CATEGORY AUSTRALASIAN DENTIST 49 Sectional Matrix System Selection and Placement In cases involving adjacent large proximal defects, selecting a suitable sectional matrix system is essential to achieve optimal anatomical form. The Garrison matrix system was used in this case due to its precision, adaptability, and stability. Proper marginal ridge height and contour are critical for replicating natural occlusal anatomy, including the adjacent triangular fossae and occlusal embrasures. Since ridge height is closely dependent on matrix band height, Firm Band FXH 175 was selected. The rigidity of the FXH 175 bands allows for easy placement and a secure fit, while maintaining shape during the composite injection molding procedure, preventing deformation and ensuring accurate anatomical reconstruction. Placement Protocol: The first sectional band (FXH 175) was positioned at the distal defect of tooth #47. Due to the minimal interdental space between teeth #47 and #48, a Strata-G yellow wedge was used to secure the matrix (Figure 4). The firm structure of the wedge enabled smooth insertion in the tight interproximal area. Subsequently, an identical band was placed between teeth #47 and #46. The quad orange wedge was slightly repositioned to allow band insertion beneath it. After band placement, the wedge was reinserted from the buccal aspect to its full seating, and gentle finger pressure ensured secure stabilization of both bands under the wedge (Figure 4). A Quad Universal Ring (blue) was then applied between teeth #46 and #47. This ring, in conjunction with the quad wedge, provided a tight seal, controlled excess material, and established a natural proximal contact (Figure 5). Following this, a Strata-G ring was positioned between teeth #48 and #47, stacked over the quad ring to simultaneously manage adjacent restorations effectively (Figure 5). This sequential matrix-ring configuration enabled efficient restoration of multiple proximal defects while preserving proximal contacts and occlusal morphology. The Garrison matrix system proved particularly advantageous in MOD situations due to its stability, anatomical accuracy, and time efficiency. Appointment 02 – Management of Defects in Teeth #46 (MOD) and #45 (Distal) The patient was recalled after a few days to complete the restoration of the remaining defects. Caries excavation was performed on the mesial surface of tooth #46 and the distal surface of tooth #45. Cavity preparation followed the same protocol previously described for the other teeth. The restoration on tooth #47 had been fully finished and polished during the previous appointment to ensure ideal proximal contact and contour, thereby facilitating accurate contact formation for subsequent restorations. CLINICAL Figure 4. Following the restoration of tooth #48, Garrison sectional matrix bands were placed and stabilized using wedges. Due to the limited interdental space between teeth #47 and #48, a Strata-G wedge was utilized to secure the matrix band effectively. For the interproximal area between teeth #46 and #47, a quad wedge was chosen to ensure firm stabilization of the matrix system. Figure 5. Quad Blue ring placed between teeth #46 and #47 & Strata G ring stacked Region between teeth #48 & #47, saving precious time without compromising any contacts and contours. Figure 6. Appointment 02, caries removal from mesial side of #46 and #45 distal and finishing of Mesial side of tooth #47. Due to time constraints, it was decided to restore the MOD defect on tooth #47 during this appointment. Following adhesive application, a thin 0.5 mm layer of Shofu Injectable XSL – a high-strength, second-generation, self-leveling flowable composite – was applied to seal the dentin. This layer plays a crucial role in protecting the hybrid layer from polymerization shrinkage stress. Its self-leveling properties allow excellent adaptation to internal cavity surfaces, minimizing voids, improving marginal integrity, and reducing the risk of post-operative sensitivity. The proximal walls were then built using Shofu Beautifil LS II (shade A3), a low-shrinkage composite (polymerization shrinkage: 0.85%). The material was placed in two increments using the snowplough technique, supported by a small volume of Shofu Injectable XSL (shade A3O) to enhance adaptation at the interface. In the second increment, the marginal ridge was sculpted with a fine instrument to achieve accurate contour, proper marginal ridge height, and a well-defined occlusal embrasure. The rigidity of the sectional matrix band allowed precise reproduction of the marginal ridge and contact area. This technique effectively converted the Class II cavity into a Class I configuration by re-establishing both proximal walls and contact. Once the proximal contour was completed, the matrix bands and rings were removed. Final occlusal morphology was then achieved with incremental layering to complete the restoration of tooth #47. Tooth #45 was restored using a freehand technique due to the small size of the defect. Shofu Injectable XSL was first applied, followed by Shofu Beautifil LS II packable composite. The distal contour was subsequently refined using finishing discs to establish proper contact and emergence profile in preparation for the restoration of the adjacent tooth. Restoration of the MOD defect on tooth #46 was then initiated. The use of stacked Quad rings once again facilitated accuracy and predictability in achieving ideal proximal form. FXH175 firm sectional matrix bands were positioned and stabilized using a quad green wedge inserted from the buccal aspect. After confirming an adequate seal of the proximal box, the first blue Quad ring was placed, followed by an orange Quad ring to enhance separation and matrix stability. The mesial proximal box of tooth #46 was restored entirely using Shofu Injectable Figure 7. Stacking for Quad Rings for MOD defect on tooth #46.
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