The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Original Title
Matrices / orthodontic courses by Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses
in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses. for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
In the late 1800s the need for a matrix became apparent
when dentists recognized that the best way to treat a tooth affected by dental caries on the approximal surfaces was by restoring its anatomical contour and contacts with adjacent tooth. The matrix was needed to proide the missing wall or walls and thus contain the restoratie material during the filling of the prepared caity. !ntil the late 1800s" the rationale for treating carious lesions on the approximal surfaces of teeth was based on either a restoratie or a prophylactic concept. EARLY CONCEPTS OF TREATING APPROXIMAL CARIES Restorative concept The rationale for restoratie treatment was to remoe the caries and fill the caity with a suitable material. #t this time" howeer" restoration of the tooth to form and function was not of general concern. Proph!actic concept The rationale for prophylactic treatment was premised on an early theory of caries" which taught that caries began at the point of contact between the teeth where pressure damaged the enamel $ the lesion being caused by the action of external corrosie agents. 1 The method adocated the creation of a self $ cleansing space by remoing diseased or healthy tooth structure from the approximal surfaces" thereby achieing total and permanent separation of teeth. The self $ cleansing space was indicated for the preention of caries" for the treatment of superficial caries" and to proide access to deep caries. The procedure was accomplished by the use of a file" the oldest method of remoing tooth structure. The procedure as described by %#&&I'(18)8* re+uired the remoal of one $ third or more of the tooth and created a shoulder at the cerical margin to maintain contact in this area and preent the teeth from drifting. In the posterior regions" the separation was referred to a , $ shaped space. If the teeth re+uired restorations" they were designed so as not to encroach on the space created. -en with these improements howeer" the results obsered by the general practitioner led to condemnation of the procedure by the profession at large. The main criticism of this techni+ue" oiced by patients and the practitioners and patients ali.e" concerned the disfigurement of teeth. /ot only did patients complain of disfigured teeth" they also complained of impaction of food on the gingiae and sensitiity of teeth due to exposed dentin. 2 0y 1881" the techni+ue was contraindicated. CONTOURED FILLINGS #round 1820" practitioners changed the way they restored teeth that had approximal lesions. The concept was premised on a new theory of caries" which taught the caries began below" not at the contact point of the teeth as with the early theory of caries(3I44-& 120)* and adocated the restoration of the natural" or original contour and contact of the tooth. #s such a contoured filling 1. 5ould reestablish the proper form of the inter $ proximal space 2. 3aintain the function of the teeth 3. -nsure no breach in the continuity of the occlural aspect of the dention. 4. 3aintain the length of the arch 5. 6reent impaction of food 6. 3aintain and promate the health of the gingiae as well as the comfort of the patient Thus 04#78(1820* brought a new and different meaning to the 9, $ shaped space . #n additional concept introduced 3 concurrently prescribed extending the margins of the approximal surfaces of the caity on to facial and lingual surfaces of the tooth. This concept not only facilitated the placement of contoured fillings" but also placed the caity margins within the range of protectie influences" reducing the possibility of recurrent caries. EARLY MATRICES The early adocates of contoured fillings included 5. % #t.inson" 3 .% 5-00 and '.% :!I4;<&=. They recognized that to fill a prepared caity and produce a contoured filling the practitioner re+uired assistance in containing the filling material without such assistance " oer contour at the cerical leel and under contour at the occlusal leel resulted. The assistance came in the form of a matrix" which proided for the missing walls of the prepared tooth and transformed a caity of two" three or more surfaces into a simple one. In addition the matrix could be molded to assist in re$ establishing the natural contours of the tooth. -arly in its use" the matrix was subject to criticism. 