Cuñas - Uso Correcto - Style Italiano

GIUSEPPE CHIODERA
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BACK TO BASICS: MIND THE WEDGE
15168 Views - Aug 2017
What do I expect a wedge to do for me?
Well, mainly, posterior direct second class restorations. Those need special recipes. We have to mix good
materials, protocols our skills and experience, and sometimes our fantasy; even if we follow the protocols,
every second class is different from all the others we have done in the past, and the ones we will do in the
future.
I would like to focus our attention on one of the most important points of the chain, the wedge, and try
to answer the former question: what do I expect a wedge to do for me?
1) To CREATE SPACE by properly separating teeth to compensate for the space between the teeth that the
dam and the matrix are going to make me lose.
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www.styleitaliano.org - BACK TO BASICS: MIND THE WEDGE
Img. 1 - The ring is really helpful, but only to make the matrix fit better, the size of the matrix remains to be
compensated.
2) To allow the CERVICAL FIT OF THE MATRIX: this one is a real challenge because we don't want the
wedge to change the matrix shape.
Img. 2 - What I need, is to give the right pressure only in the cervical area (light green). The parts of the
wedge that remain out of this area are not important for the purpose.
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CHOOSING AND USING THE WEDGE CHOICE OF THE PROPER WEDGE SIZE
Img. 3 - Now, what about the choice of the wedge? We should know the size of the wedges and the
proportions between the measurements of the different wedge colors. (In the picture, ex polydentia
wedges)
Img. 4 - Most of the wedges have a rectangular shaped section. Among them, blue and pink in section have
the same height but different widths, yellow and green have the same width but different heights. Only the
white wedge has the same height and width, meaning a square section.
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Img. 5 - Different wedges fill the interdental space in different ways
HOW TO INSERT THE WEDGE
Img. 6 - We want to separate the teeth effectively, but we must analyze the space where we will have to
work first, in order to choose the best wedge insertion.
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Img. 7 - By observing the interdental spaces on the occlusal side, we see that buccal and lingual/palatal
interdental angles may have different shapes and combinations
TRY THE WEDGE
Img. 8 - Try in of the wedges from the buccal side
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Img. 9 - Try in of the wedges from the lingual side. It is important to try both ways because we usually only
use the buccal one, even if in many clinical situations it is better to use the other insertion.
Img. 10 - TIP: Try in of the wedge should be carried out before place the matrix. In this case the wedge from
the lingual side has the better angle to fill the space. This will be our choice.
Img. 11 - Sometimes, even on the same tooth, wedges should be placed differently on the mesial and on the
distal side.
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BUT WHAT SHOULDN'T A WEDGE DO?
Img. 12 - It shouldn't interfere with the curvature of the matrix
Both standing in the way of the wedge, ot it leaning on the margin represents a problem for the future
contact point, both for the margin adaptation of the composite and oral hygiene managment in that area.
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Img. 13 - To open this space it is possible to cut the wedge in a couple ways
Img. 14 - Using a bur outside the mouth
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Img. 15 - Using a blade (#11 is the best) outside the mouth
Img. 16 - TIP: An option is to put the wedge in the interproximal space and then finish the cavity. In this
case, it is important to have a tool to pull the wedge and re-insert it in the same position.
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Img. 17 - This way we will mold our custom wedge for that cavity.
Img. 18 - This is the result: now the matrix can close the space between teeth as the wedge does not
interfere.
Img. 19 - TIP: Another option not to interfere with the matrix is to put the wedge horizontally. It also gives
more pressure than vertically.
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Img. 20 - If the contact point is low and the best matrix concavity is required to give the wall a proper
convexity, it is possible to put the wedge horizontally with the peak oriented in the direction of the cavity;
it will be important to use strips to finish the restoration in the cervical area.
Img. 21 - If the contact point is high you can put the wedge horizontally with the base oriented in the cavity
direction: it makes the matrix fit better and there is a lot of pressure in the cervical area .
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Img. 22 - Finishing the margin while the wedge is horizontally placed: the bur could not touch it.
Img. 23 - It shouldn't drag the dam
We need to control the operating field. We want to protect adhesion procedures from saliva, blood and
breath.
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Img. 24 - To avoid dragging of the dam we can use some liquid soap.
Img. 25 - Or just cut the tip of the wedge, in the area we have seen it is not important to stabilise the
matrix, so the pressure will only be where you need it, and the tip will not drag the dam
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Img. 26 - Same case with the wedge made "shorter"
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Img. 27 - Matrix in place, the wedge pefectly works.
The wedge is a fundamental step to achieve a good second class restoration

Unfortunately it is often put in an automatic way without taking advantage of the real help it can provide.
Dedicate a few seconds to find the best wedge and the best way to use it to really make the difference
between a success and a Success.
It is part of the steps that are needed to get an interproximal wall; it is made from many single easy points
to follow; it is the only case in which many points do not make a line but a point... a contact point .
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Visit: http://www.styleitaliano.org/back-to-basics-mind-the-wedge
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GIUSEPPE CHIODERA

15168 Views - Aug 2017

What do I expect a wedge to do for me?

Img. 5 - Different wedges fill the interdental space in different ways

HOW TO INSERT THE WEDGE

TRY THE WEDGE

Img. 8 - Try in of the wedges from the buccal side

BUT WHAT SHOULDN'T A WEDGE DO?

Img. 12 - It shouldn't interfere with the curvature of the matrix

Img. 14 - Using a bur outside the mouth

Img. 15 - Using a blade (#11 is the best) outside the mouth

Img. 23 - It shouldn't drag the dam

Img. 26 - Same case with the wedge made "shorter"

Img. 27 - Matrix in place, the wedge pefectly works.

The wedge is a fundamental step to achieve a good second class restoration

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