Today’s dentist is facing an unprecedented economic challenge. Just five years ago, missing cusps and ultra-wide box forms would call for an indirect restoration. Onlays and full crowns that frequently commanded a hefty insurance co-payment were well within reach of the average patient. The political expression, “it’s the economy stupid”, has dental ramifications that stress even the most avante garde offices.
Enter the ultra large direct composite into the foray. Faced with a box form that is so wide the separating rings regardless of manufacturer crush the lingual or buccal wall of the matrix or both! The tried and true Tofflemeier or Auto Matrix was the only solution especially in those cases where the entire lingual or buccal aspect is missing. A game changing system called ABC Wedge (Absolute Best Contact) is available thru Danville Materials, Inc. of San Ramon, CA, that will greatly simplify this restorative treatment. Truly difficult CL II’s can be transformed into simple CL I’s by these unique winged marvels. Imagine turning the wedge into a bilateral, biomimetic “former” that creates wall support for sectional or Tofflemeier bands. No obtrusive retainer or wound up spool required. Figures 1, 2 and 3 show the unique aspects of the ABC Wedge.
For the sake of clarity, typodont dentition is utilized in Figures 4 through 9. In Figure 4, notice that the entire ML cusp is missing with the distal box form within normal limits. Both the MOL and the DO aspects can be treated with sectional matrices if the ABC wedge is used. If a conventional separating ring such as V3, Garrison or Palodent is used the lingual aspect of the sectional matrix applied to the MOL would be crushed. Figure 5 shows typical sectional matrices sold by Danville Materials. Figure 6 shows the sectional matrices in place with buccal and lingual insertion of the ABC wedges. The entire MOL is supported with the wings. The DO can either have bilateral ABC wedges or one unilateral wedge depending on the width of the box. The wing is required where the box is the widest. Note that in Figure 6 the Mega Ring by Danville are used. The author prefers the gold colored ring because the V formed by the ring fits neatly into the V formed by the union at the mesial and distal aspects of the wings. The silver ring also works as does the Garrison, however forces for separation are greater with the gold Mega RingTM.
Figure 7 shows a tooth with the entire lingual missing. Obviously, there is no sectional band that is long enough to encompass the missing lingual and the box forms. Figure 8 shows a “full contour” Tofflemeier trimmed with scissors so that there is no overlap of the band on the buccal. Figure 9 shows the bilateral support for the Tofflemeier eliminating the need for a retainer. Again, the mesial Mega Ring is placed first and the distal ring is “stacked” after. Note how the “V” of the gold Mega Ring fits neatly into the “V” of the winged wedge. The biomimetic shape of the wings and wedge assure great morphology with little shaping required upon removal of the ABC complex. The doctor can also further shape or contour the wedges to better “clear” a rubber dam clamp or create a broader embrassure.
Figure 10 is an actual clinical case submitted by the inventor, Dr. Marc Gottlieb of Long Island, New York. Note, the wide box form on the buccal aspect after the old amalgam and caries are removed. If the doctor attempted to use a V3, Garrison, Palodent or Mega Ring without the ABC wedge in place, the band would be crushed into the cavity preparation. Figure 11 shows the ABC wedges in place secured by the gold Mega Ring. The biomimetic shape is obvious on the missing buccal cusp area. Figure 12 shows the finished restoration with a broad buccal lingual contact- no lateral food packing possible!
Figure 13 shows the same tooth with the newest Garrison ring crushing the sectional. Figure 14 shows a very wide box form with the ABC Wedge creating a “former” that greatly simplifies the packing of the composite. Figure 15 shows an Auto Matrix in place with a conventional wooden wedge. It is not possible to adequately place a separating ring of any manufacturer in place with the risk of creating an open contact. Figure 16 shows trimming the ABC Wedge wing to accommodate a rubber dam clamp. Figure 17 shows the shaping of the embrassure area of the ABC Wedge to broaden the buccal and lingual wall of the composite. The typodent and clinical photos show the customizable character of these unique wedge/former aids that truly make the Complex CL II a simple CL I.OH
Dr. Roetzer is member of the ADA, AGD, AACD and a Fellow of the International College of Dentists He is currently Vice President/Director of Clinical Affairs for Danville Materials. Oral Health welcomes this original article.
