movement
34
• Mechanical type of separation
• Creates either prox...
Dr. Nithin Mathew – Contacts & Contours
Methods
35
1. Wedge method
• By insertion of a pointed wedge shaped device between...
Dr. Nithin Mathew – Contacts & Contours
36
Elliots separator
• Indicated for short duration separation that does not neces...
Dr. Nithin Mathew – Contacts & Contours
37
Wood/ Plastic Wedges
• Used in both tooth separation for preparation and restor...
Dr. Nithin Mathew – Contacts & Contours
38
Functions:
• Hold the matrix band in position
• Slight separation of the tooth
...
Dr. Nithin Mathew – Contacts & Contours
39
• Types:
• Wooden
• Plastic
• Elastic
• Transparent
• Medicated wedges
• Shape:...
Dr. Nithin Mathew – Contacts & Contours
40
Wedging method:
• Location : Gingival embrasure just beneath the contact area.
...
Dr. Nithin Mathew – Contacts & Contours
41
Wedging techniques
1. Single wedge technique
• Single wedge is placed in the gi...
Dr. Nithin Mathew – Contacts & Contours
42
3. Double wedging technique
• Here, 2 wedges, one from the facial embrasure and...
Dr. Nithin Mathew – Contacts & Contours
43
4. Wedge wedging technique
• Used in cases when there is a gingival concavity a...
Dr. Nithin Mathew – Contacts & Contours
44
• Rounded toothpick wedge is usually the wedge of choice with conservative
prem...
Dr. Nithin Mathew – Contacts & Contours
45
Light Transmitting Wedges
• Plastic wedges which are transparent and have a lig...
Dr. Nithin Mathew – Contacts & Contours
46
Prewedging
• The procedure of inserting a wedge between the interproximal surfa...
Dr. Nithin Mathew – Contacts & Contours
47
Error’s with wedge placement
• If wedge is placed more occlusal to the gingival...
Dr. Nithin Mathew – Contacts & Contours
48
2. Traction method
• Done with mechanical devices which engage the proximal sur...
Dr. Nithin Mathew – Contacts & Contours
49
Non-Interfering true separator
• Indicated when continuous stabilized separatio...
Dr. Nithin Mathew – Contacts & Contours
50
Procedure:
• Apply the jaws closest to the bow against the tooth to be operated...
Dr. Nithin Mathew – Contacts & Contours
51
Ferrier double-bow separator
• Separation is stabilized throughout the dental o...
Dr. Nithin Mathew – Contacts & Contours
52
Procedure:
• Four arms are adjusted so each will hold a corner of proximal
surf...
Dr. Nithin Mathew – Contacts & Contours
Slow/ Delayed tooth movement
53
Indications:
• When teeth have drifted and/or tilt...
Dr. Nithin Mathew – Contacts & Contours
54
Separating wires
• Thin pieces of wire are introduced into the gingival contact...
Dr. Nithin Mathew – Contacts & Contours
55
Oversized temporaries
• Resin temporaries are oversized mesio-distally to achie...
Dr. Nithin Mathew – Contacts & Contours
56
Orthodontic appliances
• Fixed appliances – most effective and predictable meth...
Dr. Nithin Mathew – Contacts & Contours
Matricing
57
Procedure where a temporary wall is created opposite to the axial
wal...
Dr. Nithin Mathew – Contacts & Contours
Matricing
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The matrix should:
• Displace the gingiva and rubber dam away from th...
Dr. Nithin Mathew – Contacts & Contours
59
Matrix
Matrix is a device that is applied to a prepared tooth before the
insert...
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Parts of a Matrix system involves:
• Band
• Retainer
Matrix Band
• Supplied as ...
Dr. Nithin Mathew – Contacts & Contours
61
Retainer
• Device by which a band can be maintained in its designated position
...
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Qualities of a good matrix includes:
1. Rigidity
2. Establishment of proper con...
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63
Classification of matrices:
1. Based on mode of retention:
i. With retainer (To...
Dr. Nithin Mathew – Contacts & Contours
64
ii. Class II cavity
a. Single banded Tofflemire
b. Ivory matrix No. 1
c. Ivory ...
Dr. Nithin Mathew – Contacts & Contours
65
Universal Matrix (Tofflemire matrix)
• Designed by BR. Tofflemire
• Ideally ind...
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66
Parts of a Retainer:
Dr. Nithin Mathew – Contacts & Contours
67
Advantages:
• Can be placed facially/lingually
• Retainer and band are stable w...
Dr. Nithin Mathew – Contacts & Contours
68
Matrix bands:
1. Uncontoured bands
• Available in 2 thickness : 0.002” and 0.00...
Dr. Nithin Mathew – Contacts & Contours
69
Clinical Technique:
Shaping the Matrix
• Matrix band - shaped to achieve proper...
Dr. Nithin Mathew – Contacts & Contours
70
• Small round burnisher used with firm
pressure in back-forth motion until the ...
Dr. Nithin Mathew – Contacts & Contours
71
Preparing the retainer to receive the band
1. Larger knurled nut is turned coun...
Dr. Nithin Mathew – Contacts & Contours
72
3. Matrix band is folded end to end forming a
loop.
4. Band is positioned in th...
Dr. Nithin Mathew – Contacts & Contours
73
5. Two ends of band are placed in the locking
vise, smaller nut is turned clock...
Dr. Nithin Mathew – Contacts & Contours
74
Removal of the band with retainer
1. Retainer is removed from the band. Matrix ...
Dr. Nithin Mathew – Contacts & Contours
75
Clinical Application:
• Damaging gingival attachment should be avoided
• One de...
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76
Ivory Matrix No.1
• Band encircles the posterior proximal surfaces so it is ind...