'ome belieed that when a tooth was to be restored with direct filling gold" the matrix did not allow for enough contour of gold to compensate for the subse+uent polishing and adapted too closely to the 4 margins" thus proiding the potential for inade+uate condensation of gold in these areas especially at the cerical area. ORIGINAL MATRIX 1. >#78 3#T&I? 2. %!-@ 3#T&I? 3. 6-&&@ 3#T&I? 4. 0&!/T</ 3#T&I? (A) CUSTOM MATRICES I. Anato"ic "atrices II# Tie $an% "atri& III# Contin'o's !oop "atri& 1.'hellac matrix 6erry matrix %erbst A.%erbst matrix 7lapp matrix /ew.ir. modifi B.%utchinson matrix ;illebrown matrix 'oldred matrix ).%and matrix 0lac. matrix 'pot welded C.5oodward matrix #ndrews matrix Tinners joint D.&ubber matrices 0a.er matrix 5elded circumferential (i) =anforth matrix #bernethy matrix &iet matrix (ii) adapto matrix %allenbac. matrix 7ollar E band modification 1.'weeny matrix 3ar.ley modification %arrison 5 8.Ingraham $ $$$$$matrix %ampson modification 7opper band 2.'ectional matrix with 6inch band 0i$ ting ring 10.<pen face matrix (B) MATRICES (IT) RETAINERS #lthough the early matrices were intended for use with direct filling golds" these matrices were also recommended for use with amalgam which has been introduced to #merica in 18B0s. 0ecause of its plasticity amalgam re+uired a matrix for the condensation and deelopment of proper physical properties" contour and inter proximal contact. T)E ORIGINAL MATRIX The first recorded use of a matrix is of that introduced by =5I/-44-(18CC*. The matrix consisted of a band made from a broad" thin piece of dense gold. The band was wedged firmly against the tooth. %oweer it was opened against the cerical margin of the caity of the preparation to allow space for condensation of excess gold. #lthough his own personal testimony and that of his peers (0rophy 188D " >ac. 1881* point =winelle as the originator of the matrix. 4ater" the original matrix was described as the metal band that was wedged against and supported by the adjacent tooth" but was not attributed to any one inentor. 6 IMPRO*EMENTS ON T)E ORIGINAL MATRIX 5ith the new concept of contoured fillings" the matrix too. on added significance. The earliest matrices incorporating the new concepts appeared in the late 1800s and included the >#78" %!-@" 6-&&@ and 0&!/T</ 3#T&I7-'. #s a group" these matrices used arious materials of unspecified thic.ness for the band. The materials included steel" platinum plate or foil" brass" copper" phosphor $ bronze" :erman siler and tin. ;ew of these bands were precontoured. +AC, MATRIX >ac. matrix introduced in 1811" was accepted as the first matrix to satisfy the concept of contoured fillings. The matrix consisted of a slight wedge shaped piece of steel hollowed out to create a depression on its face to correspond to the desired contour. The band was made in assorted sizes and shapes and was put into place with forceps" the #djacent tooth used for retention. The band was then wedged with a boxwood wedge. MATRICING 7 3atricing is the procedure whereby a temporary wall is created opposite to the axial walls surrounding areas of tooth structure that were lost during tooth preparation. It is used with restoratie materials that are introduced in a plastic state. O-+ECTI*ES The matrix should 1. =isplace the gingiae and rubber dam away from the caity margins during introduction of the restoratie material. 2. #ssure dryness and non$contamination of the details and the space to be coered with and occupied by the setting restoratie material. 3. 6roide shape of the restoration during the setting of the restoratie material i.e band materials should be unyielding to the enregies of insertion. 4. 3aintain shape during the hardening of the materila. 5. 7onfine the restoratie material within the caity proparation and predetermined surface configration. MATRICES FOR CLASS I CA*ITY PREPARATIONS =ouble banded Toffelmire for class I. 8 Turn the large ice moing .nob until the slotted ice is about F inch from the inner end of the retainer. 4oosen the screw until its painted end is clear of the slotted ice. 3a.e a loop out of the uniersal band creating an edge with a narrow circumference. The narrow circumference is placed gingially and the wide circumference edge is placed occlusal. The free ends of the band are inserted into the ice while the looped end of the band extends away from the retainer. #lways be sure the slotted end of the ice is facing gingially. This will facilitate easy occlusal remoal of the retainer. Tighten the ice screw to loc. the band in the ice. :uide the looped end of the band gently oer the tooth. The size of the loop may be increased or decreased by turning the ice moing .nob. 5ith the band in position around the tooth" tighten the ice moing .nob. Ideally the retainer should be parallel and adjacent to the facial surfaces of the +uadrant of the teeth being operated on. #n additional small piece of matrix band material is that contoured to the facial or lingual axial configuration of the contemplated restoration and inserted between the tooth and the 9 preiously positioned and retained matrix in the area of the facial or lingual extension of the caity preparation. This piece of material should oerlap oer the margins of the extension by about 1.C $ Amm circumferentially. 