Class II Composites WITHOUT a Wedge + Contact Opening Technique - PDP188
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- Опубліковано 26 тра 2024
- Class II’s are only easy when they are small (but not too small), supragingival, easily accessible with straight-forward anatomy.
In other words, about 1% of the Class IIs I encounter - because the vast majority I see are subgingival, wide, with awkward root concavities and tricky access.
I went from using sectional matrices 97% of the time to now just using them 30% of the time - this is thanks to a circumferential matrix I started to use last year which is a game changer.
I now do not need to use a wedge in most scenarios (something I used to think was a crime!) and have been using the ‘contact opening technique’.
In this episode, Class II Composites WITHOUT a Wedge + Contact Opening Technique, meet Dr Sunny Sadana, who has brought the Greater Curve system to the UK and taught me a lot about efficiency with direct restorations.
We also discuss fee-setting and patient communication - this part of the video is only available for those on our Protrusive Guidance network. protrusive.app
Protrusive Dental Pearl:
Pre-wedging; use this technique before beginning any restorative work on the tooth you are working on, this will allow a greater field of view to work in. It also helps suppress the papilla to get better access to the caries. This can all be achieved by numbing the area first and wedging with adequate enough pressure for there to be separation. It also reduced iatrogenic damage and is also worthwhile considering using a wedge-guard/fender wedge.
Check out the DRE Composite Course: drecomposite.com/
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If you liked this episode, you will also like PDP104 Back to Back Class II Secrets (Sectional Matrix Troubleshooting) : protrusive.co.uk/104
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Dr Sunny please come to the states and host your greater curve course!!!
My friend, I'm working on it!
Hi Jaz, great content! I have a doubt, will not the greater curve give a very straight profile on the proximals? That is my main reason why i like sectionals because patient will complaint of food stuck on back to back restorations with very straight profiles as it is kind of like a black triangle. Hope to hear from you soon. Cheers.
Hi thanks for your question. My reply seems to have disappeared. I have been working this way for 6 years we now complaints of food packing. So long as I have a good seal, anatomical contact areas and rounded marginal ridges, patients and I are very pleased with the results. If having a round emergence contour is a deal breaker for you, I suggest using the Brass Greater Curve bands which do not bounce back like steel. As a result you an burnish any contour you desire.
Hey Jay, I love the podcast you shared as always. However, I do have a few questions in regards to the Greater Curve technique and I hope you can answer them. When doing multiple restorations, e.g. tooth #16mo, 15mod, 14do, 1) how do you prevent the composite resin restorations from bonding to one another while 'opening the contact point'? do you require the use of teflon? 2) Do you then consume one band for each restoration you do? can they be reused multiple times like the Tofflemire? since the cost of greater curve isn't cheap.
Hi thanks for your question. Few points, it is a very weak bond due to the small surface area in contact. We then simply insert a flat instrument between the teeth and twist, this separates said weak bond. We then use forceps to rotate the band out cleanly. This process does not give any issues and produces very tight contacts.
Jaz you brought up a great point about the importance of burnishing the GC band prior to making the perforation because you could make the perforation too apically (awkward composite extrusion towards the cervical which is indeed a nightmare to clean up). But imagine this: if there is quite a distance between the tooth you're restoring and the adjacent tooth, despite the burnishing, I find that when I perforate a hole at the "right place" this still occurs because the band cannot touch enough of the adjacent tooth to have room for a flat broad contact. so the hole would have open space at the apical portion of the hole. I would love to know how Dr Sunny addresses this particular problem where there is id say more than 1.5mm of distance to cover from your gingival margin to the adjacent tooth contact. Hope this made sense.
Great point doc and a scenario you can experience when the adjacent tooth distance is larger
I will let Sunny answer but the way I often manage these scenarios directly (if that's the most appropriate) is add some flowable to base and then use a probe at base of cavity (it will enter in to the flowable) then angle my probe to stretch the band against the adjacent tooth - then get the DA to cure the flow. Take my probe out and now the situation should look improved
@@protrusive nailed it ala "Flow Hold Technique"
Doc you could also try using the Brass Greater Curve bands, the major benefit is they do not bounce back like steel. So for space closure, posteriorly or anteriorly (black triangle/diastema closure) they are super useful. You'll be surprised at the distance you can span.
Can the greater curve matrices be sent to other countries in Europe?
They can be ordered worldwide
The only disadvantage of greater curve bands is the higher cost.
check our this cost review - based on this it works out quite well: ua-cam.com/video/2zZ7rtehlXU/v-deo.html
It's too bad that new graduates are trained to believe in the superiority of sectional matrices. Greater curve bands are great.
On a mission to change this for our patients and our benefit!
this man has never heard of a hemostat to remove matrices
lol! of course - aka the mosquito forceps