DEPARTMENT OF CONSERVATIVE

DENTISTRY & ENDODONTICS

SEMINAR

ON

CONTACTS AND CONTOURS

SUBMITTED BY

GAYATHRI .P
1ST YEAR MDS

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 CONTENTS

 INTRODUCTION

 DEFINITION

 IDEAL CONTACTS AND CONTOURS

 ROLE OF CONTACTS AND CONTOURS

 CAUSES OF IMPROPER CONTACTS, CONTOURS,

EMBRASSURES, MARGINAL RIDGES

 HAZARDS

 HISTOPATHOLOGY OF THE EFFECTED TISSUES

 PROCEDURES FOR FORMULATION OF PROPER CONTACTS

AND CONTOURS

 CONCLUSION

 REFERENCES

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INTRODUCTION:

Human teeth are designed in such a way that the individual

tooth contributes significantly to its own support as well as collectively
the teeth in the arch support the stomatognathic system. Each tooth
is attached in the alveolar bone socket by fine periodontal fibres.
These fibres act as a cushion and this arrangement relieves the
supporting bone of much responsibility. A break in the continuity of
the tooth contact throws an additional responsibility on the
periodontal membrane and alveolar bone, which they may not be able
to sustain.

From the cariogenic aspect there may be only 20 occlusal

surfaces but there are 60 contacting proximal and 64 facial and
lingual surfaces that are susceptible to decay in the full complement of
teeth.

The key to proper relationships inter-proximally is the contact

area in relation to its location, extent and size while the proper
relationships facially and lingually are the occluso-gingival and mesio-
distal configuration.

The failure to comprehend these relationships will cause not

only premature failure of restorations but also periodontal problems as
well as the carious involvement of adjacent tooth surfaces.

The contacts and contours of each tooth will vary from one
individual to another and from one tooth to another.

The contact area is defined- as the site of actual contact

between two teeth on the mesial and distal surfaces and is erroneously
called a “contact point” (Gillmore). Some authors describe the contact
as a “marble type” of relationship.

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 A positive relationship should exist between the contacts to
resist food impaction and to protect the gingival tissue.

Height of Contour:

Height of contour is the area of greatest circumference on the

facial and lingual surfaces of the tooth.

Tooth contour is very important to the function, stability and

protection of the supporting tissues. These contours divert food over
the free gingival margin and they should be placed in the restoration
for protection of the periodontium.

Gingival Embrasure:

Or inter-proximal space is a triangular space formed by the

contact area of two teeth and the supporting bone. The size of the
embrasure varies with the shape of the contact area and location of the
bony support.

This is a brief description of the general physio-anatomical

features of the normal contact, contour and related structures. These
can be used as guidelines in reproducing contacts and contours in
restorations.

I. Proximal contour, contact areas and related structures.

According to their general shape teeth can be divided into 3

types with each having its own physical characteristics in the contact
area and related structures.

1. Tapering teeth.
2. Square type.
3. Ovoid type.
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 Tapering (wide
Contact crowns and narrow Square (boxed) Ovoid (transitional)
cervices)
1. Between incisors Contact starts at Start at incisal ridge 1. Slightly lingual to
the incisal ridge incisally and in line with the incisal ridge,
incisally and a little it labio-lingually. labio-lingually.
towards the labial,
labio-lingually.
      2. Mesial contacts
start at 1/4 of the
crown inciso-
gingivally.

      3. Distal contacts
start 1/3 to 1/2 of
the crown inciso-
gingivally.

2. Canine 1. Mesial contact at 1. Close to incisal ridges 1. The same as

the incisal ridge. incisally. square type.
  2. Distal contact 2. In line with them labio-  
near the middle. lingually.
  3. Very angular.    
3. Bicuspids 1. Buccal periphery 1. Buccal periphery more 1. Convexity of MR
almost at buccal towards buccal axial carries occlusal
axial angle (buccal angle (buccal third). periphery towards
third) of the tooth. middle third.

  2. Occlusal 2. Occlusal periphery is at 2. Buccal periphery

periphery at the occlusal third. at junction of buccal
junction of occlusal and middle third.
and middle third of
the tooth.
  3. Contact is 3. Short cusps.  
deviated buccally.
  4. Cusps form 1/4 -    
1/3 of the crown.
4. Molars mesial 1. Buccal periphery 1. The same as premolar. Same as bicuspids.
contact almost at the buccal
axial angle of the
tooth.
  2. O-periphery, at 2. Extension lingually  
junction of occlusal stops in the middle third
and middle third of (1-4 mm).
the crown.

