About class 4 composite

[urooj80]

Can anybody help me with this....

When you are doing a class 4 composite that goes all the way down almost to the level of the marginal gingival. How do u restore it? When I put the thinnest wedge and the Mylar strip, it leaves me with no space to fill the part of the cavity mesially near the gingiva cuz all that space is taken up by the wedge. I can't remove the wedge and do it cause then I will get an open contact and also the emergence profile will be very bulbous cervically.
But keeping the wedge in gives me no space to place the filling.
Any advice???

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[Tooth]

Place no wedge or mylar strip. Etch, bond, restore. Use a 12 blade to clean away any flash. It is the mylar strip that causes there to be no contact if you use no wedge. By restoring the contact directly to the adjacent tooth, you get a perfect contact every time. You want to do the best job you can to not get etch or bonding agent on the adjacent tooth. If you place the mylar strip and wedge to isolate the adjacent tooth from the etch or bonding agent, you will get bleeding when you remove them and compromise your restoration. So just don't put them to begin with. Some prefer to use teflon tape over the adjacent tooth, with no wedge. I still think it gets in the way. Basically, the short answer is that you need to learn to use the 12 blade. I have to say though, this sounds more like a class III composite than class IV.

 

[nuartywayne]

Agreed on the C3 statement, if large class 4 involving M or D + FIL then : Take impression, wax up, ESF, on your ESF cut off the facial portion, do not use wedge or mylar, use Teflon (plumbers tape) to cover adjacent teeth, place esf on lingual end then fill. The ESF should leave you with an embrasure so it gives you a descent backing to shape that area and all you have to worry is the facial and its embrasure. I like to use thin composite brush from tukiyama to shape the interproximal and also either holenbeck (sp?) or the interproximal carver to shape. If adjustment necessary then a flame finishing and 12 blade to finish it. Then polish.