Dr. Nithin Mathew – Contacts & Contours
77
Ivory Matrix No. 8
• Consists of band that encircles the entire crown of the
to...
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78
Black’s matrices
1. For simple cases recommended for majority of small & medium...
Dr. Nithin Mathew – Contacts & Contours
79
2. Blacks matrix with gingival extension
• To cover gingival margin of a subgin...
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80
Copper Band Matrix / Soldered Band
• Indicated for badly broken down teeth such...
Dr. Nithin Mathew – Contacts & Contours
81
• With curved scissors, the band is festooned in the cervical region to fit the...
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82
Anatomical Matrix
• Most efficient means of reproducing contacts & contours
• H...
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83
• Must extend beyond the cavity margins
• Wedge is placed.
• Small cones of com...
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84
Roll in band matrix ( Automatrix)
• Retainerless matrix system with 4 types of ...
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85
• Advantages:
• Convenience
• Improved visibility because of absence of retaine...
Dr. Nithin Mathew – Contacts & Contours
86
S-shaped Matrix Band
• For class III, class II and with facial/lingual extensio...
Dr. Nithin Mathew – Contacts & Contours
87
T-shaped matrix
• Premade T-shaped brass/ stainless steel matrix
bands
• Longer...
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88
Indications:
• Class II cavities involving 1 or both proximal surfaces of a pos...
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89
Mylar Strips
• For composite restorations in Class III and Class IV cavities.
P...
Dr. Nithin Mathew – Contacts & Contours
90
• Strip is then cut to place the belly where the
contact is desired.
• A wedge ...
Dr. Nithin Mathew – Contacts & Contours
91
• Lingual aspect of strip is secured with index
finger
• Facial portion is refl...
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92
Aluminium Foil Incisal Corner Matrix
• Stock metallic matrices shaped according...
Dr. Nithin Mathew – Contacts & Contours
93
Procedure:
• A corner matrix closest in size and shape of teeth is selected.
• ...
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94
Transparent Crown Form Matrix
• Stock plastic crowns
• Can be used for light cu...
Dr. Nithin Mathew – Contacts & Contours
95
• Should be perforated at the incisal angle.
• The prepared tooth is partially ...
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96
• Indications:
• Large bilateral/unilateral class IV cavity
• Oblique fractures...
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97
Window Matrix
• For class V cavities
• Formed using either a Tofflemire matrix ...
Dr. Nithin Mathew – Contacts & Contours
98
Preformed Transparent Cervical Matrix
• For use with light cured resin material...
99
Dr. Nithin Mathew – Contacts & Contours
Contact Forming Instruments
100
• These are special instruments designed to create...
Dr. Nithin Mathew – Contacts & Contours
Contact Rings
101
• Work by providing slight separation of the contacting teeth.
•...
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102
• According to their evolution, categorized as
• First generation systems
• Se...
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103
Palodent BiTine I and BiTine II
• First system that was available.
• Rings hav...
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104
Contact matrix
• These rings have rectangular tines which are converging and h...
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105
Composi-Tight matrix
• Two separate rings are available for premolar and molar...
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106
Precontoured sectional matrix bands
• All these systems rely on precontoured s...
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107
Benefits with the Sectional Matrices and Contact Rings
• Ease of use and good ...
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108
Problems with early contact rings
• Ring collapse or displacement in case of w...
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109
Second - Generation Rings
Eg:-
• Composi-Tight 3D soft face ring system
• V3 r...
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110
Composi-tight 3D Soft Face Ring System
The orange Soft Face 3D-Ring
• Used in ...
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111
V3 Ring System
• Developed by Dr. Simon McDonald in 2008
• System has two type...
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112
It has two major innovations
• Fully made of Nickel-Titanium ;imparts more spr...
Dr. Nithin Mathew – Contacts & Contours
Fender Wedges
113
• For protection and separation during tooth
preparation.
• Comb...
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114
• Available in four color coded sizes
• Should be inserted with firm pressure ...
Dr. Nithin Mathew – Contacts & Contours
Conclusion
115
• Proper restoration of the anatomical landmarks is important for
e...
Dr. Nithin Mathew – Contacts & Contours
References
116
1. Operative Dentistry – MA Marzouk
2. Art & science of operative D...
117
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Contacts & Contours

Contacts & Contours

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Contacts & Contours

  1. 1. 1
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  3. 3. Dr. Nithin Mathew – Contacts & Contours Contents • Introduction • Contacts • Contours • Proximal Contact Area • Embrasures • Marginal Ridges • Procedures for formulation of proper contacts and contours: • Toothmovement • Rapid • Slow 3
  4. 4. Dr. Nithin Mathew – Contacts & Contours • Matricing • Classification • Types • Recent Advances • Conclusion • References 4
  5. 5. Dr. Nithin Mathew – Contacts & Contours 5 • Presence of proper contacts & contour is important to maintain stability & occlusal harmony. • A thorough knowledge of the contacts & contours of various teeth is mandatory for understanding: • Predisposing factors of proximal caries like faulty interrelationships. • Significance of marginal ridges, embrasures for re-establishing the form and function of restored teeth. • Periodontal aspect & health of the tooth to be restored.
  6. 6. Dr. Nithin Mathew – Contacts & Contours 6 • Benefits of an ideal contact & contour: 1. Conserves the health of peridontium 2. Prevents food impaction 3. Makes area self cleansable 4. Improves longevity of proximal restorations 5. Maintains normal mesiodistal relationship of the teeth in the dental arch
  7. 7. Dr. Nithin Mathew – Contacts & Contours 7 • Role of a dentist is to establish the ideal extension so as to perform optimal functions, maintaining the integrity and longevity of individual tooth.
