Using a matrix during restorative work contributes to case outcomes in multiple ways. We examine how matrices help with restorative work, why they increase success, what makes a system helpful, and what options are available for different cases.
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How a Dental Matrix System Can Help with Restorative Dentistry
Jason Goodchild, DMD, Vice President of Clinical Affairs at Premier Dental Products Company, says the most common direct posterior restoration is Class II per the American Dental Association (ADA). And that proper restoration of interproximal areas via an efficient matrix system is critical to restorative success.
Along with the proper materials and techniques, understanding the mouth’s form and function is essential to avoid poor outcomes for restorative cases. The matrix system helps shape and contour dental restorations by maintaining their form during placement and setting.1
A flexible band that wraps around a natural tooth, the dental matrix conforms to the tooth's surface, recreating the natural curves and walls possibly missing in the interproximal area. This band holds the restorative dental material in place, ensuring the completed restoration takes the right shape and fits well between adjacent teeth.2 Matrices also allow clinicians to create a non-retentive surface finish for plaque or food debris, reducing the chances of secondary caries. Additionally, using a dental matrix for your restorative work increases the longevity of composite restorations and protects the adjacent teeth during cavitary prep.2
Before everyone was using composite for these restorative procedures, clinicians used amalgam. The Tofflemire-type systems worked well with that material, Dr Goodchild explains. However, dentists needed a new solution since the migration to dental composite materials, which clinicians cannot pack into the system the same way they could when using amalgam. Hence, the sectional matrix systems came into play around 20 years ago.
“Those sectional matrices had 3 pieces: a ring, a matrix, and a wedge. The wedge is supposed to push the matrix against the tooth, but the ring is designed to separate the tooth to account for the thickness of the matrix and to help achieve proper contact,” Dr Goodchild says. “The matrices are usually pretty contoured, designed primarily for composite.”
Why Does Proper Recreation of the Interproximal Area Matter?
Restoring the interproximal area is critical. The contact area, the interproximal niche, and the triangular-shaped interdental papilla are crucial in protecting the gums. However, having proper contact between teeth also contributes to the stability of the dental arches by providing combined support.2
Proper interproximal contact also avoids future oral health problems. Improper contact or having open spaces between teeth can cause misalignment in the arch. It also contributes to oral health issues like food getting stuck in gaps, bad breath, cavities, and gum disease.3
What Characteristics Make a Dental Matrix Helpful?
A few qualities of a dental matrix system can help improve your treatment workflow. Per DentalTix, a dental supplies distributor in Spain, there are a few characteristics of a helpful dental matrix2:
The Types of Matrices
DentalTix also explains that dental matrix systems have different types. Some differ in material, with metal options like steel or titanium and plastic choices such as acetate or celluloid, which may be less durable but permit the passage of photopolymerization light. Also, some matrices are universal and standardized, like Tofflemire-type matrices, while others are custom-made by dentists for specific cases. Additionally, some matrices have fixed shapes due to their elastic memory, while others, like laminated matrices, can be modified to enhance contour and contact points. Finally, adaptation systems differ, meaning some matrices remain stable without a holder, while others require one for proper adaptation.2
Two types of dental matrix systems are circumferential and sectional:
Circumferential matrices are already shaped in 3 dimensions and, when combined with wedges and separators, create tight contacts between teeth. They are comfortable and provide good visibility for quick work on a section of teeth.
Sectional matrices are shaped like natural teeth, and have a long lifespan. Dentists use sectional matrices when they want to achieve the best tooth shape and function and save as much of the natural tooth structure as possible.3
A British Dental Journal study suggests sectional matrices can be challenging. First, they require specific techniques, which could lead inexperienced clinicians to use circumferential matrices even if sectional matrices might lead to better clinical outcomes. Second, sectional matrices have numerous options. For dentists with limited experience in this area, choosing the optimal sectional matrix system can feel overwhelming. Additionally, sectional matrix techniques with separating rings establish predictable contact areas but could lead to a concavity in the restored surface there. This concavity is hard to clean, allowing the buildup of biofilm that could go unnoticed clinically, leading to caries on the neighboring surface of an untreated tooth.4
That same study says that circumferential matrices have some drawbacks, too. Recreating a natural emergence is challenging, making achieving a proper contact area difficult. Also, contact might exist as a single point rather than a broad area and in a non-natural position. This situation results in a ridge more prone to fracture and a flatter emergence form that can catch and shred floss, leading to patient complaints. Combining a higher or non-existent contact point and a flatter, non-natural cervical emergence increases the chances of incomplete papilla infill, creating spaces below the contact point where food can get stuck. Additionally, the design of the circumferential matrix holder can also limit access for wedge placement, impacting their effectiveness.4
A study looked at the performance of each of these types with respect to pediatric patients. The researchers determined that the circumferential matrices were more time-efficient, but the sectional matrices produced more restorations with ideal contacts. Overall, the preference favored the circumferential matrix band system for its efficiency, except when clinicians were aiming for ideal contacts in pediatric cases.3
A paper suggests the specific matrix system significantly influenced tooth anatomy and treatment success. The paper also looked at the evidence for the advantages and disadvantages of the various dental matrix types, which include the following5:
Thin, Sectional Matrices:
Pros:
Provide tight interproximal contacts.