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  3. Large cusps.    
5. Molar distal contact 1. Buccal periphery More lingually deviated Buccal periphery in
at the middle third. than the mesial but not to line with the central
the extent of the tapering groove in the
teeth. occlusal surface.

  2. Occlusal    
periphery at the
middle third.
  3. Distal contact fo    
first molar is
variable due to
position of distal
cusps.
6. Embrasures 1. Wide variations. 1. Incisal, lingual occlusal 1. Incisal, buccal,
and buccal embrasures labial and occlusal
are nil. embrasures are
wider and deeper
than the others.

  2. Incisal and labial 2. Gingival embrasures 2. Gingival and

are negligible. are almost not noticeable; lingual are short
if found, they are very and broad.
narrow and flat.

  3. Gingival and 3. Lingual embrasures are  

lingual embrasures very narrow (may be slit)
between anterior and long.
teeth are the widest
and longest in the
mouth.
  4. Buccal    
embrasures are
small.
  5. Lingual    
embrasures are
long, with medium
width.
  6. Gingival    
embrasures
between posterior
teeth are broad and
long.

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II. Marginal Ridges:

It is imperative to have a marginal ridge of proper dimensions i.e.

compatible to the dimension of the occlusal cuspal anatomy, creating a
pronounced adjacent triangular fossa and producing an adjacent
occlusal embrasure. A marginal ridge should always be formed in two
planes bucco-lingually, meeting at a very obtuse angle. This feature is
essential when an opposing functional cusp occludes with the
marginal ridge.

A marginal ridge with these specifications is essential for;

1. The balance of the teeth in the arch.

2. Prevention of food impaction proximally.

3. Protection of the periodontium.

4. Prevention of recurrent and contact decay.

5. For helping in efficient mastication.

III. Facial and Lingual contours and related structures:

In a vertical direction all tooth crowns will exhibit some convex

curvatures occlusal to the cervical line. This curvature is called the
Cervical Ridge.

The curvatures on the labial, buccal and lingual surfaces of all

maxillary teeth and on the buccal surfaces of the mandibular-posterior
teeth will be rather uniform. The average curvature is about 0.5 mm
or less. Mandibular posterior teeth will have a lingual curvature of
approximately 1 mm, with the crest of the curvature at the middle 3 rd
of the crown instead of at the cervical 3 rd (because of lingual inclination
of these teeth). Mandibular anterior teeth have less curvature on the
crown above the cervical line than any other teeth. It is less than 0.5
mm . Canine shows a little more curvature than the central and lateral
incisor.
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 For upper anteriors– The concavities are an essential anterior
determinant for mandibular movement. For upper and lower anteriors
the concavities serve to reduce the tooth bulk from its gingival 3 rd
(Max. bulk) to its incisal 3rd (minimal dimension).

In posterior teeth there will be a mesio-distal convexity,

corresponding to each cusp in the anatomical crown portion of the
tooth. The proper mesio-distal contour of different levels and locations
of the facial and lingual surfaces is vital for the health of the investing
periodontium. A comparison between the contour of the teeth and
periodontium contour mesio-distally will reveal that both contours
should be the same to ensure physiologic movement of the structures
and material.

IV. Hazards of faulty reproduction of physio-anatomical features

of teeth is restorations:

A. Contact size:

Creating a contact that is too broad, bucco-lingually or occluso-

gingivally in addition to changing the tooth anatomy will change the
anatomy of the inter dental col.

The normal “saddle shaped” area will become broadened.

1. As a result the area for the development of incipient periodontal
disease is markedly increased.
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2. The broadened contact produces an inter-dental area that the
patient is less able to clean i.e. increases the area susceptible to
future decay.
3. The microbial plaque develops more readily and as a result the
papillary area becomes inflammed and edematous.
4. Broadening the contact area will of necessity be at the expense of
the dimensions and shapes of the buccal and lingual embrasures.
This usually leads to improper movement or flow of masticated
material, leads to adhesion of debris and possible intraproximal
impaction of that debris.
5. Broadening the contact area could also be at the expense of the
gingival embrasure, so that the restoration could encroach physio-
mechanically on the interdental periodontium predisposing to its
destruction.
Creating a contact that is too narrow bucco-lingually or occluso-
gingivally.
Besides changing the anatomy of the tooth it will allow food to be
impacted vertically and or horizontally on the delicate non-keratinised
epithelial col area, leads to greater susceptibilitiy for microbial plaque
accumulation, predisposes to the same periodontal and caries
problem.
A contact area placed too occlusally will result in a flattened
marginal ridge at the expense of the occlusal embrasure.
A contact area placed too buccally or lingually will result in a
flattened restoration at the expense of the buccal and lingual
embrasures.
A contact area placed too gingivally will increase the depth of the
occlusal embrasures at the expense of the contact areas own size on at
the expense of broadening or impinging upon the interdental col.

