Hi people, as the title suggests, I need some help.
I've been struggling to get good contact with my class 3/4 fillings. We only use a mylar strip (no wedges even). We're told to pull the strip tightly as it will give a good contact but mine are far from good...
Removing excess composite is also such a nightmare for me. We have soflex polishing discs and burs but i feel as if everytime I use the discs I end up damaging the teeth. The same goes for the burs. 7901 bur and flame shaped bur.
Please help guys, I'd really appreciate it. I feel so demotivated and scared everytime I have to do one of these fillings. Thank you in advance.
Class 3/4 fillings can be tricky, since it's a hybrid of esthetics and function. You can close the diastema, but if the diastema is too big, you won't get an esthetic result (especially around 8/9). You have to look at the big picture and it also depends on your objectives and patient objectives.
If given a typodont and ideal circumstances and ideal prep, then you can use a standard mylar strip (with no precurvature), but that's why they probably taught you to avoid breaking the facial contact.
The technique of pulling the strip tightly actually doesn't give you much information, the big question(s) are, is it a flat or precurved mylar strip, how much was the contact broken/how much space do you need to close, and the direction you should pull the mylar strip (it's actually not linear).
So, tackling each question: flat v. precurved mylar strip, flat mylar strips are good, if the the tooth has sharp line angles and not too rounded. If the tooth is rounded, you have to overbuild the fill by holding the strip apically and towards the contact area, with your finger on the side that's opposite to the access of the prep, i.e if you started your access from the lingual (lets say #9 DL), you need to insert the strip apically to the gingival floor of the prep, secure the strip facially with your index finger, pull the strip mesially and incisally (mesial pull for the adaptation to the gingival cavosurface margin + incisal pull to create a bulge towards the distal, then with your other hand, place composite and lightcure. It's a balancing act, but if you train yourself, these interproximal fills can be quick and predictable for treating caries. Esthetics throws a wrench in these types of cases, since esthetics and function don't always go hand in hand in direct restorations. If the contact is too large to close, you will most likely have an unesthetic result, since the first thing people notice is symmetry. In this case, consider sending out for a diagnostic waxup + prep guide + stent. Show the patient their preop, how the lab wants you to prep the teeth, and the proposed final result.
With this technique, flash is minimal, adjustment is minimal, and is pretty quick. It's easier done than said. However, this is for ideal, if I had a bunch of malpositioning of the teeth, I'd consider ortho, veneers, or combination. If the shape is good, position is off, ortho would be more consevative. If position and shape are off, consider ortho/veneer, if it's just the shape that's the problem but good occlusion, consider veneers. If shape/position is good and treatment is for caries only, direct restorations should be ok for interproximal class 3's. However, with class 4's, you have to look at parafunctional habits. if they have parafunctional habits, you need to consider material limitations, occlusial issues, and other factors. Do not try and restore a class 4 if you see wear facets or other evidence of parafunctional habits that may have exacerbated the initial presentation. You will be in a world of re-fills/remakes that are non-productive time wasters.