Show fewer problems with marginal overhangs.
Cons:
May result in concave contours.
Less effective in avoiding overhangs.
Circumferential Bands (Tofflemire-type):
Pros:
Produce flat contours.
Decrease the occurrence of marginal overhangs.
Cons:
Interproximal contacts may not be as tight.
Traditional bands may have more problems with fitting.5
Dr Goodchild says that like most dental materials and systems, clinician develop a feel for a given system and tend to stick to it. Some of the common Matrix Systems that clinicians choose are the Garrison’s Strata-G,Palodent Plus, Premier X5 Sectional Matrix System, andUltradent’s Halo Sectional Matrix System. Each have their distinguishing characteristics that may appeal to a clinician.
For example, the Premier X5 Sectional Matrix System comes with 10 Universal Matrix Rings made of their proprietary resin. This feature makes it possible to have more rings in the practice without being concerned about accidentally throwing one away. By contrast, the rings in other systems can be expensive to replace.
“We came up with this idea of having a resin that will hold its shape and create the separating force, but it's less than $4 per ring. So, you can buy a bag of 30 rings and have enough rings around the office. Or they could be used in a school where they can become disposable after single-patient use,” Dr Goodchild explains. “It’s just a different approach, and all of it will work. Do you like to have 1 ring that you protect with your life and don't throw that thing away, or do you have 30 rings lying around that you can throw away and pick up a brand new one each time?”
So, When Do You Use Either Type?
Brett Richins, DMD, Clinical Advisor for Ultradent Products, Inc., writes on the Ultradent Blog that his preferred choice for regular Class II restorations with well-aligned adjacent teeth and no major damage is a sectional matrix system.6 Sectional matrix systems offer a fast and reliable way to achieve good results. However, having circumferential bands as part of the tools is crucial. In specific situations, like when there's no adjacent tooth or restoring the buccal or lingual surface, Dr Richins prefers circumferential bands. In the past, when he was focused solely on sectional bands, he would sometimes try to rebuild these teeth without any matrix system. Now, he realizes that circumferential bands help him quickly and easily place a restoration in the intended area, avoiding frustrating situations.6
In Dr Richins's Salt Lake City practice, circumferential bands prove helpful when dealing with patients who have missing cusps, a situation where sectional matrices may result in under-contoured restorations due to insufficient tooth structure support. Additionally, circumferential bands are particularly advantageous in pediatric cases, where placing sectional bands on primary teeth can be challenging, and achieving critical contours is less straightforward. For restoring MOD in primary teeth, circumferential bands are often more stable and efficient in Dr Richins' approach.6
Dr Goodchild says that many clinicians have likely adopted a sectional matrix system. However, sectional matrices require more technique to place than a Tofflemire-type, and the case's complexity (e.g., the morphology or existence of misalignment makes it difficult to seat the ring) can steepen the technique’s difficulty. Likewise, multiple restorations in a quadrant increases the technical difficulty of using a sectional matrix. Dr Goodchild says he might use a Tofflemire-type, or both systems in some of those more complicated cases.
“When I have a Class II on my schedule, I plan to use a sectional, but sometimes it doesn't work, or I can't get it seated. So, I still need a Tofflemire-type matrix system in my office,” Dr Goodchild says. “There is always the right tool for the right job.”
Vaishnavi Rajendra Patekar*, Nikhil Mankar, Karuna Burde and Aparna Achanta
*Correspondence: Dr. Vaishnavi Rajendra Patekar, Department of Conservative and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, Maharashtra, India, :
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Matrixing is a procedure that involves the formation of a short term wall contrary to the axial walls, encircling a tooth structure region that has been lost during the procedure. A dental matrix is a type of band that adheres to the surface of the to be restored tooth, replicating its anatomical features, while the repair is being completed, the lost walls will be replaced, thereby converting compound cavity into a straight forward cavity for quick repair. A matrix primarily is used when a proximal surface is to be restored.
