how to break proximal contact(that hook/lip)?

[StarCraft]

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I was wondering how to break the proximal contact when doing class IIs without hitting the adjacent tooth. They tell us that we just need to barely break contact and it should be the size of the explorer tine. How can the 330(my fav bur) do this? I don't see how anything can fit in between to give it the .5mm broken contact. What strategies do you guys use in order to do this perfectly? I always seem to hit the tooth next door. Thank you!

 

[IdahoDoc]

I was wondering how to break the proximal contact when doing class IIs without hitting the adjacent tooth. They tell us that we just need to barely break contact and it should be the size of the explorer tine. How can the 330(my fav bur) do this? I don't see how anything can fit in between to give it the .5mm broken contact. What strategies do you guys use in order to do this perfectly? I always seem to hit the tooth next door. Thank you!

Try not to cut it out, break out the enamel. Use your bur to drop the box and move toward the contact in the box leaving a thin bit of enamel. Then use the end of the bur while it is not moving or any hand instrument to break the thin enamel out. If you need to smooth it off after that use a hand instrument like hatchet to smooth it.

 

[peg lateral]

Try not to cut it out, break out the enamel. Use your bur to drop the box and move toward the contact in the box leaving a thin bit of enamel. Then use the end of the bur while it is not moving or any hand instrument to break the thin enamel out. If you need to smooth it off after that use a hand instrument like hatchet to smooth it.

Ditto to the above. Gingival margin trimmers are great at removing the thin shell of enamel. You can also pre-wedge and/or place a small piece of metal matrix between the teeth to create some separation and protect the adjacent tooth from the bur.

 

[StarCraft]

Thanks for the advice. Do you guys use the 330 too? Since you guys are experienced, do you go through the whole prep with the bur? Or do you use hand instruments 100% of the time. I guess I just want to learn how to use it only with the burs so I can get better. I know the hand instruments are more safe but should I just keep trying to practice and it'll just click one day? Without hand instruments, what's the best way to break through(which burs to use)? Thank you

 

[sw4gger]

169L or 170 burs are valuable to eliminate lips on the buccal or lingual wall of the box area and making it smooth with the outer surface of the tooth.
for the gingival floor you have to be careful when you are using hand instruments you can easily nick the gingival floor. a flat headed bur might be useful moving it BL with light strokes.

 

[tinman831]

If you leave too much of a shell, and you try to break the contact manually, you may end up breaking off a larger piece and opening up the contact even more than you originally wanted to. Be careful.

 

[peg lateral]

Thanks for the advice. Do you guys use the 330 too? Since you guys are experienced, do you go through the whole prep with the bur? Or do you use hand instruments 100% of the time. I guess I just want to learn how to use it only with the burs so I can get better. I know the hand instruments are more safe but should I just keep trying to practice and it'll just click one day? Without hand instruments, what's the best way to break through(which burs to use)? Thank you

I use the 330 to get most of the prep done/outline form. I will use a round latch bur to excavate caries, the more decay the bigger the bur I use. And then as I get closer to the pulp I will use my spoon excavator. You will get better with practice and get to the point where you can use just burs for most/all of the prep. If I am removing old amalgams or composites, I personally like to use a diamond bur or a 56 carbide. Just my personal preference. I know I used hand instruments more in pre-clinic because I felt that it was so easy for me to make one mistake with high speed on the soft ivorine teeth. While in school, try out different burs, see what you like. And get lots of teeth to practice on. Even if you are in clinic treating patients, it doesn't hurt to break out the typodont and practice on plastic teeth or mount some extracted teeth in some stone and practice on those.

 

[beannaithe]

I like the 557 on molars (56 in school) and 330 on premolars. I drop my box on the inside (slightly) of the marginal ridge. Then I'll stay at the depth of the box and move the bur slowly toward the adjacent tooth until I remove the extra shell of enamel. Just touch up using the same bur.

Then I use the slow speed with a round bur to pass over the inside of the prep to remove decay.

If you want to flatten the floor in school, a 957 either in slow or high speed will cut only the floor. I used to use a shoulder edged diamond. Though not as much in private practice.

Only hand insturment I've used in practice/residency was the spoon for deep decay and checking to make sure the prep is clean.

It's definitely best to err on the side of caution when breaking the contact though. Most of mine end up being slightly larger then breaking it with a tine of an explorer. If you look at the edge of the decay, 95% of the time there are large amounts of decalicification that will end up decaying later. Just be careful too about breaking on the mesial of max 1st premolars too, it's highly visible especially with amalgam. I'd leave the mesiofacial contact in place on those unless decay/decalficiation told me otherwise.

 

[omaralt]

in real life it doesnt matter since real tooth dont mark as easy

in pre clinic lab i used this weird metal thing that i wedged between the teeth. i would cut until i hit metal and then i knew i was too far. it was a nice safety net that i also used on practicals and even for the boards. it's straight metal in the middle and on each side it's rolled. forgot what it's called, sorry 🙂

 

[drkmgk]

in real life it doesnt matter since real tooth dont mark as easy

in pre clinic lab i used this weird metal thing that i wedged between the teeth. i would cut until i hit metal and then i knew i was too far. it was a nice safety net that i also used on practicals and even for the boards. it's straight metal in the middle and on each side it's rolled. forgot what it's called, sorry 🙂

perhaps a matrix band?

 

[StarCraft]

thanks for the help!

 

[ZenoVT]

in real life it doesnt matter since real tooth dont mark as easy

in pre clinic lab i used this weird metal thing that i wedged between the teeth. i would cut until i hit metal and then i knew i was too far. it was a nice safety net that i also used on practicals and even for the boards. it's straight metal in the middle and on each side it's rolled. forgot what it's called, sorry 🙂

titanium band?

 

[omaralt]

its not a matrix band. they gave them to us at school; it's a metal strip with the ends rolled. kinda looks like an old school tape. i'll try to find a picture

FOUND A PIC;



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thats what i used. they're called interguard, you can buy them here or your school schien store

https://store.ultradent.com/index.php?_a=viewProd&productId=652782

 

[pixidust]

I was wondering how to break the proximal contact when doing class IIs without hitting the adjacent tooth. They tell us that we just need to barely break contact and it should be the size of the explorer tine. How can the 330(my fav bur) do this? I don't see how anything can fit in between to give it the .5mm broken contact. What strategies do you guys use in order to do this perfectly? I always seem to hit the tooth next door. Thank you!

Drill as close to the adjacent tooth as you can but leave a sliver of a wall in between. Then take your hatchet and break down the wall. That eliminates the chance of your fav 330 bur nicking the adjacent tooth. Plus you'll get your 0.5mm broken contact if you go deep enough.

 

[Althingsdentist]

You can pre-wedge prior to whittling with any number of 3 trillion types of wedges - and place a tofflemire/kidney shaped band before whittling to ding rather than teeth. Then like the others, use a 169 or a flame shaped finishing bur - keep the prep nice and tight with a flame bur.

http://youtu.be/unNW3J0PWY0

Hope this helps.

Ashley

 

[Ryltar]

The best way I found to break contact was to get close to breaking contact with the 245 (while pre-wedged), and then break it *carefully* with by lightly planing the buccal/lingual box walls with your gingival marginal trimmer (the right side of course, as one side is mesial cutting and the other distal cutting). The gingival margin trimmer is shaped perfectly the break contact the way you want to.

The other way to fold a matrix band over on itself twice and wedge it. Then break the contact with the "pencil-shaped" composite finishing kit bur (don't recall the number) in a slow speed. It should have a red line on it, which means superfine and is what you want so as to not take away tooth structure to fast.