Matrices, retainers, wedge

placement. Separation of the

teeth. The protective role of
liners and bases.
 Separation
 Increasing the spatium interdentale
without preparation
 Should be restore the original anatomy of
the tooth
 Two main form:
-slow
-rapid
 Rapid form
 Never use in
anaethesia because
we need the control
of the patient
 Don’t destroy the
gingiva
 Activate the
instrument, 0.5-
1minute later stop
the streching, than
can we activate
again
Rapid
 With special
instruments Ivory
separator: in a front
region, two wedge
slide on each other
 Eliot separator: on
every tooth similar
than the Ivory
Rapid
 Eliot separator: move
away two tooth from
each other
 Slow
 At least for 24 hours
 Can damage the
papilla
Slow
 Bonwill temporary
filling with hard
guttapercha
 Little bit higher than
the normal occlusal
surface
 2-3-4 days enough
for the swelling
Slow
 Rubber ring around
the contact point
 Stainless steal wire
fix around the
contact point –How
forceps
 At least for 24 hours
 Matrices for two or three
surface restoration
 Need a way to the  The functions
support, form and -restore anatomical contours and
contact areas
necessary
Need:
separation -rigidity
essential for good -establishment of proper anatomical
restorative material cotour
condensation -restoration of proximal contact
relation
-prevention of gingival excess
-convenient application
-easy of removal
Yvory retainer
 For MO or OD cavity
 Ended in two wedges,
which slides side by
side. The wedges
between the gingiva and
the contact point
 Concave surface to
occlusally
 The band form a surface
on cone
 Different size
 Swelling part to
gingivally
 Nyström retainer
 -for MO, OD, MOD
cavity types
 Straight or angled slot
(20-30o)
 Slot size can be: 5-6-
7 mm
 Steriband retainer
 for MO, OD, MOD
cavity types
Universal matrix
 Designed by Tofflemire
for three surface
restoration of posterior
tooth.
 It can be used for two
surface restoration too.
 The retainer may be
positioned on the facial
or lingual aspect of the
tooth.
 Straight or contra-angled
retainer
Bands
 Non contoured
bands available in
two thicknesses:
0.05 mm, 0.038mm
 There is a normal
and a wider form
Bands
 Must be reshaped to
achieve proper
contour and contact
 Precotoured bands
are available and
need little or no
adjustment,
expensive
Bands
Straight retainer
 Slot
 Large knurled nut
 Pointed spindle
 Small knurled nut