The dentist has a lot of options when it comes to procedures and materials when treating missing tooth structures. Reconstruction of lost tooth structure caused by caries, injury, abrasion, erosion, attrition, or a combination of factors has long been a source of concern. There are benefits and drawbacks to both direct and indirect restorative methods. The reestablishment of optimal both form and function related with tooth anatomy on the proximal surface has presented several challenges in each case. Consequently, the periodontal apparatus is directly influenced in terms of protection and stimulation is brought back to origin. Visualization of the surviving tooth structure, thorough understanding of tooth anatomy, is required for effective odontogenic recovery [1-4].
Demand for cosmetic repair and a minimally invasive restorative technique are increasing. The usage of resin composite for posterior carious lesion repair has increased as a result of this. During the operation, the key issue is to restore an intact proximal surface, particularly good interproximal connections. A good matrix system offers a slew of advantages. Plane region where the locations of the proximal faces that are adjacent to each other come into contact is referred to as a "proximal contact.” Dentition support, arrangement and balance as well as care of interdental gingival papilla to avoid food impingement also development of approximate tooth decay, are all functions of a good (tight) proximal contact surface. The establishment of these criteria guarantees that the oral tissues are adequately protected and stimulated, resulting in an oral cavity having good health [5]. Contact is either absent or open, as well as planes of proximal contact having improper measurements, can lead to misaligned teeth and shift which can lead to food impaction, halitosis, caries formation, and periodontal disease [6-8].
During the restorative process, they isolate one tooth from another and contain composite material. Matrix methods assist build adequate interproximal contacts, shape, and keep flash at bay by forming a wall on the surface of a tooth where none previously existed. This not only saves practitioners time, but also protects patients from the risk of sub gingival irritation. Dental matrices, helps formation of interproximal planes with quick recovery have gained fame as dental composites have improved. There are many distinct sorts of matrices, sectional matrix systems, matrix bands, and other configurations are available, they intended and to be put between the repaired tooth and the neighbouring teeth, form the restorative materials outside shape.
Modern dentistry depend on tripartite method of restorative care that includes viewpoints such as enhancing tooth shape and basis, preserving dental building with little interference, and restoring teeth to their original state. Improvement in "aesthetic" technology proficiency and matter sciences they separate one tooth from another and contain composite material during the restorative process. By creating a wall on the surface of a tooth where none exists, matrix systems help to form proper interproximal contacts, help shape restorations, and keep flash at bay which not only saves clinicians clean up time, but also saves patients from the potential for sub gingival irritation [9].
Food impaction and associated periodontal disease can be avoided with a properly reconstructed proximal surface that considers both anatomical and obstructive considerations. Correctly implemented principles of contemporary, evidence based techniques are used to stimulate tissues of the mouth and stabilize the teeth within an arch and the obstructive close up [10]. Anatomically accurate contoured restorations that allow for the preservation of functional functions depend on tried resources, armoury, and methods in current restorative dentistry. The degree of constraint and location of point at which adjacent teeth come into contact, as well as shape of the proximal planes, are important element in periodontal tissue strength [11]. The contact power is affected by a variety of elements such as tooth kind and position, alteration in positions, periodontal disease of the tooth, and individual variability [12].
Three things are required of a matrix system
• Recreate the natural tooth form and interproximal contact.
• Seal the prep's proximal and gingival walls.
• Get around the band's thickness.
Any system that meets these three criteria will be successful.
Characteristics of dental matrixes
• Rigidity
• Minimal thickness
• Flexibility
• Compatibility
• Stability
• Optimal transmittance
Matrix retainer
Depending upon the mode of retention
• With retainer-ivory no.1, ivory no.8
• Without retainer-auto matrix
Depending on the cavity preparation for which it is used
• Class I cavity with buccal and lingual extension- Double banded tofflemire.
• Class II cavity single banded tofflemire, ivory no.1, ivory no.8, copper band matrix, T band matrix, and pre countered sectional matrix.
• For other type’s cavity preparations-Auto matrix, clear plastic matrix.
Tofflemire universal matrix band retainer
Also known as universal matrix. A Tofflemire matrix system results in which a temporary wall is constructed on the opposite side of the axial partitions to build up the tooth structure around the missing portions during preparations. Tofflemire or universal matrix system is a metallic circumferential type of matrix that provides a good barrier in class II restorations.
Functions of tofflemire matrix systems
• Create a temporary barrier to the pressure required for the restoration.
• Give the restoration some shape and contour.
• Form preservation during the placement and setting of the repair (amalgam or composite) (Figure 1).
Figure 1: Tofflemire universal matrix system.
Indications
• Mesiooccluso distocavity construction of posterior teeth.