5ith a beaer$tail burnisher" create a separation between the two bands. 'elect a wedge that will create and maintain the proper separation between the two bands and thereby enable the formation of the proper contour facially and E or lingually. 7oer the wedges with softened compounds and insert it between the two bands and cool to harden. MATRICES FOR CLASS II CA*ITY PREPARATIONS a) SINGLE.-ANDED TOFFELMIRE FOR CLASS II This is the most practical matrix for class II caity preparations. Its use is made uniersal by the easy application and remoal of the band to and from its holder without disturbing the condensed material. PROCEDURE The basic steps are repeated from the preiously described double banded arrangement. 10 If the caity preparation inoles one proximal surface only and there is a substantial difference between the heights of the interproximal gingia on the mesial and distal sides of the tooth" the matrix band should be trimmed so that it is narrower on the side where the interproximal gingia is more occlurally located. It may also be possible to use matrix bands with only one gingial projection" which should coincide with the proximal side where the interproximal gingia is more apically located. If the gingial extension of the proximal portion of the caity preparation is more apically located than gingial lines facially and lingually" there is a danger of cutting the gingial tissues facially and lingually in using a band with a straight gingial edge. In this situation it is necessary to reduce the occlusal $ apical width of the band facially and lingually or to use a band with apical projections which coincide and coer the gingial extension of the proximal portion of the caity preparation. In preparation with subgingial margins" especially at the axial angles or any surface protrusion of the tooth" the edges of the band occasionally encounter the gingial margin and become bent inward" preenting further seating of the band. ;or this reason there should be unprepared" exposed tooth surface apical to the gingial margin of the preparation to support the band in its apical path and to preent its inward collapse or bending. This may necessitate gingial retraction or cutting. 11 #lso in these situations" the band edges should be guided in their apical path by placing a flat $ bladed" blunt instrument between the band and the adjacent unprepared tooth surface apical to the gingial margin. #lthough it is preferable to put the retainer in the buccal estibule" parallel to the adjacent teeth" sometimes" due to shallow sulcus or sizable buccal inolement of the tooth in a actiity preparation" the retainer is placed on the lingual. This usually necessitates a contrangled retainer. %oweer a retainer should neer be located at right angle to the facial or lingual surfaces of the teeth operated upon as this will drastically change the occluso$apical contour of the band. #s soon as the band is in place and all caity margins can be seen inside the matrix" a wedge" comparable to the dimensions of the future gingial embrassure is chosen and tied(always from the opposite side of the retainer attachment*. !sing a ball burnisher from within the caity preparation" shape the matrix material to create the out line of the contact and contour of the future restoration. If the caity has buccal or lingual extension" repeat the modifying steps in the double$banded Toffelmire application. ;or all Toffelmire applications" after the insertion and initial hardening and manipulation of the restoratie material" the wedges 12 and secondary band are remoed. Then the retainer is loosened and disengaged. The primary band is bent against adjacent tooth surfaces and remoed from between the teeth in an occlusal direction" while being pressed against the adjacent tooth. If the contact area is extremely tight and the band is resistant to remoal" it is a good idea to cut the band on the opposite side of the retainer" remoe the roughened portion of the band and then pull it buccal$lingually with pressure against the adjacent tooth. b) I*ORY MATRIX NO#/ The band encircles a posterior proximal surface so it is indicated in unilateral class II caities. c) I*ORY MATRIX NO#0 The band encircles the entire crown of the tooth so it is indicated for bilateral class II caities. %1 -LAC,2S MATRICES i*0lac.s matrix for simple cases is recommended for a majority of small and medium size caities PROCEDURE 7ut a metallic band so that it will extend only slightly oer the buccal and lingual surfaces of the tooth. 