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