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 A loose (open) contact creates continuity of the embrasures with
each other and with the interdental col.

Allow for the impaction of food and the accumulation of bacterial

plaques with accompanying periodontal and caries problems.

Therefore, the proper reproduction of the size and location of

contact areas to imitate the natural dentition is essential for the
success of the treatment and restoration of the proximal surface.

B. Contact Configuration:

Creating a contact area that is flat (deficient convexity) can make

it too broad buccally, lingually, occlusally and or gingivally, on the
other hand, a contact area with excessive convexity will diminish the
extent of the contact area. Both will predispose to the problems of
decay and periodontal destruction.

A concave contact area in a restoration usually occurs in

restoring adjacent restoration with a convex proximal surface. Besides
broadening and miss locating the contact area, the interlocking
between the concavity and adjacent convexity can immobilize the
contacting teeth depriving them of normal stimulating physiologic
movements, resulting in periodontitis and or mechanical breakdown.
In restorations with a concave contact area it is impossible to create
the proper size of marginal ridge or adjacent occlusal anatomy.

C. Contour:

Facial and lingual convexities.

It was previously theorized that the vertical convex curvatures

on the facial and lingual surfaces of teeth hold the gingival under
definite tension and also protect the gingival margin by deflecting food
over the gingival margin, thereby preventing undue frictional irritation
while allowing stimulation of the soft tissues enabling them to keep
their tone.
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 Recently experimental and clinical data do not fully support this
theory. It has been revealed that there is always more inherent danger
in over convex rather than under convex facial and lingual surfaces of
teeth. The over convex curvature can create an undisturbed
environment for the accumulation and growth of cariogenic and plaque
ingredients at the gingival margin, apical to the height of contour.
Additionally, this deprives the free and attached gingiva facially and or
lingually from the massaging effect of the apical components of the
food stream.

Facial and lingual convavities:

Those concavities occlusal to the height of contour, whether they

occur on anterior or posterior teeth are involved in the occlusal static
and dynamic relations as they determine the pathways for mandibular
teeth into and out of centric.

Deficient or mislocated concavities will lead to premature

contacts during mandibular movements, which could inhibit the
physiologic capabilities of these movements. On the other hand
excessive concavities can invite extrusion, rotation or tilting of
occluding cuspal elements into non-physiologic relations with opposing
teeth.

Concavities apical to the height of contour therapeutically or

pathologically exposed are essential for the proper maintenance of the
accompanying new components of the adjacent periodontium and
must be imitated in a restoration. Deficient concavities at these
locations can create restoration overhangs and excessive concavities
decrease the chance for successful plaque control in these extremely
plaque retaining areas.

3. Areas of proximal contour adjacent to the contact area.

In addition to creating a contact area of proper size, location and

configuration it is also essential to restore to a proper contour that
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portion of the proximal surface not involved in the contact. This would
include the areas occlusal, buccal, lingual and gingival to the contact
area.

If not it will lead to restoration overhangs and under hangs,

vertical and horizontal impaction of debris and impingement upon the
adjacent periodontal structures.

D. Marginal Ridge:

In the absence of a marginal ridge force 1 will be directed

towards the proximal surface of the adjacent tooth. 1 H and 2 H, the
horizontal components of forces 1 and 2 will tend to drive the 2 teth
away from each other. Meanwhile the vertical components, 1 V and 2
V, can impact food and other intra oral materials inter-proximally.

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2. Marginal ridge with an exaggerated occlusal embrasures.

Exaggerating the occlusal embrasures will direct forces 1 and 2

towards the adjacent proximal surfaces with the horizontal
components, 1 H and 2 H separating the teeth and the vertical
components 1 V and 2 V driving the debris inter-proximally.

3. Adjacent marginal ridges not compatible in height:

Contraction of a restoration with a marginal ridge higher than

the adjacent. One will allow force A to work on the proximal surface of
the restoration.

