Garrison Dental Solutions
150 DeWitt Lane
Spring Lake, MI 49456 USA
Phone: 616.842.2244, ext. 268
Fax: 616.842.2430
bjames@garrisondental.com

Publication date: November/December 1998 (Volume 2, No. 6)

Reprinted with permission.

By John E. Garrison, DDS

Over the last decade there has been a dramatic increase in the use of posterior composite resins. Problems with these restorations were many. The excessive wear, post operative sensitivity, fracture resistance, and marginal and micro leakage problems have largely been resolved. The final hurdle for many clinicians is the difficulty in achieving optimal interproximal contacts.

COMPOSI-TIGHT®
Scores of products exist to address the difficulty of achieving interproximal contacts. One of the easiest and most consistent techniques involves the use of the Composi-Tight® Sectional Matrix System by Garrison Dental Solutions. The system’s three sizes of contoured sectional matrices (.0012" thickness) assure that proximal anatomy can be replicated. Wedging and subsequent placement of the G-Rings® assures additional separation for excellent, anatomical contacts.

G-RINGS®
The G-Ring’s come in two tine lengths, standard and long, with burnished retentive ends, allowing for easy, consistent placement and the ability to stack for an MO.D.

A SECTIONAL MATRIX BAND
A significant factor in achieving excellent, natural contacts is the use of a sectional matrix band. The band segment can be moved into intimate contact with the adjacent tooth without affecting the matrix band placement on the opposite proximal surface. Any system using a single matrix band forming a continuous ring around the tooth will inhibit the consistent achievement of tight, anatomical contacts.

CASE STUDY
A patient presented with posterior amalgam fillings he wished to have replaced.

MO & DO PREPARATION
The amalgams were removed, taking care not to remove excessive tooth structure. The teeth were then stained with Snoop (Pulpdent) caries detector and the caries removed. This is an important step. Most clinicians using caries detector are surprised at the frequency of finding previously undetected caries. It has been said that recurrent decay may not be as prevalent as residual decay.

BAND SELECTION
The M.O. on the second molar and the D.O. on the second bicuspid were then restored simultaneously. The contoured bands were chosen, making sure to pick a band where the occlusal edge would approximate the height of the adjacent marginal ridge. For ease of placement, the contoured band was pre-curled by gently rolling with the fingers and then unfurled into the interproximal.

WEDGES, ETCHING, BONDING, FILLING
Wedges were placed following the placement of each band. The teeth were then etched with 37% phosphoric acid for 15 seconds, bonded (Optibond/Solo/Kerr) and filled with composite (3M Z100). Several excellent products exist for these procedures. Flowable, hybrid and condensable composites all work well.

BAND & WEDGE REMOVAL, POLISHING
The bands and wedges were removed followed by removal of any composite flash with a finishing bur (Brassler E.T.). The proximal surfaces were quickly polished with a finishing strip. The unfilled M.O.D. allowed for excellent access for this purpose. Notice that no rings were used in filling the M.O. or D.O. Using the rings for the M.O. or D.O. in this multiple restoration application would tend to bow the bands into the confines of the M.O.D. preparation. Obviously, this is undesirable. However, when restoring to achieve contact, the rings are always used.

MOD PREPARATION WITH G-RINGS®
The bands were then placed on the mesial and distal of the M.O.D. preparation. Wedges were placed and G-Rings® applied with a rubber dam forceps. The G-Rings provide additional separation above and beyond that of the wedge. The bands were burnished to the proximal surfaces of the previously restored second molar and second bicuspid. The routine of etch, rinse, bond and fill was then performed.

Occlusal adjustment time was significantly reduced by roughing in the anatomy first with a #6 round carbide burr and then with a cone shaped diamond (Bisco Raptor) even prior to the removal of the rubber dam.

ADJUSTMENT, TOUCH UP, POLISH, SEAL
The dam was removed and the occlusion adjusted. The anatomy was touched up, the restoration polished and sealed (Bisco Fortify). Some research has shown that a sealed restoration can result in up to a 60% reduction in first year wear rates.

CONCLUSION
Composite fillings bond intimately to the tooth structure restoring its natural strength, function and beauty. Patients love them! With the Composi-Tight® system, restorations are achieved quickly and easily, with a high level of patient comfort and satisfaction.

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