CATEGORY 46 AUSTRALASIAN DENTIST CLINICAL Dr. Mario Romero Background: A 34-year-old female patient in good general health presented to my practice with interproximal carious lesions affecting teeth #12 on the distal-occlusal (DO) surface and #13 on the mesial-occlusaldistal (MOD) surface. Procedure: After profound anesthesia was accomplished using a carpule of OraBloc Articaine 4% with epinephrine 1:100.000 via infiltration, rubber dam isolation was completed (Black Hysolate-Coltene) (Figure 1). Caries was removed using a minimal intervention approach which helped with keeping the central groove area intact on tooth #13 (Figure 2). Once the infected dentin was completely removed and a clean peripheral seal zone obtained, we cleaned the preparations using 23-micron aluminum oxide combined with distilled water (AquaCare) and then moved forward with selecting the ideal matrix system for this case. Garrsion’s Quad matrix system has quickly become my preferred due to its “split” wedge systems that helps with “pushing” the band mesial, distal or both (in back-to-back cases) (Figure 3). The Restorative procedure was initiated with #13 DO. After placing the matrix system, selective enamel etching for 15 seconds was completed, rinsed and dried (Figure 4). A two-step SE adhesive system was applied (OptiBond Extra Universal- Kerr) and light cured. We then restore the proximal wall using Brilliant EverGlow A2 dentin shade (Coltene) (Figure 5) and continued with a single horizontal layer (2mm) to replace the dentin, followed by two oblique layers (buccal and lingual) to replace the enamel layer (Figure 6). Each of these increments were cured individually. We remove the sectional matrix system and place it in between teeth #12-13 to restore both preparations simultaneously (Figure 7). See how the Quad wedge split tip contours the bands even prior to placing the ring. Make sure that the black arrow is always placed towards the lingual and that it The back-to-back dilemma, what matrix system should I use? By Dr. Mario Romero Figure 1 Rubber dam isolation was completed after anesthesia. Figure 3 After cleaning and preparation was completed, the Garrison Quad matrix system was selected to help with pushing the band mesial, distal or both. Figure 5 A two-step SE adhseive system was applied and light cured. We then restored the proximal wall using Brilliant EverGlow A2 dentin shade (Coltene). Figure 7 Removed the sectional matrix system and placed it in between teeth #12-#13 to restore both perparations simultaneously. Figure 9 Repeated the adhesive steps as before and built bot proximal walls between #12-#13. Figure 2 Carries was removed using a minimal intervenetion approach, keeping central groove area intact on tooth #13. Figure 4 After placing the matrix system, selective enamel etching for 15 seconds was completed, rinsed and dried. Figure 6 Continued with a single horizontal layer (2mm) to replace the dentin, followed by two oblique layers (buccal and lingual) to replace the enamel layer. Each were cured individually. Figure 8 The black arrow was placed towards the lingual and pushed each end of the split wedge towards the mesial and distal. Figure 10 Continued resotration on the occlusal surface.
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