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 The horizontal component, AH will drive the restored tooth away
from the contacting tooth and the vertical component will drive debris
inter-proximally. Even in the presence of force B, with its horizontal
component acting on the marginal ridge, there will be some separation
of teeth as the surface hold for force B is too small to counteract that
of force A. By constructing a restoration with a marginal ridge lower
than the adjacent over the same thing will occur, but the major
movement will be in the non-restored tooth.

d. A marginal ridge with no occlusal embrasure:

In this case, the two adjacent marginal ridges will act like a pair
of tweezers grasping food substance passing over it. Although debris
may not be forced inter-proximally, it will be very difficult to remove
once it is trapped.

e. A one-planed marginal ridge in the bucco-lingual direction.

Usually, the facial and lingual inclines of a marginal ridge are

part of the occluding components of the tooth. Therefore, making
them one-planed can create premature contacts during both functional
and static occlusion. A one-planed marginal ridge;

1. Increases the depth of the adjacent triangular fossa magnifying

stress in this area.

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2. Increases the height of the marginal ridge in the center making it
amenable to the adverse effects of the horizontal components of
force.

3. Will deflect the food stream away from normal, proximal

embrasure movements (spill away).

f. A marginal ridge with no triangular fossa.

In this situation there are no occlusal planes in the marginal

ridges for the occlusal forces to act upon, so there are no horizontal
components to drive the teeth towards each other, closing the contact.
Furthermore the vertical forces will tend to impact food inter
proximally.

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g. A thin marginal ridge in its mesio-distal bulk will be susceptible to
fracture or deformation leading to the problems of the previously
mentioned faulty marginal ridge.

h. Marginal ridges not compatible in dimension or location with the

rest of the occluding surface components predisposes to similar
problems.

Procedures for the formulation of proper contacts and contours.

For the proper reproduction with a restorative material of the

previously described physio-anatomical features of teeth, two operative
acts must precede or accompany the restorative procedure, tooth
movement and matricing.

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Tooth movement:

It is the act of either separating the involved teeth from each

other bringing them closer to each other and / or changing their
spatial position in one or more dimensions.

The objectives of tooth movement are:

1. To bring drifted, tilted or rotated teeth to their indicated

physiologic positions as a prerequisite for proper reproduction of
the proximal surfaces in restorative materials.

2. To close space between teeth nor amenable to closure by the

contemplated restoration.

3. To move teeth to another location, so that when restored, they will

be in a position most physiologically acceptable by the
periodontium.

4. To move teeth occlusally (extrusion) or apically (intrusion) in order

to make them restorable.

5. To move teeth from a non-functional or traumatically functional

location to a physiologically functional one.

6. To move teeth to a position so that when restored they will be in

the most esthetically pleasing situation.

7. To move tooth in a direction and to a location to increase the

dimensions of available tooth structure for resistance and retention
forms of the contemplated restoration.

8. To create a space sufficient for the thickness of the matrix band

inter proximally. [This space should be in addition to the
mesiodistal dimension of the restoration not at its expense]. This
is necessary to create a positive, tight contact.

Besides, it can also be used as convenience means for facilitating

access to proximal cavity preparation especially Cl-III preparations.
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  To detect proximal caries.

 To facilitate adequate polishing of the restoration proximal

surfaces and to remove foreign bodies impacted proximally that
are not dislodged by floss or brush
HISTORY:
The first separator was introduced by O.A.Jarvis in 1874. A
number of separators have been developed since then notable among
them are those by Dr.Safford, G.Perry and W.I.Ferrier.
There are two principal methods of tooth movement.
1. Rapid or immediate tooth movement.
2. Slow or delayed tooth movement.
1. Rapid or immediate tooth movement:
This is a mechanical type of separation that creates either
proximal separation at the point of the separator introduction and / or
improved closeness of the proximal surface opposite the point of the
separator’s introduction.
Indications:
1. Preparatory to slow tooth movement.
2. Maintain space gained by slow tooth movement.
This type of tooth movement should not exceed the thickness of
the involved tooth’s periodontal ligament as more separation can tear
these ligaments at one side and crush them at the other. It should not
exceed 0.2 mm to 0.5 mm. Rapid tooth movement can be done by one
of the following methods.
Wedge Method:
1. Separation is accomplished by the insertion of a pointed wedge
shaped device between the teeth. The following are the examples
of these types of separations.