• Only mesioocclusal/distoocclusal class II recovery.
Types of tofflemire matrix
• Straight: Buccal positioned
• Contra angled: can be put lingual as well
Advantages
• When the retainer and band are properly secured, they are more stable.
• The retainer from the band may be readily separated, allowing for easy removal from the band.
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• It takes less time to place the item.
• Assist with maintaining the cotton roll's position.
Disadvantages
• When restoring utilize the matrix to create proximate surfaces, more sculpting is required as compared while using complex supported matrix.
• Matrix band outline is necessary.
• Does not produce the best outcomes with resin restorations.
Ivory matrix no. 1
A stainless steel band is wrapped around one proximal surface of a posterior tooth. A wedge shaped protrusion on the retainer connects this to the retainer. The band is adapted to the prepared tooth's proximal shape via an adjustment screw at the retainer's end. For unilateral class II tooth preparations, ivory matrix holder no.1 is the widely used. The matrix holder has two arms in the shape of a semicircle with slanted positions at one arm and a claw at the other. There's a screw in the opposite direction of the matrix band holder that, when tightened, draws the claws' ends closer together. One of the margins in the middle of the band used with this matrix is slightly projected. On the side of tooth preparation, this anticipated margin is kept in the direction of gingiva. Appropriate size band is picked out and ringed close to the tooth. The retainer's screw is tightened while the matrix band is kept around the tooth, ensuring fitting of band exactly close to the tooth. Following this, a wedge is used to help the matrix band fit more snugly around the tooth (Figure 2).
Figure 2: Ivory matrix no.1.
Indications: For the repair of class II cavities, particularly when the contact on the unprepared side is quite limited.
Ivory matrix no.8
The ivory matrix band retainer secures the matrix band, which encircles the teeth and fills in the gaps on both proximal sides. The matrix band is constructed of a thin sheet of metal for easy passage through the contact region of the tooth's unprotected proximal side. The band's outline may be modified using the screw included with the matrix band retainer (Figure 3).
Figure 3: Ivory matrix no.8.
Indications
• Class II preparations can be done unilaterally and bilaterally (MOD)
• Class II complex tooth preparations with more than two missing partitions
Advantages of ivory matrix system
• Economical
• Class II tooth preparations are restored with this material
• Can be purify
Disadvantages of ivory matrix system
• Difficult to put on and take of
Auto matrix
The auto matrix technology enables matrix positioning and maintenance without the usage of bulky retainers, resulting in easier placement, improved access, a clearer perspective on the operative field, increased patient satisfaction. The circumferential auto matrix system bands, which are only used once, enable proper sub gingival and proximal adaptation (Figure 4).
Figure 4: Auto matrix system.
Indications: When one or more cusps need to be changed in a complex amalgam restoration.
Advantages
• It is simple to use due to the lack of interference from a retainer, visibility has improved
• Quick implementation
Disadvantages
• Because the bands are not pre-contoured, proximal contouring is challenging
• Expensive
Copper bands
A continuous band is recommended for MOD and sophisticated restorations. It can be retained till the restorations are completed. Amalgam fillings with more than two surfaces are commonly used.
Indications
• For severely decayed teeth, particularly those requiring pin amalgam restorations
• If you have a complicated condition, such as a class II cavity with a big buccal or lingual extension
Advantages: It provide excellent contour
Disadvantages: Time consuming
Pre-countered matrix strips: Pre contoured matrix strips, such as the palodent and Darvag, are now widely available.
Prefabricated plastic matrices
• Available in a variety of sizes
• A handle is included to help keep the matrix in place while the material cures
• It's best to use with light cure restorations
Sectional matrix
Proximal caries is one of the most common pathologies we see in our everyday restorative treatment. It is critical to restore the class II cavities properly as well as to achieve a functioning associated surface in the middle of teeth. In two planes class II cavities, the sectional matrix system produces statistically substantially proximal connections are more tightly packed than in the circumferential matrix system. When class II composite resin restorations marginal ridge fracture strength having a matrix band that is either straight or curved employing composite resins is compared, the ridge at the edge of a class II composite resin restoration used in conjunction along contoured matrix band has a stronger marginal ridge.
It is critical to have a decent tooth preparation in order to use this matrix properly and achieve a satisfactory result. Because the matrix must be applied passively, it is usually required to arrange the preparation margin outside the contact site, in a safer and easier to clean zone. Otherwise, the matrix will always be at risk of deformation. We can get a pretty good shape if the matrix is put passively. Another requirement for a suitable contact surface is a space within the mouth to make up for the matrix width and composite polymerization shrinkage. The majority of important tools for this purpose are separation rings. If the gingival edge of the preparation is not too sub gingival, powerful stiff wedges can be used to achieve tooth separation.
