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Class I I Composite Restorations and Proximal Concavities
Class I I Composite Restorations and Proximal Concavities
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Michael Patras
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Class II Composite
Restorations and Proximal
Concavities: Clinical
Implications and
Management
M Patras ! S Doukoudakis
Clinical Relevance
Proper configuration of the proximal surface of a Class II composite restoration is essential
for the preservation of dental and periodontal tissues and subsequent long-term success.
Adequately customized or designed wedges can assist in reproducing an imitation of
natural form in the interproximal area and ensure sufficient contact tightness with the
adjacent tooth.
Figure 2. Occlusal view of the cavity preparation. Note the existence Figure 4. The insertion of the customized wedge ensures adequate
of a proximal concavity. matrix adaptation.
premolar. A conventional wooden wedge of adequate fit was verified (Figure 4).8 A ring maintained their
dimensions was placed during the preparation of the positions, held the matrix against the tooth surfaces,
cavity (pre-wedging technique) in order to protect and added to the wedge’s separation capacity.6,14
the soft tissues, separate the adjacent teeth, and Subsequent burnishing of the matrix provided
ensure proper proximal contacts.13 During the cavity adequate configuration and contact with the adja-
preparation, special care was given so that the cent tooth.6 The total etch technique was used and
cavosurface margin finished on enamel, in order to the composite (Tetric EvoCeram, Ivoclar Vivadent
minimize the microleakage (Figure 2). Upon com- AG, Liechtenstein) was preheated, then applied by
pletion, a proximal concavity made it impossible for incremental layering and polymerized in a soft-start
the precontoured sectional matrix (Contact Matrix, mode (Figure 5) in order to improve adaptation and
Danville Materials, San Ramon, CA, USA) to reduce shrinkage at the cervical interface.15,16
maintain precise contact with the cavosurface
margin. Therefore, a larger wedge (Kerr, Bioggio, Case 2: Plastic Wave-Wedge
Switzerland) than that needed was selected and A 40-year-old female patient presented to the clinic
customized with a #15 blade in a corresponding with a failing composite restoration that also had
convex shape to accommodate the interproximal clinically unacceptable contours (Figure 6). After a
space (Figure 3).8 rubber dam was placed the old restoration and
After the wedge was inserted in the proximal secondary caries were removed and the outline form
space, securing the matrix in place, proper marginal of the cavity preparation was assessed (Figure 7).
Upon insertion of the conventional wooden wedge a
Figure 6. Preoperative occlusal view of the existing restoration. Figure 9. The Wave-Wedge (Triodent Ltd) in three different, color-
coded sizes.
distortion of the matrix during the insertion of the 7. Scheid RC (2007) Woelfel’s Dental Anatomy: Its Relevance
wedge, as well as the cost of the plastic wedges. to Dentistry, 7th ed Lippincott Williams & Wilkins,
Philadelpia, PA.