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a. Elliot separator:
Is indicated for short duration separation that does not
necessitate stabilization.
It is useful in examining proximal surfaces or in final polishing
of restored contacts.
b. Wood or Plastic Wedges:
These are triangular shaped wedges usually made of medicated
wood or synthetic resin.
Wedges leading to separation include;
a. Wooden Wedges
b. Metal Wedges
c. Silver Wedges
d. Celluloid or plastic wedges
e. Medicated wood wedges
2. Traction Method:
This is always done with mechanical devices which engage the
proximal surfaces of the teeth to be separated by means of holding
arms.
Examples of the traction method include;
Non-interfering true separator developed by Dr.Harry.
This device is indicated when continuous stabilized separation is
required during the dental operation.
Its advantages are, the separation can be increased or decreased
after stabilization and the device is non-interfering.
Ferrier double-bow separator.
The separation is stabilized throughout the operation. Its
advantage is that the separation is shared by the contacting teeth and
not at the expense of one tooth.
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 Slow or delayed tooth movement.
When teeth have drifted and / or tilted considerably rapid
movement of teeth to the proper position will endanger the periodontal
ligaments. Therefore, slow tooth movement over a period of weeks will
allow the proper repositioning of teeth in a physiologic manner.
Methods:
1. Separating wires.
2. Oversized temporizes
3. Orthodontic appliances
4. Wood
5. Rubber
6. Base plate
7. Gutta-percha
8. Copper wire
After repositioning of teeth by any of the afore mentioned delayed
tooth movement techniques, it is necessary to use one or more of the
immediate tooth movement techniques just before or during the
restoration fabrication to create space and to compensate for the
thickness of the band materials, if a proximal matrix is involved.
Matrix:
The matrix is derived from the Latin work “Mater” which means
mother. It was introduced in the year 1871 by Dr.Louis Jack.
The matrix is a device used to contour a restoration to simulate
that of a tooth structure, which it is replacing.
Evolution of matrices:
Early matrices:
The early advocates of contoured fillings included W.H.Atkinson,
M.H.Webb and S.H.Guilford.
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 They recognized that to fill a prepared cavity and produce a
contoured filling the practitioner required assistance in containing the
filling material. The assistance came in the form of a matrix, which
provided for the missing walls of the prepared tooth.
The original matrix is the 1st matrix used. It was introduced by
Dwinello (1855). The matrix consisted of a band made from a broad,
thin piece of dense gold.
Improvements on the original matrix:
With the new concept of contoured fillings, the matrix took on
added significance.
Jack matrix introduced in 1871 was accepted as the 1 st matrix to
satisfy the concept of contoured fillings.
The others included the Huey, Perry and Brunton matrices. As a
group, these matrices used various materials of unspecified thickness
for the band.
The materials included steel, platinum plate or foil, brass,
copper, Phosphor bronze,german bronze,silver and tin. Few of these
were precontoured.
Classification:
They can be classified in two ways:
1. Based on mode of retention
a. Mechanically retained matrices.
b. Self retained.
2. Based on transparency
a. Non-transparent
b. Transparent
Matricing:
Matricing is the procedure whereby a temporary wall is created
opposite to the axial walls, surrounding areas of tooth structure that
were lost during preparation.