  8. 8. Dr. Nithin Mathew – Contacts & Contours 8 Food we consume moves in 3 different directions: • Occlusal surfaces • Contact & Gingival embrasures • Facial & Lingual sulcus
  9. 9. Dr. Nithin Mathew – Contacts & Contours 9 • Any decay occurring on the proximal surface is mainly due to faulty interrelationship between • Contact Areas • Marginal Ridges • Embrasures • Gingiva.
  10. 10. Dr. Nithin Mathew – Contacts & Contours 10 • Time of eruption: only contact point • Proximal Contact Point Proximal Contact Area
  11. 11. Dr. Nithin Mathew – Contacts & Contours Proximal Contact Area 11 • Area of proximal height of contour of the mesial or distal surface of a tooth that touches the adjacent tooth in the same arch. • According to their general shape, 3 types: 1. Tapering teeth : Wide crowns & narrow cervical region 2. Square type : Bulky, angular with little rounded contour 3. Ovoid type : A transitional type between tapering & square types : Surfaces are convex but infrequently they may be concave
  12. 12. 12 CONTACT TAPERING SQUARE OVOID Between Incisors Contacts starts at incisal ridge & labial, labiolingually Starts at incisal ridge & incline with it labiolingually Slightly lingual to incisal ridge Mesial contact start at 1/4th of crown incisogingivally Distal contact start 1/3rd to ½ of crown incisogingivally Canine Mesial: incisal ridge Distal: middle third Very angular Close to incisal ridge incisally Close to incisal ridge incisally Bicuspids Buccal periphery is almost at bucco-axial angle Buccal periphery more towards bucco-axial angle Buccal periphery at junction of buccal & middle third Occlusal periphery at junction of occlusal & middle 3rd of crown Occlusal periphery at occlusal third Contact deviated buccally Short cusps
  13. 13. 13 CONTACT TAPERING SQUARE OVOID Molars (mesial contact) Buccal periphery almost at bucco-axial angle of tooth Same as premolars Same as premolars Occlusal periphery at junction of occlusal & middle third of crown Large cusps Molars (distal contact) Buccal periphery at middle third More lingually deviated than mesial Buccal periphery in line with central groove Embrassures Wide variations Incisal & labial are negligible Incisal, lingual, occlusal & buccal embrasures are NIL Incisal, labial, buccal & occlusal embrasures are wider & deeper Gingival & lingual embrasures between anterior teeth are the widest & longest in the mouth Gingival embrasures are almost not noticeable Gingival & lingual are short & broad - Buccal embrasures are small, lingual are long
  14. 14. Dr. Nithin Mathew – Contacts & Contours Contours 14 • Convexities on the facial & lingual surfaces of tooth that affords protection & stimulation of the supporting tissues during mastication. Functions of contour: 1. Deflecting food 2. Maintenance of periodontal tissues 3. Maintain contact with adjacent tooth
  15. 15. Dr. Nithin Mathew – Contacts & Contours Height of Contour 15 • Area of greatest circumference on the facial and lingual surface of the teeth. • Protects the gingival tissue by preventing food impaction. ANTERIOR POSTERIOR Cervical 3rd on facial & lingual surface Gingival 3rd on facial surface Middle 3rd on lingual surface
  16. 16. Dr. Nithin Mathew – Contacts & Contours Types of contour 16 OVERCONTOUR • Deflects food away from gingiva • Understimulation of supporting tissues • Plaque accumulation UNDERCONTOUR • Irritation to soft tissues ADEQUATE CONTOUR • Stimulation of supporting tissues • Healthy peridontium
  17. 17. Dr. Nithin Mathew – Contacts & Contours Embrasures (spillways) 17 • V-shaped spaces between the teeth that originate at the proximal contact areas between adjacent teeth. • Curvature formed by two adjacent teeth in an arch form a spillway space that is called an embrasure. • Serves 2 purposes: • Provides a spillway for passage for food during mastication • Prevents food from being forced into the contact area
  18. 18. 18 • Named for the direction towards which they radicate: facial, lingual, incisal/occlusal, gingival Lingual/Palatal Facial/Buccal Incisal/Occlusal Gingival
  19. 19. Dr. Nithin Mathew – Contacts & Contours 19 • Gingival embrasures filled with papilla – prevents food being trapped in this region • Anterior : papilla is triangular • Posterior : tent shaped (col) • Correct relationship of embrasures, cusps, sulci, marginal ridges & grooves of adjacent and opposing tooth provide escape of food from the occlusal surface during mastication
  20. 20. Dr. Nithin Mathew – Contacts & Contours 20 • Embrassure is reduced: additional stress is created in teeth & supporting structures. • Embrassures is large: less protection to supporting structures • Lingual embrasure is greater than buccal, since tongue can displace food occlusally.
  21. 21. Dr. Nithin Mathew – Contacts & Contours Marginal Ridges 21 • Rounded borders of enamel that forms the mesial & distal margins of occlusal surfaces of molars & premolars and the mesial and distal margins of lingual surfaces of incisors and canine. • Always formed in 2 planes: buccolingually meeting at a very obtuse angle • This feature is essential when an opposing functional cusp occludes with the marginal ridge.
  22. 22. Dr. Nithin Mathew – Contacts & Contours 22 • Functions: • Helps in prevention of food impaction proximally • Mastication • Protection of peridontium • Marginal ridges of adjacent posterior teeth should be at the same height to have a proper contact and embrasure forms.