13 To preent a wrap" around holding ligature from slipping off the band and the band sliding gingially. The corners of the gingial ends are turned up to hold the ligature. ii) -LAC,2S MATRIX with a gingial extension to coer the gingial margin of a subgingial caity. In this form of extension is created in the occluso$gingial width of a band to coer the gingial margin of a subgingial caity. The retaining procedures are the same as for the preious type of 0lac.s matrix. e) SOLDERED -AND OR SEAMLESS COPPER -AND MATRIX These are indicated for badly bro.en teeth" especially those receiing pin retained amalgam restorations" with large buccal and lingual extension i.e 7lass II design preparation PROCEDURE # stainless steel band is cut according to the measured diameter of the crown of the tooth" then the two ends are soldered together or a seamless copper band is selected so that it barely clears the diameter of the tooth in the cerical area. -ither the band could be heated in a flame until it glows red light. It is then +uenched in alcohol thus softening the band for easy handling. 14 5ith cured scissors" fasten the band so its gingial periphery corresponds to the gingial curature and the 7->. The band is then smoothed to remoe rough edges cerically and occlusally. 5ith containing pliers contour the band to produce the proper shape in the contact area. #reas of the band in the contact area are reduced to a paper thinness using a coarse sand paper disc. Then they are recontoured . /ext the band is seated on the tooth and tightened at the cerical end by pinching a 9tuc." using a flat bladed plier at the gingial edge in the area accessible to the plier. To stabilize the band and preent cerical flashes of amalgam" wedges are placed gingial to the cerical margin of the preparation. The external portions of the matrix and the wedges are coered with compound to further stabilize the matrix. # wire is inserted facio$ lingually in the compound to further stabilize it. #pply a heated ball burnisher from the inside of the caity to the band" softening the external compound and insuring the proper contour" contacts and embrasures. #fter condensation and initial coering" the compound is remoed and the matrix is cut at the area of the tuc.. 15 5ith a plier or hemostat" grip the band at either side of the scissors" cut and tear through each thinned contact portion to remoe the band without damaging the proximal region of the amalgam. f) T)E ANATOMICAL MATRIX This is the most efficient means of reproducing contacts and contour. It is entirely hand made and contoured specifically" for each indiidual case. It is specially useful in mutilated teeth. It is indicated for class II designs. PROCEDURE # piece of G0.001 $ 0.00AH stainless steel matrix band 1E8 th in width is drawn between the handle of a pair of festooning scissors. This procedure facilitates the adaptation of the free ends of the matrix to the proximal surface of the tooth. The matrix is cut to proper length. It must extend well beyond caity margins. To obtain a proper length the centers of the proximal buccal and proximal lingual cusps are used as a guide. The matrix band is contoured with contouring pliers. The band is then trimmed so that the matrix will extend well below the gingial margin of the caity and at least Amm beyond the buccal I lingual margin of the caity. 16 # wedge is selected and shaped to conform to the gingial embrasures" and it is then placed in warm water to soften it slightly. Two small cones of compound are warmed in hot water. These compound cones are forced one at a time" using thumb and finger pressure into the buccal and lingual embrasures. The pressure is maintained until the compound has flowed eenly oer the entire buccal and lingual surface of the adjacent teeth. # wire staple is constructed from a paper clip. The staple is heated in a flame and forced into the compound in the buccal and lingual embrasures. This adds to the stability of the matrix by loc.ing together the A pieces of the blac.ing compound. # warm ball burnisher is used to soften any compound that has been forced between the matrix and the adjacent tooth. The matrix is burnished lightly against the contacting tooth. #fter initial hardening of the inserted restoratie material" the compound is crac.ed at its occlusal junctions using a sharp chisel or .nife. The wedges are remoed using a hemostat and the band is curled bac.wards against the adjacent tooth and withdrawn buccolingually" with pressure against the adjacent proximal surface. 