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 It is used with restorative materials that were introduced in the
plastic state.
The matrix should have the following qualities.
1. The matrix should be easy to apply and remove without altering
the tooth or the restoration.
The matrix wall should possess the exact 3-dimensional contour of
the future restoration.
2. The proximal contour should be reproduced with minimal carving.
3. The strip should be fine enough to allow firmness and contour in
the contact area.
4. The matrix should control the gingival extrusion of the alloy and
accept the wedge for rigidity and control.
5. The material should not be costly and should be reusable.
6. It should be immobile during the setting of the restorative material
and also it should not react with or adhere to the restorative
material.
The matrix is always formed of 2 parts.
The band which is a piece of metal or polymeric material used to
support and give form to the restorative material during its
introduction and hardening and the retainer, which is a device by
which the band can be retained in its designated position and shape.
The retainer could be a mechanical device, a wire, dental floors and /
or compound.
Matrices are commonly supplied as strips of different
dimensions.
They may be 0.001 (0.25 mm) or 0.002 (0.05 mm) thick. The
width of the matrix band may be 1/4, 3/8, 5/16 or 1/8. They are also
supplied as crown forms, split crown forms, hollow cylinders, and
curved bands with one or more cervical extension.
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Objectives of Matrix:
The objective should:
1. Displace the gingival and rubber dam away from the cavity
margins during introduction of the restorative material. This will
assure maximum wetting and adaptation of the restorative
material to the preparation details.
2. Assure dryness and non-contamination of the details and the
space to be covered with and occupied by the setting restorative
material.
3. Provide shape for the restoration during setting of the restorative
material i.e. the hand materials should be unyielding to the
energies of insertion.
4. Maintain its shape during hardening of the material.
5. Confine the restorative material within the cavity preparation and
pre-determined surface configuration. Therefore, the matrix
should provide a temporary wall of resistance during introduction
of the restorative material. It should also resist and compensate
for the dimensional change in the material during its setting by
applying a positive pressure against it at this stage.
Types of matrix:
Matrices for class-II cavity preparation universal matrix.
The universal matrix system designed by B.M.Tofflemire is
ideally indicated when three surfaces of a posterior tooth have been
prepared (mesial, occlusal, distal) of a posterior tooth have been
prepared. It is commonly used for the two surface class-II
restorations. A definite advantage of the tofflemire matrix retainer is
that it may be positioned on the facial and / or lingual aspect of the
tooth. Lingual positioning however requires the contra-angled design
of the retainer even though the universal retainer is a versatile
instrument it does not meet all the requirements of the ideal retainer
and band. Proximal surfaces restored using the tofflemire band may
require more carving than those restored with the compound
supported matrix.
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 Pre-contoured bands for universal retainer are available
commercially and need little or no adjustment before placing in the
retainer. Although they are more expensive the difference in cost
seems justified because they require less chair side time.
The non-contoured bands are available in two thickness 0.002
(0.05 mm) and 0.0015 (0.38 mm). Burnishing the thinner band to
contour is more difficult.
The junction of the retainer and the hand should be located next
to unprepared intact tooth surface to insure its stability and prevent
unnecessary accumulation of excessive restoration material.
Ivory matrix No.1:
The hand encircles a posterior proximal surface so it is indicated
in unilateral class-II cavities. The hand is attached to the retainer via
a wedge-shaped projection, which engages with the tooth embrasures
of the unprepared surface.
Ivory Matrix No.8:
The band encircles the entire crown of the tooth, so it is
indicated for bilateral class-II cavities.
Soldered band or seamless copper band matrix indicated for
badly broken down teeth, especially those receiving pin retained
amalgam restoration with large buccal and lingual ext.
Auto-matrix (L.D.Chauk Company)
The automation is a retainer less matrix system with four types
of bands designed to fit all teeth regardless of circumference. The
hands vary in height from 3/16 to 5/66 inch and are supplied in two
thicknesses, 0.015 inch and 0.02 inch. The indicated use of this
matrix is for extensive class-II preparation, especially those replacing
two or more cusps.
Advantage: The auto lock loop can be positioned either on the facial
or lingual surface with equal ease.
Dis-advantage: The bands and not pre-contoured and dev. of
physiological proximal contour is difficult.

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S-shaped matrix band.
T-shaped matrix band.
Matrices for a cavity preparation for amalgam restoration on the
distal of the cuspid.
S-shaped matrix band.
T-shaped matrix band.
Matrices for class-II direct tooth coloured restoration.
These are usually transparent plastic matrix strips. For silicate
cement they are usually celluloid strips and for resins they are
cellophane strips. Mylar material may be used for both.
Matrices for class-II preparation for direct tooth coloured
material.
 Plastic strip for incise proximal cavities.
 Aluminium foil.
 Transparent crown forms matrices.
 Anatomic matrix.
 Modified S-shaped band.
Matrices for class-II amalgam restoration.
They are usually not indicated except for very wide cavities
occluso gingivally or / and mesiodistally.
Window matrix:
This matrix is formed using either a tofflemire matrix or a copper
band matrix.
S-shaped matrix:
Matrices for class-V preparation for direct tooth coloured
restorations.
a. Anatomic matrix for non-light cured direct tooth coloured material.
b. Aluminium or copper collars.
c. Anatomic matrix for light cured direct tooth coloured material.

