Limitations of tofflemire bands
Tofflemire style matrix bands are slowly going out of fashion due to a few limitations and are being replaced by more "in season" contoured sectional matrix bands. Tofflemire matrix bands have a few uses and I find them useful in large buildups including core buildups in some cases as well as in deep subgingival cavities but some limitations preclude their use in modern dentistry:
-Tofflemires must be tightened around the tooth to allow a seal at the cervix. This generally draws the band away from the adjacent tooth and makes gaining a tight contact difficult. Use a wooden wedge tightly between the teeth and loosen the band a 1/4 after wedging to assist in a contact.
Due to the shape of a tofflemire band, a flat, non anatomic surface is created. This has a contact point very high in close proximity to the marginal ridge. Due to the lack of an occlusal embrasure, it is difficult for floss to flow down between the teeth.
-The thickness of material at the marginal ridge is often very thin and is likely to fracture after a few years causing an open contact and food impaction. If using a GIC, the thin nature of the ridge increases the risk of restoration fracture when removing the matrix band especially if the material is riding up the matrix band above the marginal ridge. Before the material sets, take a flat plastic or sickle probe and shape the marginal ridge so there is no thin excess of material adhering to the matrix band. Wait 30 seconds longer than the recommended setting time (it is faster than breaking the restoration and redoing it) and rotate the matrix band out rather than lifting vertical (remove the matrix retainer and lift the buccal or lingual side of the band out first.
-Tofflemires aren't fully circumferential as the mid buccal aspect at the location of the retainer isn't fully enlosed. Automatrices are an alternative but have the same limitations of contact points as previously mentioned. I find that overbulking the restoration into the buccal area and cutting back after full set is sufficient to make an acceptably contoured restoration.
thin ridge fracture, wait till set
-Tofflemires must be tightened around the tooth to allow a seal at the cervix. This generally draws the band away from the adjacent tooth and makes gaining a tight contact difficult. Use a wooden wedge tightly between the teeth and loosen the band a 1/4 after wedging to assist in a contact.
Due to the shape of a tofflemire band, a flat, non anatomic surface is created. This has a contact point very high in close proximity to the marginal ridge. Due to the lack of an occlusal embrasure, it is difficult for floss to flow down between the teeth.
-The thickness of material at the marginal ridge is often very thin and is likely to fracture after a few years causing an open contact and food impaction. If using a GIC, the thin nature of the ridge increases the risk of restoration fracture when removing the matrix band especially if the material is riding up the matrix band above the marginal ridge. Before the material sets, take a flat plastic or sickle probe and shape the marginal ridge so there is no thin excess of material adhering to the matrix band. Wait 30 seconds longer than the recommended setting time (it is faster than breaking the restoration and redoing it) and rotate the matrix band out rather than lifting vertical (remove the matrix retainer and lift the buccal or lingual side of the band out first.
-Tofflemires aren't fully circumferential as the mid buccal aspect at the location of the retainer isn't fully enlosed. Automatrices are an alternative but have the same limitations of contact points as previously mentioned. I find that overbulking the restoration into the buccal area and cutting back after full set is sufficient to make an acceptably contoured restoration.
 |
| Tofflemire bands results in very flat interproximal contours (red) compared to the natural tooth contour (Green). They result in very thin, unsupported material at the marginal ridge (orange) which is likely to fracture long term |
thin ridge fracture, wait till set
Comments
Post a Comment
Please leave a comment and let me know what you think or if there are any topics you would like covered in the future