17 g) ROLL . IN . -AND MATRIX 3A'to "atri&1 h) S . S)APED -AND This is used for class II caity preparations. 6rocedural instructions are exactly as described in class III preparations 41MATRICES FOR A CA*ITY PREPARATION FOR AMALGAM RESTORATION ON T)E DISTAL OF T)E CUSPID a) The S . shape% "atri& This is an ideal matrix for class III caity preparation on the distal of the cuspid" with either a labial or lingual access. PROCEDURE <ne half to one inch of regular strip matrix 0.001 $ 0.00A in thic.ness is used. # mirror handle is used to produce the '$shaped in the strip. The band is contoured oer the labial surface of the cuspid and the lingual surface of the adjacent bicuspid. 5ith contouring pliers" the strip is contoured in its middle part to create desired form for the restoration. It is then placed inter proximally and wedged firmly apical to the gingial margin and coered with compound at its facial and lingual ends. The remaining procedure is similar to those of the anatomic matrix. 18 4) MATRICES FOR CLASS III DIRECT TOOT) COLOURED RESTORATIONS These are usually transparent plastic matrix strips. ;or resins cellophane strips are used. 3ylar strips may also be used. a) 3atrix for class III preparations with teeth in normal alignment. The suitable plastic strip is burnished oer the end of a steel instrument. -g J$ handle of a tweezer " to produce a 0-44@ in the strip. This will allow for curature which if properly contoured and designed" will reproduce the natural proximal contour of the tooth. The strip is cut to allow the belly to be placed where the contact is desired. In placing a plastic strip between the teeth" it should be cut as wide as the tooth is long. The corners of the strip should be trimmed therefore " to allow for better adaptation to the tooth and to preent any excess material from forming on and beyond the facial or lingual margins. The length of the strip should be just sufficient to coer the labial and lingual surfaces of the tooth. # wedge is trimmed and applied to hold the strip in place. ;or labial approach use fingers of the left hand for holding the strip firmly against the lingual surface of the tooth while the material is being placed in the caity. 19 b) 3atrix for class III preparation in teeth with irregular alignment PROCEDURE # suitable plastic strip is contoured and adopted as described preiously and then remoed. ;or a labial approach preparation a compound impression is ta.en of the lingual surface. The compound is allowed to oerlap the adjacent teeth. It is cooled and then remoed. The compound impression should show an imprint of the caity preparation. The compound impression is then warmed. The surface is softened without distorting the form of the entire impression. This can be done by holding the impression close to the flame only for a moment. The strip is then placed into position again" followed by the compound impression against the strip" assuring perfect adaptation of the matrix to the caity on the lingual surface. The material is then introduced from the labial. c) MATRIX FOR T(O SMALL PROXIMAL PREPARATIONS IN CONTACT (IT) EAC) OT)ER #n appropriate plastic strip is folded with one end slightly longer than the other. 20 # loop K inch in diameter is formed in the matrix strip. The loop is flattened and ceased with a finger" ma.ing a T $ shaped and trimmed. The trimmed matrix is then placed between the teeth. ;or labial approach preparations" the strip is held oer the lingual surface with the finger while the caities are filled. 5) MATRICES FOR CLASS I* PREPARATIONS FOR DIRECT TOOT) COLOURED MATERIALS a) The plastic strip for inciso proximal caities PROCEDURE # suitable plastic strip is folded at an angle into an 4 $ shaped then sealed with a plastic cement or any adherence that does not react with tooth coloured material. <ne side of the strip is cut so that it is as wide as the length of the tooth. The other side is cut so that it is as wide as the width of the tooth. The strip with a wedge in place is adapted to the tooth $1 ALUMINIUM FOIL INCISAL CORNER MATRIX 21 These are 9stoc. metallic matrices shaped according to the proximo $ incisal corner and surfaces of anterior teeth. They can be adapted to each specific case. PROCEDURE # corner matrix closest in size and shape of the lost area of the tooth is selected. It is trimmed gingially so that it coincides with the gingial architecture and coers the gingial margin of preparation. #s it is readily deformable" shape it with the thumb and first finger until it fits the mesio distal and labio $ lingual dimensions of the tooth. 