Using modern rings, matrix, and wedge technologies, a sectional matrix system provides easy, predictable, and accurate contact formation. It has precise junction and a close fitting marginal seal, minimal overhang and final touches, is simple to install and remove (Figure 5).
Figure 5: Sectional matrix.
Example: Palodent, garrison, dentsply
Indications
• For minor to average class II cavities affecting one or both proximal surfaces of backside tooth
• This applies to both amalgam and composite materials restorations
Advantages
• It's simple to use and has a lot of visibility
• The bands' anatomical contour ensures ideal contact points and indentation
• Appropriate functional proportions and anatomical site is correct
Disadvantages
• Matrix bands can easily dent, particularly when continuity of beside dentition is very close, obstruct the band from being inserted easily
Circumferential matrix system palodent 360
• Palodent 360 matrix bands can be put in a variety of configurations to address field of view, tooth structure loss, and instrument accessibility. Palodent 360 is a ground breaking innovative circumferential matrix system. Without the need of an inconvenient retainer or applicator, tight contacts with anatomically natural curves can be achieved with just a twist of your fingers.
• The integrated lightener/retainer allows for matrix placement and retention without the use of bulky retainers or accessory placement and lightener instruments, resulting in increased efficiency (no set up required), ease of placement, better access, a clearer view of the operating field, and patient comfort.
• For superior restorations that are quicker and easier than you ever imagined. The cycle of success is complete (Figure 6).
Figure 6: Palodent 360 kit.
Indications
• Palodent 360 circumferential matrix bands can be used for all class II restorations, but they are particularly beneficial in challenging class II cases when there is no next tooth, too much dental structure is lost to use a sectional matrix, or a misaligned or severely rotated tooth
• Palodent 360 matrix bands work with palodent plus retention rings, which can be utilized to gain temporary space in interproximal gaps. They can be used with palodent plus wedges for a better fit
Advantages
• System that is simple to utilize
• Natural looking curves
• Contact point that is tight and anatomically accurate
• Interproximal finishing is kept to a bare minimum
Wedges and wedging
• A wedge is a piece of wood, metal, or other material with a sharply angled border created by double covering surfaces that is used to tighten or impart tension in a variety of ways.
• Nowadays, a wedge is frequently used in conjunction with matrices for the purpose of putting plastic restoration materials in.
• Wedges, when properly selected and applied, can make a significant contribution to the initial quality and longevity of some restorations, as well as greatly simplifying a variety of clinical procedures (Figure 7) [13].
Figure 7: Wedges and wedging.
Functions of wedges
• Prevents gingival extrusion of restorative material
• Defines gingival range of contact area
• Creates partition to make up for band thickness
• A traumatic retraction of rubber dam along with gingiva
Piggy back wedging
• When the wedge is substantially high to the gingival border, a smaller wedge is piggybacked in addition to the first
• This approach is useful in patients with interproximal tissue level recession
Double wedging: For wide proximal restorations, two wedges were employed, one from the lingual and the other from the face embrasure.
Wedge wedging: A second sharpened wedge is kept between the first and second wedges and the band if there is a concavity on the proximal surface [14-18].
The major goal of operative dentistry is to safeguard the tissue and maintain the health of the teeth. The goal of a restoration is to rebuild missing tooth structure while also providing sufficient strength and protection for the pulp against external shocks. The sciences of restorative technology has advanced due to advancements in material formulations, refinements in insertion techniques and arm a mentarium, and the gradual replacement of missing tooth structures with appropriate materials and resources. The occlusion of the matrix band to the remaining healthy tooth structure of the gingival cavo surface line angle should be achieved solely by the correct application of the wedges; the effect of the wedges on the proximal contour and prior to inserting the restorative material, the contact area should be thoroughly readdress; various sizes and forms of wedges, as well as a cutting tool to cut, should be freely accessible. When paired with a contact matrix separation ring, the use of circumferential matrices or sectional pliable matrices result in small marginal extends. The use of more traditional restorative methods may result in clinical failure and a reduction in the durability of these repairs. As a result of the challenges inherent in placement, innovative advances in matrix system technology, changes in matrix plan and interdental separation procedures, have evolved. The advancements have enabled dentists in order to produce the best proximal contact surfaces and anatomically accurate shapes, which are critical for best dentition shape and purpose, as well as activation and defence of the periodontal complex. The occlusion of the matrix band to the remaining living tooth planes of the gingival cavo surface line angle should be accomplished entirely by the proper placement of the wedges.
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