  23. 23. 23 • Marginal ridges with normal occlusal
  24. 24. Dr. Nithin Mathew – Contacts & Contours 24 • Marginal ridges with exaggerated occlusal embrasures causes drifting of tooth which leads to wedging of food
  25. 25. Dr. Nithin Mathew – Contacts & Contours 25 • Adjacent marginal ridges are not compatible in height - drives the debris interproximally.
  26. 26. Dr. Nithin Mathew – Contacts & Contours 26 • Marginal ridges with no triangular fossa, the vertical forces will impact food interproximally.
  27. 27. Dr. Nithin Mathew – Contacts & Contours 27 • Thin marginal ridges will be susceptible to fracture or deformation
  28. 28. Dr. Nithin Mathew – Contacts & Contours 28 • Marginal ridges with no occlusal embrasures, the 2 adjacent marginal ridges will act like a pair of tweezers grasping the food substance passing over it.
  29. 29. Dr. Nithin Mathew – Contacts & Contours Procedures of proper contacts & contours 29 • Intraoral procedures: • Tooth movement • Matricing
  30. 30. Dr. Nithin Mathew – Contacts & Contours Tooth movement 30 • Act of separating the involved teeth from each other, bringing them closer to each other or changing their spatial position in one or more dimensions.
  31. 31. Dr. Nithin Mathew – Contacts & Contours 31 Objectives: • To bring drifted, tilted or rotated teeth to their indicated physiological positions • To close space between teeth not amenable to closure by restoration • To move teeth to another location • To move the teeth occlusally or apically to make them restorable. • To move teeth from a non-functional or traumatically functional location to a physiologically functional one.
  32. 32. Dr. Nithin Mathew – Contacts & Contours 32 • To move teeth to a position so that when restored, they will be in a most esthetically pleasing situation. • To move teeth in a direction and to a location to increase the dimensions of available structure for resistance and retention form. • To create sufficient space for thickness of matrix band.
  33. 33. Dr. Nithin Mathew – Contacts & Contours 33 Tooth Movement Rapid / Immediate Slow / Delayed
  34. 34. Dr. Nithin Mathew – Contacts & Contours Rapid/ Immediate movement 34 • Mechanical type of separation • Creates either proximal separation at the point of separator’s introduction and/or improved closeness of proximal surface of opposite side. Indications: • As preparatory to slow movement • To maintain the space gained by slow movement • Separation shouldn’t exceed the thickness of the involved tooth’s periodontal ligament thickness. ie: 0.2 – 0.5 mm
  35. 35. Dr. Nithin Mathew – Contacts & Contours Methods 35 1. Wedge method • By insertion of a pointed wedge shaped device between the teeth • The more the wedge moves facially or lingualy, greater is the separation.
  36. 36. Dr. Nithin Mathew – Contacts & Contours 36 Elliots separator • Indicated for short duration separation that does not necessitate stabilization • Useful in examining proximal surfaces in final polishing of restored contacts.
  37. 37. Dr. Nithin Mathew – Contacts & Contours 37 Wood/ Plastic Wedges • Used in both tooth separation for preparation and restoration • Triangular shaped wedges (wood/synthetic resin) • Cross-section base of triangle will be in contact with interdental papillae. • Two sides of the triangle should coincide with the corresponding 2 sides of the gingival embrasure. • Apex must coincide with the gingival start of the contact area.
  38. 38. Dr. Nithin Mathew – Contacts & Contours 38 Functions: • Hold the matrix band in position • Slight separation of the tooth • Provides space for placing matrix band • Prevent gingival overhang • Stabilizes matrix and retainer • Assure close adaptability of matrix band to the tooth • Protect interproximal gingiva from unexpected trauma
  39. 39. Dr. Nithin Mathew – Contacts & Contours 39 • Types: • Wooden • Plastic • Elastic • Transparent • Medicated wedges • Shape: • Triangular • Round • Trapezoidal
  40. 40. Dr. Nithin Mathew – Contacts & Contours 40 Wedging method: • Location : Gingival embrasure just beneath the contact area. • Selection : Depending upon the clinical situation. : Wooden wedges can be trimmed using a knife or scalpel blade to produce a custom fit. • Placement : From the lingual embrasure which is normally larger in size. : But if it interferes with the tongue it may be placed from the buccal side. • Length : ½” or 1.3cm so that it does not irritate the tongue or the cheek. • After placement the wedge should be firm and stable.
  41. 41. Dr. Nithin Mathew – Contacts & Contours 41 Wedging techniques 1. Single wedge technique • Single wedge is placed in the gingival embrasure 2. Piggyback wedging • A second wedge is placed on top of the first wedge to wedge adequately the matrix against the margin • Indicated for patients whose interproximal tissue level has receded.
  42. 42. Dr. Nithin Mathew – Contacts & Contours 42 3. Double wedging technique • Here, 2 wedges, one from the facial embrasure and the other from the lingual embrasure are used. • Used when proximal box is wide faciolingually. • Should be used only if the middle 2/3rd of the proximal margins can be adequately wedged.
  43. 43. Dr. Nithin Mathew – Contacts & Contours 43 4. Wedge wedging technique • Used in cases when there is a gingival concavity as in the case of a fluted root. • Inorder to wedge a matrix band tightly against such a margin, a second wedge is inserted between the first wedge and the band.
