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J Am Dent Assoc, Vol 131, No 9, 1326-1327. © 2000 American Dental Association

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One of the challenges of restorative dentistry is obtaining tight contacts in Class II resin-based composite restorations. This article describes a technique I have used to produce tight contacts predictably.

THE TECHNIQUE
After the Class II preparation of the tooth, fit a band around the tooth. Place the wedge firmly, making sure the band is tight at the gingival margin of the teeth. The band should meet the adjacent tooth at the contact.

Acid-etch the tooth and rinse it thoroughly, taking care not to let etchant touch the adjacent contact area. The only problem I have experienced with this technique, in fact, arose when etchant got onto the enamel of the contact area.

The only problem I have experienced with this technique arose when etchant got onto the enamel of the contact area.

Apply bonding agent and light-cure it. Fill and light-cure the box area in 1-millimeter increments, leaving the last 1 mm of the box area unfilled (Figure).

View larger version (90K): [in this window] [in a new window]   Figure. Bonding agent is placed in the box area and light-cured in 1-millimeter increments, and the last 1 mm of the box area is left unfilled.

 
Remove the band with a small curved hemostat, leaving the wedge in place. Retighten the wedge after removing the band.

Lubricate the contact area of an adjacent resin-based composite restoration with petroleum jelly only if it has just been placed in the tooth. Lubrication is not necessary if the adjacent restoration is more than 24 hours old or if the new restoration is being placed against the natural tooth, amalgam, porcelain or a gold crown. Add composite in the box area, carefully blending it with the previously light-cured composite. Have the patient close in centric occlusion while this final layer of composite is still soft. Contour the marginal ridge and light-cure the material. Remove the wedge.

Contour the composite with finishing burs in the usual manner. I use an 1170 carbide bur interproximally, a Midwest TF 7404 (Midwest Dental Products Corp.) for the occlusal surface and a Midwest TF 7901 (Midwest Dental Products Corp.) for the marginal ridge. Pass a piece of waxed dental floss on a floss threader at the gingiva interproximally from either the buccal or the lingual aspect. Bring the floss through the contact area. (It is important to use waxed floss for this first pass because it is stronger than the unwaxed variety.)

If the threader will not fit interproximally and the floss will not go through the contact from the occlusal aspect, use a Midwest TF 7901 bur. This bur’s very fine point will open the space between the new composite and the adjacent tooth on the occlusal surface so that floss can pass through.

CONCLUSION
This technique gives consistently tight contacts in Class II resin-based composite restorations. I have used the technique for three years, and it has proved very useful, though it required several attempts before I mastered it.

DO YOU HAVE A TIP TO SHARE?
Do you have a time- or work-saving clinical technique to share with your colleagues? Submit it to JADA’s Clinical Directions department. A Clinical Directions item should be a maximum of two double-spaced typed pages and should include no more than one figure or illustration. Submit items to Clinical Directions, JADA, 211 E. Chicago Ave., Chicago, Ill. 60611.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by DERRICK, R. E. Search for Related Content PubMed PubMed Citation Articles by DERRICK, R. E. Related Collections Restoratives