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 Anatomic matrix for non-light cured direct tooth coloured
matrix.
Procedure:
The class-V cavity may be filled with inlay wax or gutta percha
and trimmed to the proper contour. The wax and the tooth are then
coated with cocoa butter on Mylar strip and compound expression is
taken of the tooth surface to the restored. Adjacent surfaces are to be
included in the impression. After the compound has cooled it is
removed and the wax is removed from the cavity.
A mix of the restoration material is made and placed into the
cavity and the compound matrix is placed into position and held
securely in place until the material sets.
Matrix retainers:
Matrix retainers are gadgets used to retain the matrix bands in
position. Some matrices do not need any special mechanical devices to
hold them in position. Some matrices could be simple retainers like
wires, silk thread, dental flors and impression compound. Some
matrices need special mechanical retainers.
Mechanical retainers: Various types of mechanical retainers used are
as follows:
a. Nystrom’s retainer.
b. Ivory matrix I & 8.
c. Steele’s siqveland self-adjusting matrix clamp.
d. The Tofflemire Universal Dental matrix band retainer.
Wedges:
Wedges are the 3rd component of the matrix system.
Wedges serve the following purposes:
 Prevents surplus amalgam being forced into the gingival crevice.
 Assists in contouring the cervical part of the proximal surface.

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 Separates the teeth to compensate for the thickness of the matrix
band such that a proximal contact is reestablished when the band
is removed.
 Produce temporary homeostasis and minimizes moisture
contamination in the area of restoration.
 Stabilize the matrix.
 Protect the inter-proximal gingival from unexpected trauma.
Wedges are made of wood or plastic. Wooden wedges are
preferred because;

 They are easy to trim with a scalpel and they adapt well to the tooth
surface.

 When properly shaped they remain stable during condensation.

 Wooden wedges can be cut from toothpicks.

In general, a wedge must be triangular or trapezoidal in cross

section. The width of the base should be slightly larger than the space
between the tooth to be restored and the neighbouring tooth in order
to separate the teeth.

Classification of Wedges:

I. According to the material

Wood – e.g. Orangewood
Plastic
Metallic – Silver wedges (Messing 1900)
II. Preformed
Custom-made (according to the situation)
III. Medicated – Hemo wedge
Non-medicated – Orangewood
IV. Synthetic – resins, metal, light transmitting plastic wedges.
Natural – Wood

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 Occlusally however the wedges must not be too thick as this may
influence to proximal contour.
If the wedge is not high enough only point contact between the
wedge and the band is achieve. This may lead to poor contour or
displacement of the wedge during condensation. This may had to poor
contour or displacement of the wedge during condensation.
Loss of contact point may occur if the cross-sectional height of
the wedge is too large. A uniform tapering of the wedge is needed in
order to render sufficient and even contact throughout the proximal
embrasure.
They should be approximately 9 mm in length for anterior teeth
and 1.2 cm for posterior teeth. The wedging action between the teeth
should provide enough separation to compensate for the thickness of
the matrix band. This will ensure a positive contact relationship after
the matrix is removed following the condensation and initial carving of
the amalgam.
Wedge placement:
Insert the pointed tip from the facial, lingual embrasure,
whichever is larger slightly gingival to the gingival margin.
If the wedge is significantly apical to the gingival margin, a
second usually smaller wedge may be “piggy-backed” on the 1 st to
wedge adequately the matrix against the margin. “Piggy-back” wedging
is particularly useful in patients with recession of inter-proximal tissue
level.
Occasionally ‘double-wedging’ is permitted if access allows
securing the matrix when the proximal box is wide facio-lingually.
Double wedging refers to inserting two wedges one from the lingual
and a second from the facial embrasure.

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 Occasionally a concavity may be present on the proximal surface
gingivally of the contact and extending as fluting on the root. To wedge
a matrix band tight against such a margin, a second pointed wedge
can be inserted between the 1st wedge and the band by ‘wedge
wedging.’
Evaluation of different matrix techniques:
It is clear that no matrix technique is capable of the exact
replication of normal anatomic contour of restored teeth overall, the
anatomic matrix procedure most closely reproduces normal tooth
contours. Wedging is universally imperative in order to eliminate
cervical flash of restorative material.
Although matrix contouring in the absence of wedging produces
a more rounded contour especially on square type teeth it does not
reduce cervical overhangs with tapering type teeth an accurate
reproduction of the proximal surface can be achieved without
contouring (i.e. using wedging alone). Ovoid teeth are the most
difficult to reproduce.
Too many human variables come into play in trying to trim
overhangs and to change proximal contours after removal of a matrix.
Of clinical significance is the fact that circumferential matrix
bands retained by tightening devices (e.g. tofflemire) have been shown
to elastically deform tooth structures. Immediately after removal of the
matrix band, tooth structures then regain their original dimension
resulting gaps between the tooth and the hardened restorative
material. These gaps may range from 11.4 to 25 microns. The width
of this gap is directly proportional to the width of the preparation, the
pressure applied with the matrix and postoperative contraction of the
particular restorative material used.
Passively inserted matrix bands, like anatomic matrix and T-
shaped bands etc. have no deformative effect on the remaining tooth
structure.

