WREB - Class II lesion

Discussion in 'NBDE Exams & Licensure Exams' started by Dr.McSultry, May 6, 2007.

  1. Dr.McSultry

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    Ok here's another Operative question:

    Say I'm doing DO's (amalgam and composite) on #5 and #12...any suggestions on how to tackle the "rare but often present" DISTAL concavities when restoring the proximal box?...aka, what's the best way to get good closure at the gingival cavosurface margin.
    My second question is related to the above as well...it has more to do with composite Class II restorations. I don't have much experience in placing posterior composites...I hear interprox. contacts can be a b**ch to achieve. Any suggestions?...do sectional matrices/BiTine rings work better than toffelmires? Anyone have any past experiences that they can share?

    thanks :hardy:
     
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  3. K2 Dental

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    Alright I'll bite at this one...

    Just took wreb and I did DO on #4 and #12.
    For composite I used the toffelmeir with the dead soft matrix bands. Wedge really good and make sure that you have a good seal with the matrix around the ginigival margin. Burnish really well against the adjacent tooth. I then place a thin layer of flowable in the box (about a mm or so) and press a small condenser up against the matrix to hold it in place against the adjacent proximal surface. I then light cure while doing this and it will hold the matrix in place against the adjacent tooth. Then fill in incremental layers with packable composite makins sure that you push the material up against the adjacent tooth and cure in layers. I have never had a problem attaining a tight contact using thie method. My contacts were money on the wreb.


    For the amlagam I just used the dead softs again and wedged really well and was sure to condense against the adjacent tooth with pressure.

    This is just what I did. There are many other methods. Practice a few and the dentiform and see what works for you.
     
  4. Prosthoman

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    fill the half of your box with flowable composite, cure it then for the 1/3 occlusal part use a packable composite this helps alot in establishing a good contact.
     
  5. LonestarYankee

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    finished the wreb yesterday and had a wicked composite contact. a key is to pre-wedge for a solid 3-4 minutes prior to placing the composi-tight. use the segmental matrix (NOT a tofflemire), wedge the matrix, place a tight bi-tine (sp???) ring, and let it sit for another minute or two to push the pdl. burnish the matrix against the adjacent tooth really well, and then place your composite as normal. i really don't see a need to use any flowable in the box, but that's your call. i chose to use heliomolar for the entire composite as it's a microfill so it polishes really nice (it looks just like tooth) and it can actually be carved with hand instruments to ensure you have great anatomy and no flash. good luck!
     

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