  44. 44. Dr. Nithin Mathew – Contacts & Contours 44 • Rounded toothpick wedge is usually the wedge of choice with conservative premolar boxes. • Triangular wooden wedges are more recommended since: • Easy to trim and adapt well to tooth surface • When properly shaped, they remain stable during condensation • Absorb moisture and swell to provide adequate stabilisation • Wooden wedges can be cut from toothpicks
  45. 45. Dr. Nithin Mathew – Contacts & Contours 45 Light Transmitting Wedges • Plastic wedges which are transparent and have a light reflecting core. • Used with transparent matrices • Can transmit 90 – 95% of the incident light : drawing the curing light to the gingival margins of the restoration • Provides better marginal adaptation at the cervical area of the class II composite resin restorations
  46. 46. Dr. Nithin Mathew – Contacts & Contours 46 Prewedging • The procedure of inserting a wedge between the interproximal surfaces of two adjacent teeth prior to cutting a cavity involving a proximal wall. Purpose is to achieve some tooth separation such that, after restoration, the teeth will return to their original position and a more positive tooth contact area will be achieved.
  47. 47. Dr. Nithin Mathew – Contacts & Contours 47 Error’s with wedge placement • If wedge is placed more occlusal to the gingival margin, creates abnormal concavity in the proximal surface of the restoration. • If wedge is for apical to gingival margin, band will not be held tightly against the gingival margin & creates gingival overhangs in the restorations. • Tightness of the wedge is tested by pressing the tip of an explorer firmly several points along the middle 2/3rd of the gingival margin against the matrix band.
  48. 48. Dr. Nithin Mathew – Contacts & Contours 48 2. Traction method • Done with mechanical devices which engage the proximal surfaces of the teeth to be separated by means of holding arms. • Non-Interfering true separator • Ferrier double-bow separator
  49. 49. Dr. Nithin Mathew – Contacts & Contours 49 Non-Interfering true separator • Indicated when continuous stabilized separation is required. • Advantage: • Separation can be increased or decreased after stabilization • Device is non-interfering
  50. 50. Dr. Nithin Mathew – Contacts & Contours 50 Procedure: • Apply the jaws closest to the bow against the tooth to be operated upon. • Apply a piece of softened compound to teeth under separator. • A wrench used to move the jaws over the approximating tooth. • The Nut on the facial side moved first until the jaw touches the surface needed, then that of lingual side. • Repeat the adjustment until desired amount obtained.
  51. 51. Dr. Nithin Mathew – Contacts & Contours 51 Ferrier double-bow separator • Separation is stabilized throughout the dental operation. • Advantage : • Separation is shared by the contacting teeth and not at the expense of one tooth
  52. 52. Dr. Nithin Mathew – Contacts & Contours 52 Procedure: • Four arms are adjusted so each will hold a corner of proximal surface of contacting teeth. • Arms will be gingival to contact area. • Wrench applied to labial and lingual to make desired separation.
  53. 53. Dr. Nithin Mathew – Contacts & Contours Slow/ Delayed tooth movement 53 Indications: • When teeth have drifted and/or tilted considerably, rapid movement of the teeth to proper position will endanger the periodontal ligaments. • Therefore slow tooth movement over weeks will allow proper repositioning of teeth in physiological manner. Methods: • Separating wires • Oversized temporaries • Orthodontic appliances
  54. 54. Dr. Nithin Mathew – Contacts & Contours 54 Separating wires • Thin pieces of wire are introduced into the gingival contact area • It is then wrapped around the contact area. • The 2 ends are then twisted together to create separation not to exceed 0.5mm • Wires are tightened periodically to increase the separation.
  55. 55. Dr. Nithin Mathew – Contacts & Contours 55 Oversized temporaries • Resin temporaries are oversized mesio-distally to achieve slow separation • Resin added periodically to increase the amount of separation not to exceed 0.5mm
  56. 56. Dr. Nithin Mathew – Contacts & Contours 56 Orthodontic appliances • Fixed appliances – most effective and predictable method • Removable appliances can also be used – requires longer treatment
  57. 57. Dr. Nithin Mathew – Contacts & Contours Matricing 57 Procedure where a temporary wall is created opposite to the axial walls, surrounding areas of tooth structure that were lost during preparation.
  58. 58. Dr. Nithin Mathew – Contacts & Contours Matricing 58 The matrix should: • Displace the gingiva and rubber dam away from the cavity margins • Assure dryness and non-contamination of the cavity • Provide shape for the restoration during setting of the restorative material • Maintain its shape during hardening of the material • Confine the restorative material within the cavity
  59. 59. Dr. Nithin Mathew – Contacts & Contours 59 Matrix Matrix is a device that is applied to a prepared tooth before the insertion of the restorative material to assist in the development of the appropriate axial tooth contours and inorder to confine the restorative material excess. Primary function of a matrix is to restore the anatomic contours and contact areas.
  60. 60. Dr. Nithin Mathew – Contacts & Contours 60 Parts of a Matrix system involves: • Band • Retainer Matrix Band • Supplied as strips of various dimensions • Thickness of 0.001” or 0.002” • Width may be ¼”, 3/8”, 5/16” or 1/8” • Depending on the height of the proximal surface, suitable size is selected.
  61. 61. Dr. Nithin Mathew – Contacts & Contours 61 Retainer • Device by which a band can be maintained in its designated position and shape. • Can be a mechanical device, dental floss, a metal ring or an impression compound.