 Small size for using

on the primary
dentition
Prepare the retainer to receive
the band
 Turn the larger of the
knurled nuts until the
locking vise is a short
distance from the end
 While holding the large
nut move the small
knurled nut
counterclockwise until
the pointed spindle is
free of the slot
Prepare the retainer to receive
the band
 Fold the band end to
end forming a loop
 Position the band in
the retainer- the
slotted side directed
always gingivally-
placing the occlusal
adge of the band in
the correct guide
channel
Position
 The two end of the
band placed in the
slot of the locking
wise and the smaller
of the knurled nuts is
turned clockwise to
tighten the pointed
spindle against the
band
Tofflemire universal retainer
Position
 Slip the matrix band over
the tooth allowing the
gingival edge of the
band to be positioned
beyond the gingival
margin at least 1mm, but
don’t damage the
gingival attachment. The
larger of the larger
knurled nuts is turned
counterlockwise to
obtain a larger loop.
 Every case check the position with an
explorer.
 The occlusogingival contour should be
convex, contacting the adjacent tooth.
 Wedging
 Inserted between the teeth and against the
matrix
 Seal the gingival margin
 Separate the teeth
 Assure proximal contact
 Push the proximal tissue and rubber dam
gingivally to open the gingival embrassure
 Prewedging
Wedge placement prior to preparation
 Allows greater separation
 More space to build contact (not always
helpful)
Wedge placement
 Break off 1.2 cm of a
toothpick
 Wedging the band tightly
against the tooth and
margin. If the wedge is
occlusal to the gingival
margin the band will be
pressed into the
preparation create
abnormal concavity in
the proximal surface
 Wedge placement
 Improper wedge placement will result in a
gingival excess-overhang-during the
condensation
 The wedge too apical of the gingival margin
will be piggy-backed
 Double wedging is permitted to secure the
matrix when the proximal boksz is wide
faciolingually.
 The wedging action between the teeth
should provide enough separation to
compensate for the tickness of the matrix
band.
 Always check the position and the fixation of
the wedge
Wedge
 Triangular shaped
wedge can be modified
to conform to the
proximaling tooth
contours.
Recommended for deep
gingival margin.
 The anatomic wedge is
preferred for deeply
extended gingival
margin
 Matrix removal
 Following insertion of the amalgam and
carving the occlusal portion remove the
retainer from the band
 Remove the band linguoocclusal
direction- avoid a straight occlusal
direction to prevent breaking the marginal
ridges.
 At last removal the wedge
 Plastic matrix strips
 Cellulose acetate
strips used for resins
 Transparent
 Class III direct tooth
colored restoration
 Simple and
precontoured
 Transparent crown form matrices
 Stock plastic crowns
 Can be adapted to
the tooth anatomy
 Bilateral class IV
restorations - entire
crowns
 Unilateral class IV
restorations - one half
of the crowns
 Liner or base placement
Aim:
 Pulp protection
 Earlier:
-toxic properties of restorative materials
Nowdays:
-Microleakage, bacteria
 Liner or base placement
 Dentinal termal protection– 1-1,5 mm
 against:
 -Heat (amalgam, cast metal inlays)
 -Electrical irritation (amalgam, cast metal
inlays)
 -Chemical agents
 -Mechanical agents
 Liner or base placement
Indications
 Deep cavities
 Beneficial effects on the pulp tissue
 Hard tissue formation (dentinal bridge)
 Closure of dentinal tubuli
 Dentinal remineralisation
 Block out the undercuts
 Expectations
 Good adhesion and marginal seal
 Good mechanical properties
 Groups
Thin film liners – Solution liners (varnishes) and
suspension liners
 -1-50 um thickness
 -dentinal tubuli covering,
 -protection agains chemicals
 Dentin and amalgam bonding systems are becoming
substitutes for liners
Thicker Liners
 -0,2-1 mm thickness
 -calcium-hydroxide cements, GIC
Bases
 -1-2 mm thickness
 -Polycarboxylate cement
 History
 Zinc phosphate cement, resin reinforced
ZOE cement were widely used for bases
before 1960s
 Polycarboxylate cement gained popularity
starting in 1970
 Glass ionomer cements (GIC) became
more popular from 1985 to 1994
 Calcium-hydroxide cements
 Ca and (OH)2 releasing
 Slow dissolution
 Stimulates the formation of reparative dentin
 May degrade severely over long periods of time
- Inadequate mechanical properties
 Self and light cure types
 Low toxicity
 Apply in very thin layer
 Near or actual pulp exposure
 Polycarboxylate cement

 Zinc phosphate cement (zink-oxide)

powder and poliacrilic acid
 poliacrilic acid carboxilate group - tooth Ca
–chemical bonding to the toth structure
 Good mechanical properties
 Mechanical support
 Distribution of local stresses
 Sticky, not easy to manipulate
 ZOE cements
 Release minor quantities of eugenol to act
as an obtundent to the pulp
 Provide thermal isolation
 Eugenol has the potential to inhibit
polymerisation of layers of bonding agent
or composite in contact
 GIC
 Powder: calcium-aluminium-fluor-silicate or stroncium-
aluminium-fluor-silicate
 Fluid: poliakrilic acid, policarbon acid or polialcenic acid
 Acid-base reaction ion releasing (F, Str – Ca, phosphate),
free radical polymerisation
 Chemical bonding to the tooth structure (policarbonic acid
carboxyl group – hydroxiapatite Ca)
 Self and light cure
 Good mechanical strenght
 Hidrophylic properties
 Resin modified GIC (polimerisation shrinkage, allergy, pulp
irritation – remaining monomer. Thickness max 0.5 mm
Dual cure cements.
 GIC
 Fluoride release
 Well controlled setting
 Rapid achivement of strenght