Tips for restoring a contact?

[Vapor1122]

I placed a composite restoration on #31 (MO) the other day. Apparently I didn't wedge well enough, because there's practically no contact (oops). Since the session was almost over, I told the patient to make sure they keep the area well-flossed, and that I'd fix it the next time they came in for #30 (O).

My plan is to wedge a Palodent matrix in there and try to add more composite material interproximally, but I'm wondering how well that's going to work. Any pointers? Will I need to remove some of the composite that's already there to give myself some more working room?

---

Members don't see this ad.

 

[Daurang]

It's not gonna work. You need to take out some composite on mesial of #31 first.

 

[aphistis]

It's not gonna work. You need to take out some composite on mesial of #31 first.

But every dentist has to learn this one the hard way. 🙂

 

[OceanDMD]

Just tell the patient that throughout our lives our teeth have a tendency to drift mesially and the contact should close itself in about 5 years.....😉

 

[omaralt]

Just tell the patient that throughout our lives our teeth have a tendency to drift mesially and the contact should close itself in about 5 years.....😉

lol thats hilarious. but seriously, just remove composite material and open up that contact. i personally love the toffelmire/matrix band even with composite. just make sure you burnish it against the other tooth. i've found in a lot of cases no wedge is necessary, and it may actually mess up your contact. the way you determine if a wedge is necessary is first place the matrix band. then look down on it, and if you see any light between the band and the floor of the box you need to wedge it. if it's tight against the tooth, no need for wedge.

 

[puncho]

Drop a little box and make sure you burnish it against the tooth.

The wedge's main purpose is not to push the teeth apart, but so that you get a good smooth transition between the restorative material and tooth (e.g. no open margin/overhang).

 

[OceanDMD]

Drop a little box and make sure you burnish it against the tooth.

The wedge's main purpose is not to push the teeth apart, but so that you get a good smooth transition between the restorative material and tooth (e.g. no open margin/overhang).

The wedge if sized correctly DOES push the teeth apart and improve the contact.

 

[puncho]

Yeah it does, but I don't believe that's its main purpose.

 

[Demeter]

Redo the restoration.
Buy a Garrison set up and never have a weak interproximal contact again.
I used to dread composite resins, but with the Garrison rings its pretty easy to restore good interproximal contacts. That 500$ out of pocket expense may save your ass when its time for NERB/WREB. Nothing worse then sending your WREB up for a final check with a weak interproximal contact.

 

[Stephie3]

what are these garrison rings you speak of and where can i get them??

 

[Sephisabin]

Garrison is similar to the palodent system, but much more intelligently designed. Unfortunately, I'm pretty sure we can't use it at NYU since it's not supplied in the clinics.

 

[tinman831]

Yeah it does, but I don't believe that's its main purpose.

Wedging adds a little room to make up for the thickness of the matrix band as well.

 

[DrJeff]

Redo the restoration.
Buy a Garrison set up and never have a weak interproximal contact again.
I used to dread composite resins, but with the Garrison rings its pretty easy to restore good interproximal contacts. That 500$ out of pocket expense may save your ass when its time for NERB/WREB. Nothing worse then sending your WREB up for a final check with a weak interproximal contact.

👍 for Garison's sectional matrix system! 👍 Been a BIG fan ever since I 1st used them probably 6 or 7 years ago now 😀

 

[mike3kgt]

The best combination for class II composites on the planet:

1. V-ring (for 95% of cases)
http://www.triodent.com/v3-system/general.html?country_code=us

2. Greater curve matrix bands (for really large embrasures or core-build ups)
http://www.greatercurve.com/

V-ring is a significant investment but one that will pay off for years. I've used Compositight, Palodent, regular tofflemires, Kerr auto-matrix and no matrix. V-ring, is by far, the best product available in my hands, but then again, try them all because you might feel another product works better in yours.

Good luck!

 

[klpennin]

Just curious.... What happens if contact is not restored? Over stimulation of the gingiva and bone loss? Will the tooth eventually shift to close the contact?

 

[Daurang]

Just curious.... What happens if contact is not restored? Over stimulation of the gingiva and bone loss? Will the tooth eventually shift to close the contact?

The patient will forever feel the discomfort of food stuck in between the teeth every time they chew. No it won't close on its own. Redo the filling.

 

[DrJeff]

The patient will forever feel the discomfort of food stuck in between the teeth every time they chew. No it won't close on its own. Redo the filling.

You forgot one key thing there Daurang that will happen everytime they come into the office for a hygiene check after you leave them with an open contact. The patient wil; *cough* remind *cough* of it, and your hygienist will harass you about it too 🙄😳🙁

 

[Vapor1122]

So, roughly three weeks later, before I got a chance to fix it, the contact closed on its own. I guess it's worth mentioning that the patient is my girlfriend (also a D3), so I've been constantly asking her about it. She kept flossing the area daily, and sure enough, one day she actually felt it snap. It was slight at first, but there's a definite contact now.

She does have an unerupted impacted third molar distal to that tooth, so I'm wondering if that could be a causative factor here, though should it have happened that quickly?

 

[shwan]

So, roughly three weeks later, before I got a chance to fix it, the contact closed on its own. I guess it's worth mentioning that the patient is my girlfriend (also a D3), so I've been constantly asking her about it. She kept flossing the area daily, and sure enough, one day she actually felt it snap. It was slight at first, but there's a definite contact now.

She does have an unerupted impacted third molar distal to that tooth, so I'm wondering if that could be a causative factor here, though should it have happened that quickly?

Teeth always tend to drift mesially so that is quite possible even without the presence of third molar but not as fast.

 

[sokrman14]

It could be that you wedged it a lot more than you previously thought and the PDL was finally shifting back into its normal position, thus closing the contact.

 

[DentinBond]

All teeth are programmed to move mesially and occlusally. This is to make up for attrition, both occlusal and interproximal, and attrition was far more severe for our distant ancestors than it is today. Many dietary factors enter into this, but in many cultures people would grind up their grains with stone tools and all that stone grit got in there... So my anthropologist friends tell me.

In any event, the answer to why some teeth with open contacts drift back into place, as in your example, and why some remain open has to do with occlusion. If the palatal cusp of #2 in your example sufficiently engages the fossa of #31, the dynamics of closing during eating and speaking throughout the day may keep it in place. Especially in bruxers, I suppose. Other times the cusp angles and muscle habits are more relaxed and the tooth can drift. It's all a matter of force equilibrium over time.

 

[Firm]

First ask if the patient is catching food in the area, then floss the contact to see if you can find anything. Sometimes a contact seems very light, but they aren't catching food. On the contrary, a heavy broad contact can catch all kind of food.
If the patient is catching food, place a little topical between #29 and 30. Then placed the biggest wedge interproximally between #29 and 30 for 15-20 minutes (or longer if you have another procedure to do on them). The patient is going to hate you, but just ask them to take a tylenol before their appointment. Finish your other procedure (doesn't matter where you were working), remove the wedge and bring the patient back in 3-4 weeks and check your contact. It should be closed. Explain to the patient you would rather do that then numb them up, rubber dam them and do it again, but you will do it again if it's not right. All you are doing is expanding both PDL's and letting them drift back to a natural position. PDL is on average .25 mm so 2 teeth will give you .5 mm of working room. Any more than .5 mm will not work.