  62. 62. Dr. Nithin Mathew – Contacts & Contours 62 Qualities of a good matrix includes: 1. Rigidity 2. Establishment of proper contour 3. Prevention of gingival excess 4. Convenient application 5. Ease of removal 6. Inexpensive
  63. 63. Dr. Nithin Mathew – Contacts & Contours 63 Classification of matrices: 1. Based on mode of retention: i. With retainer (Tofflemire matrix) ii. Without retainer (Automatrix) 2. Based on type of band i. Metallic non transparent ii. Nonmetallic transparent 3. Based on type of cavity for which it is used i. Class I cavity a. Double banded Tofflemire (barton’s matrix)
  64. 64. Dr. Nithin Mathew – Contacts & Contours 64 ii. Class II cavity a. Single banded Tofflemire b. Ivory matrix No. 1 c. Ivory matrix No. 8 d. Copper band matrix e. Automatrix iii. Class III cavity a. Mylar strip b. S-shaped iv. Class IV cavity a. Mylar strip b. Transparent crown form matrix c. Modified S-shaped v. Class V a. Window matrix b. Cervical matrix
  65. 65. Dr. Nithin Mathew – Contacts & Contours 65 Universal Matrix (Tofflemire matrix) • Designed by BR. Tofflemire • Ideally indicated for 3 surface posterior tooth • Commonly used for class II restorations • 2 types: • Straight • Contra-angled
  66. 66. Dr. Nithin Mathew – Contacts & Contours 66 Parts of a Retainer:
  67. 67. Dr. Nithin Mathew – Contacts & Contours 67 Advantages: • Can be placed facially/lingually • Retainer and band are stable when in place • Retainer is separated easily from the band • Retainer helps to hold the cotton roll (for isolation) in place
  68. 68. Dr. Nithin Mathew – Contacts & Contours 68 Matrix bands: 1. Uncontoured bands • Available in 2 thickness : 0.002” and 0.0015” • Burnishing the thinner band to contour is more difficult and less likely to retain contours 2. Precontoured bands • Needs little or no adjustment • Expensive • Difference in cost justified by lesser chair time.
  69. 69. Dr. Nithin Mathew – Contacts & Contours 69 Clinical Technique: Shaping the Matrix • Matrix band - shaped to achieve proper contour and contact • Band is burnished before assembling matrix system • No. 26 – 28 burnisher - recommended • Band is placed on a resilient paper (contouring cannot occur on hard surfaces)
  70. 70. Dr. Nithin Mathew – Contacts & Contours 70 • Small round burnisher used with firm pressure in back-forth motion until the band is deformed occlusogingivally. • After the band is deformed, larger egg shaped end is used to smoothen the burnished band.
  71. 71. Dr. Nithin Mathew – Contacts & Contours 71 Preparing the retainer to receive the band 1. Larger knurled nut is turned counterclockwise until the locking vise is 6mm from the end of retainer. 2. Holding the larger nut, smaller nut is turned counterclockwise until the pointed spindle is free of the slot in the locking vise.
  72. 72. Dr. Nithin Mathew – Contacts & Contours 72 3. Matrix band is folded end to end forming a loop. 4. Band is positioned in the retainer so that the slotted side of the retainer is directed gingivally. The band is placed through the appropriate guide channel depending on the location of the tooth.
  73. 73. Dr. Nithin Mathew – Contacts & Contours 73 5. Two ends of band are placed in the locking vise, smaller nut is turned clockwise to tighten the pointed spindle against the band. Placing the band with retainer on prepared tooth 1. Matrix band is fitted around the tooth ( 1mm apical to the gingival margin) 2. Larger knurled nut is rotated clockwise to tighten the band slightly. After checking gingival margins and band positioned correctly, band is securely tightened. 3. All aspects are checked and wedges are placed.
  74. 74. Dr. Nithin Mathew – Contacts & Contours 74 Removal of the band with retainer 1. Retainer is removed from the band. Matrix is removed only after ensuring hardening of the amalgam. 2. Index finger is placed on occlusal surface to stabilize the band as retainer is removed. 3. No.110 pliers are used to tease the band free from one contact point at a time. A straight occlusal direction should be avoided during matrix removal to prevent breaking of the marginal ridges. 4. Wedge is left in place to provide separation of teeth while matrix band is removed. After that it is removed.
  75. 75. Dr. Nithin Mathew – Contacts & Contours 75 Clinical Application: • Damaging gingival attachment should be avoided • One deeper proximal margin – band is modified (prevent damage to gingiva or attachment on shallow side) • Band may be trimmed for shallow gingival margin • Positioned 1mm apical to gingival margin or deep enough to be engaged by the wedge and 1-2mm above the adjacent marginal ridge.
  76. 76. Dr. Nithin Mathew – Contacts & Contours 76 Ivory Matrix No.1 • Band encircles the posterior proximal surfaces so it is indicated in unilateral class II cavities. • Band is attached to the retainer via a wedge shaped projection. • Adjusting screw at the end of the retainer adapts the band to the proximal contour of the prepared tooth. • As adjusting screw is rotated clockwise, the wedge shaped projections engage tooth at the embrasures of the unprepared proximal surface.
  77. 77. Dr. Nithin Mathew – Contacts & Contours 77 Ivory Matrix No. 8 • Consists of band that encircles the entire crown of the tooth. • Indicated for bilateral class II cavities. • Circumference of the band can be adjusted by adjusting the screw present in the retainer.
  78. 78. Dr. Nithin Mathew – Contacts & Contours 78 Black’s matrices 1. For simple cases recommended for majority of small & medium size cavities • Metallic band is cut so that it will extend only slightly over buccal & lingual extensions of cavity • Held in place by a wire or a dental floss.
  79. 79. Dr. Nithin Mathew – Contacts & Contours 79 2. Blacks matrix with gingival extension • To cover gingival margin of a subgingival cavity • Corners are rounded to prevent wounding the soft tissues. • Held in place by a wire or a dental floss
  80. 80. Dr. Nithin Mathew – Contacts & Contours 80 Copper Band Matrix / Soldered Band • Indicated for badly broken down teeth such as those receiving pin retained amalgam restorations & in complex class II restorations with buccal or lingual extensions • Cylindrical in shape • Band with appropriate dimensions of crown are taken and the 2 ends are soldered.