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II. Extra Oral Procedures:

Contacts and contours are better maintained by the extra oral

procedures because of better access and visibility.

1. Wax Patterns:

This is usually built in a slightly overcontoured condition,

especially at the contact area to allow for the finishing and polishing

surface losses.

Yuodelis et al. (1973) demonstrated that the greater the amount

of facal and lingual bulge of an artificial crown the more the plaque

retained at the cervical margin. In a review of periodontal-prosthetic

interactions, Becker and Kaldahl (1981) gave an opinion that buccal

and lingual crown contours should be flat and not fat usually <0.5mm

wider than the CEJ.

Undercontouring than overcontouring of interproximal

restorations is preferred and to place contact areas as far occlusally as

possible and furthermore to make pontics narrow in order to facilitate

access for interproximal plaque control as well as ample space for the

interdental papilla.

In a patient whose gingival margins are apical to the

cementoenamel junction, the sulcular morphology differs from that of

a healthy patient whose gingival margins on enamel.

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 Wagman has estimated the angle of enamel flare from the CEJ to

the vertical axis of the gingival housing to be approximately 22.5.

As the gingival margin progresses more apically, the sulcus

narrows and the intracrevicular contours of the tooth become the flat

contours of the root rather than the convex surface of the anatomic

crown. In this situation the intracrevicular contours of the artificial

crown do not mimic the root but depend on the adjacent gingival

morphology.

Thin gingival responds to irritation by receeding and thick

gingiva enlarges, forms pockets or both.

When intracrevicular margins are adjacent to thin gingiva on the

root, the sulcular contours of the artificial crown should be flat,

mimicking the shape of the root to prevent overcontouring. In the

anterior region, the normal facial contours are reestablished for

esthetics, but this flare of the crown is far away from the gingival

margin to avoid plaque accumulation.

Thin gingiva-root relationship with flat emergence of the root

from the gingiva. The same emergence angle reproduced in the

artificial crown. Enamel bulge is added supragingival.

The gingiva adjacent to the flat root surface develops thick free

gingival margin when the underlying bone is thick and often presents
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with a slight, chronic marginal gingivitis despite of minimal plaque

accumulation. In these situations it may be advisable to create a

thicker intracrevicular crown similar to that of a natural crown.

Thick gigniva-root relationship with a natural crown and the

artificial crown incorporating the average enamel bulge angle to

support the thick gingiva.

In some cases even the dental floss is incapable of removing

plaque from the concave surfaces, so artificial crown contours and

solder joints are created to accommodate the passage of floss,

otherwise gingivitis or periodontitis may result because of the inability

to clean.

2. Cast adjustments:

These are usually done with rubbergy stones incrementally

removing cast material surface wise to obtain the exact dimensions,

configuration and interrelationship of the contact and contour. It is

partly done on the working models and partly or finally intraorally.

CONCLUSION:

Proper reproduction of the size and location of the contact areas

to imitate the natural dentition is essential for the success of treatment

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and the restoration of proximal surface. The health of the periodontal

tissues is dependent on properly designed restorations. Overhanging

restorations and open interproximal contacts should be addressed and

remedied during the disease control phase of periodontal therapy.

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REFERENCES:

 Dental Anatomy, Physiology, Occlusion – Wheeler’s. 5th edition.

 Art and Science of Operative Dentistry – Sturdevant. 4th edition.

 Operative Dentistry – Modern Theory and Practice – M.A. Marzouk.

1st edition.

 A Text Book of Operative Dentistry – McGhree. 4th edition.

 Advanced Operative Dentistry – Baratieri. 2nd edition.

 Text Book of Operative Dentistry – Vimal K. Sikri. 1st edition.

 Operative Dentistry – Gillmore. 4th edition.

 Fundamentals of Fixed Prosthodontics – Shillngbur__. 3rd edition.

 Theory and Practice of Fixed Prosthodontics – Tylman. 8th edition.

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