4oosely place the wedge allowing space for the matrix band thic.ness. 6artially fill the preparation and then the corner matrix preferably after enting the corner. #pply the partially filled matrix oer the partially filled tooth preparation at its predetermined location between the loosened wedge and the tooth. c) TRANSPARENT CRO(N FORM MATRICES These are 9stoc. plastic crowns which can be adapted to tooth anatomy. In bilateral class I, preparations use the entire crown form. 22 In unilateral class I, cut the plastic crown inciso $ gingially into two hales and use only the side corresponding to the location of the preparation. PROCEDURE 7hoose the crown form with the size and shape close to the tooth to be restored. ;or a unilateral class I," after cutting the crown from inciso $ gingially" so that the correct incisal angle of the crown form matches the last tooth incisal angle. If for bilateral class I, .eep the crown as it is. Trim the crown form gingially" so that it coincides with the gingial architecture and completely coers the gingial margin of the preparation. 7hec. the matrix to ensure that it will recreate proper contact and contour. Then remoe the matrix and thin it at its contact area with a sand paper disc. It should be perforated at the incisal angle. 7ompletely fill the matrix with the restoratie material and partially fill the preparation with the restoratie material. 6lace the filled crown form on the tooth in the desired location. The wedge is then tightened. d) ANATOMIC MATRIX 23 6rior to preparing the teeth" study model for the affected tooth together with at least one intact adjacent tooth on each side is made. It is preferable" especially in multiple inolement. The defectie area is restored on the study model in a fairly heat resistant material ( plaster" acrylic resin" blac.ing compound" plasticine" etc* to the appropriate configuration. # plastic template is made for the restored tooth on the model using a comb of heat and suction conse+uently to draw the mouldable material onto the study model. The template is trimmed gingially to fit the tooth and adjacent peridontal architecture. It should seal on atleast one unprepared tooth on each side. This is the matrix which should be ented by perforating the corners of its part corresponding to the future restoration. 6) MATRICES FOR CLASS * AMALGAM RESTORATION a) (INDO( MATRIX This matrix is formed using either a Tofflemire matrix or copper band matrix. PROCEDURE FOR USING T)E TOFFLEMIRE MATRIX 24 The contrangle retainer is applied at the side of the tooth that does not hae the preparation. # window is cut in the band slightly smaller than the outline of the caity (perforated windowed bands are aailable*. 5edges are placed mesially and distally to stabilize the band. PROCEDURE FOR USING T)E COPPER -AND # seamless copper band is selected that is just larger than the prepared tooth. ;asten and adjust the band to the tooth. # window is cut coinciding with the caity but smaller in diameter. The edges are smoothed. b) T)E S . S)APED MATRIX This is usually indicated for a proximal extension of a buccal or lingual class , preparation. 7) MATRICES FOR CLASS * PREPARATIONS FOR DIRECT TOOT) COLOURED RESTORATIONS a) #natomic matrix for non light cured direct tooth colored materials. PROCEDURE The class , caity may be preliminary filled with inlay wax or gutta $ percha and trimmed to the proper contour. The wax and the tooth are then coated with cocoa butter or mylar strip and 25 compound impression is ta.en of the tooth surface to be restored. #djacent surfaces are to be included in the impression. #fter the compound has cooled" it is remoed and the wax is remoed from the caity. # mix of the restoratie material is made and placed into the caity" and the compound matrix is placed into position and held securely in place under pressure until the material sets. SUMMARY 5 CONCLUSION #lthough there hae been ery few inestigations conducted on this subject" it is clear that no matrix techni+ue is capable of the exact replication of normal anatomic contour of restored teeth. <erall the anatomic matrix procedures must closely reproduce normal tooth contours. 5edging is uniersally imperatie in order to eliminate cerical flash of restoratie material. 'ome of the clinical significance is the fact that circumferential matrix bands retained by tightening deices(Toffelmire* hae been shown to deform tooth structures. 6assiely inserted matrix bands li.e anatomic matrix and T $ shaped bands etc hae no deformatie effect on the remaining tooth structure. 26