  81. 81. Dr. Nithin Mathew – Contacts & Contours 81 • With curved scissors, the band is festooned in the cervical region to fit the gingival contour of the tooth. • Then with the contouring pliers, the band is contoured to reproduce the proper shape of the contact areas.
  82. 82. Dr. Nithin Mathew – Contacts & Contours 82 Anatomical Matrix • Most efficient means of reproducing contacts & contours • Hand-made and contoured especially for individual teeth. Procedure: • Stainless steel band (0.001” – 0.002” in thickness) and 1/8 “ in width is drawn between the handle of a pair of festooning scissors. • Band is cut to appropriate length.
  83. 83. Dr. Nithin Mathew – Contacts & Contours 83 • Must extend beyond the cavity margins • Wedge is placed. • Small cones of compound material are warmed and then forced into the buccal and lingual embrasures. • Pressure is maintained until compound has evenly flowed into the buccal and lingual surfaces of adjacent teeth • Staple is heated and forced into the compound in the buccal and lingual embrasures. • Restoration is then placed
  84. 84. Dr. Nithin Mathew – Contacts & Contours 84 Roll in band matrix ( Automatrix) • Retainerless matrix system with 4 types of bands that are designed to fit all teeth regardless of circumference and height. • Types: • 3/16” (4.8mm), 0.002” thickness • 1/4” (6.35mm), 0.002” & 0.0015” thickness • 5/16” (7.79mm), 0.002” thickness
  85. 85. Dr. Nithin Mathew – Contacts & Contours 85 • Advantages: • Convenience • Improved visibility because of absence of retainer • Ability to place the autolock loop on facial/lingual surface • Disadvantages: • Band is flat, difficult to burnish • Sometimes unstable even with the use of wedges • Development of proximal contour is difficult.
  86. 86. Dr. Nithin Mathew – Contacts & Contours 86 S-shaped Matrix Band • For class III, class II and with facial/lingual extensions of class V • Matrix band of 0.001” – 0.002” is used • Mirror handle is used to produce the S-shape in the strip • Strip is contoured in its middle part with contouring pliers to create desired form for the restoration • Compound material is used to hold the band in position in the facial and lingual aspect and also in the gingival aspect.
  87. 87. Dr. Nithin Mathew – Contacts & Contours 87 T-shaped matrix • Premade T-shaped brass/ stainless steel matrix bands • Longer arms of the matrix is bent to encompass the tooth circumferentially and to overlap the short horizontal arm of ‘T’ • This section is then bent over the long arm, loosely holding it in place. • Wedges can be used to stabilize the matrix.
  88. 88. Dr. Nithin Mathew – Contacts & Contours 88 Indications: • Class II cavities involving 1 or both proximal surfaces of a posterior tooth Advantages: • Simple • Inexpensive • Rapid • Easy to apply Disadvantages: • Flimsy in structure and not stable
  89. 89. Dr. Nithin Mathew – Contacts & Contours 89 Mylar Strips • For composite restorations in Class III and Class IV cavities. Procedure • Mylar strip is burnished with the end of an instrument handle to produce a belly. • This produces a normal contour of the proximal surface of the teeth.
  90. 90. Dr. Nithin Mathew – Contacts & Contours 90 • Strip is then cut to place the belly where the contact is desired. • A wedge is trimmed and applied to hold the strip in place.
  91. 91. Dr. Nithin Mathew – Contacts & Contours 91 • Lingual aspect of strip is secured with index finger • Facial portion is reflected away for access. • Following insertion of composite, matrix strip is closed and material is cured through strip.
  92. 92. Dr. Nithin Mathew – Contacts & Contours 92 Aluminium Foil Incisal Corner Matrix • Stock metallic matrices shaped according to proximo-incisal corner and surfaces of anterior teeth. • Cannot be used for light cured resin materials.
  93. 93. Dr. Nithin Mathew – Contacts & Contours 93 Procedure: • A corner matrix closest in size and shape of teeth is selected. • Trimmed gingivally to coincide with gingival architecture and covers gingival margin of preparation. • It is shaped with fingers until it fits mesio-distal and labio-lingual dimensions of tooth. • Wedge is placed • Apply the restorative material • Tighten the wedge and wipe off excess material.
  94. 94. Dr. Nithin Mathew – Contacts & Contours 94 Transparent Crown Form Matrix • Stock plastic crowns • Can be used for light cured resin material • For Class III and Class IV Procedure: • Appropriate size is selected that matches closely with the inciso- gingival dimension of the tooth to be restored. • Trim the crown gingivally to match with the gingival architecture.
  95. 95. Dr. Nithin Mathew – Contacts & Contours 95 • Should be perforated at the incisal angle. • The prepared tooth is partially filled with the restorative material while the matrix is completely filled. • Placed over the prepared tooth surface. • Wedge is tightened • Excess material is wiped off, held under the finger pressure.
  96. 96. Dr. Nithin Mathew – Contacts & Contours 96 • Indications: • Large bilateral/unilateral class IV cavity • Oblique fractures of anterior teeth • Advantages: • Easy to use • Good contours can be established • Disadvantages: • Time consuming • Expensive
  97. 97. Dr. Nithin Mathew – Contacts & Contours 97 Window Matrix • For class V cavities • Formed using either a Tofflemire matrix or copper band. Procedure: • A window is cut slightly smaller than the outline of the cavity. • Wedges are placed, mesially & distally to stabilize the band.
  98. 98. Dr. Nithin Mathew – Contacts & Contours 98 Preformed Transparent Cervical Matrix • For use with light cured resin material or RMGIC • Matrix must be held in place while the restoration is setting • Indications: • Class V restorations with composite or RMGIC • Advantages: • Provides good contour for restorations • Disadvantages: • Expensive
  99. 99. 99
  100. 100. Dr. Nithin Mathew – Contacts & Contours Contact Forming Instruments 100 • These are special instruments designed to create good contacts with posterior composites. • They push the matrix toward the contact area during light curing. Eg: • Contact Pro • Optra contact
  101. 101. Dr. Nithin Mathew – Contacts & Contours Contact Rings 101 • Work by providing slight separation of the contacting teeth. • Spring action applies equal and opposite forces against the teeth thus providing optimum separation. • After separation, the composite is incrementally built and cured in a passive manner. • Finally, the ring is removed and the teeth are brought back into contact.
  102. 102. Dr. Nithin Mathew – Contacts & Contours 102 • According to their evolution, categorized as • First generation systems • Second-generation systems First generation systems • Introduced in the late 1990s Include :- • Palodent Bitine • Contact matrix • Composi-Tight Palodent Bitine Composi-Tight
  103. 103. Dr. Nithin Mathew – Contacts & Contours 103 Palodent BiTine I and BiTine II • First system that was available. • Rings have rectangular tines which are parallel. • Provide optimum separation (0.55 kg/mm). • Lack retentive design because of the parallel tines but are easy to place on wide preparations. • BiTine II is an elongated ring to allow stacking over the main ring in case of MOD preparations.
  104. 104. Dr. Nithin Mathew – Contacts & Contours 104 Contact matrix • These rings have rectangular tines which are converging and hence are more retentive. • Provide optimum separation (0.38 kg/mm). • A reverse ring is available for MOD preparations.
  105. 105. Dr. Nithin Mathew – Contacts & Contours 105 Composi-Tight matrix • Two separate rings are available for premolar and molar teeth. • The rings have converging tines with retentive balls at the end for firmer grip on the teeth. • Omnidirectional. Drawback: • Contacts produced are not so tight (0.27 kg/mm). • Large diameter of the rings can lead to their collapse if used in wide cavities.
  106. 106. Dr. Nithin Mathew – Contacts & Contours 106 Precontoured sectional matrix bands • All these systems rely on precontoured sectional dead soft metal matrices • Available in various shapes, thicknesses and sizes.
  107. 107. Dr. Nithin Mathew – Contacts & Contours 107 Benefits with the Sectional Matrices and Contact Rings • Ease of use and good visibility. • Anatomic contour of the bands ensures optimal contact areas and embrasures. • Less tension on the teeth and greater comfort for the patient • No need for pre-wedging. • Contact dimensions are adequate and in the correct anatomic location. • Gingival adaptation of the restoration is good.
  108. 108. Dr. Nithin Mathew – Contacts & Contours 108 Problems with early contact rings • Ring collapse or displacement in case of wide proximal boxes. • Ring stacking that is, placing one ring over the other in case of MOD restoration is a problem. • Most importantly, since the contact rings are made of stainless steel, repeated usage and sterilization effects make them lose their springiness over time.
  109. 109. Dr. Nithin Mathew – Contacts & Contours 109 Second - Generation Rings Eg:- • Composi-Tight 3D soft face ring system • V3 ring system.
  110. 110. Dr. Nithin Mathew – Contacts & Contours 110 Composi-tight 3D Soft Face Ring System The orange Soft Face 3D-Ring • Used in most circumstances • Ease of placement • Ability to adapt to a wide variety of tooth anatomies while reducing flash and restoring proper contour. The gray thin tine G-Ring • Burnished tine ends • Used where the shape of the dentition makes ring retention more problematic
  111. 111. Dr. Nithin Mathew – Contacts & Contours 111 V3 Ring System • Developed by Dr. Simon McDonald in 2008 • System has two types of rings for bicuspid and molar teeth • Precontoured matrix bands • Special wedge called the ''wave wedge'' to provide optimum gingival adaptation of the matrix band.
  112. 112. Dr. Nithin Mathew – Contacts & Contours 112 It has two major innovations • Fully made of Nickel-Titanium ;imparts more springiness and longevity than stainless steel. • V-shaped plastic tines to accommodate the wedge. • The tines have extra width that enables the ring to contact more tooth structure buccally and lingually.
  113. 113. Dr. Nithin Mathew – Contacts & Contours Fender Wedges 113 • For protection and separation during tooth preparation. • Combination of a steel plate and a plastic wedge. • Inserted into the inter dental space it provides a protector for the tissue and separates the teeth, simplifying the following application of a matrix. • Can be applied buccally or lingually for optimal access and vision.
  114. 114. Dr. Nithin Mathew – Contacts & Contours 114 • Available in four color coded sizes • Should be inserted with firm pressure providing a tight stable fit throughout preparation.
  115. 115. Dr. Nithin Mathew – Contacts & Contours Conclusion 115 • Proper restoration of the anatomical landmarks is important for enhancing the longevity of restorations as well as to maintain the occlusal health and harmony. • Matricing is a vital step during the placement of different restorations. • Selection of the matrix should be based on its ease of use and efficiency to provide the optimum contacts and contours.. • The dentist should select the right method according to the needs of individual case.
  116. 116. Dr. Nithin Mathew – Contacts & Contours References 116 1. Operative Dentistry – MA Marzouk 2. Art & science of operative Dentistry – Sturdevants (5th edition) 3. Art & Science of Operative Dentistry – Sturdevants (South Asian Edition) 4. Textbook Of Operative Dentistry – Vimal K Sikri (1st Edition) 5. Dental Anatomy, Physiology & Occlusion – Wheeler’s (9th Edition) 6. Optimizing tooth form with direct posterior composite restorations JCD Oct-Dec 2011 | Vol 14 | Issue 4
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