Handling the matrix band in a diastema closure

 Today I did a diastema closure in composite resin and have a tip on how to handle the matrix band during the procedure. There was uneven addition to both central incisors so I used a clear strip to contain the material for the addition to the first one. I decided to do the tooth that needed the least addition first to allow the most space when doing the second one to place composite. I packed cord and then teflon tape to retract the gingiva to allow me to take the material subgingival for emergence and to block fluid for moisture control. Holding the clear strip wrapped around the tooth i packed small amounts of composite in with a microbrush. I packed this all the way down to the base of the matrix band. The teflon and tightness around the tooth prevented extrusion of the composite and overhangs without a wedge. Even if there was some extrusion, this could be polished off before the other tooth was bonded to. Once I cured the cervical portion, I took the clear strip off and built the rest of the tooth freehand to the desired tooth width.

I then finished and polished the tooth. The challenge then was to have a well fitting and contoured matrix band and wedge for the adjacent tooth as it would not be easy to remove overhangs and recontour the tooth in the tight space once the contact was closed. I used a sectional matrix and wooden wedge and achieved a good seal. However the band kept slumping away from the adjacent tooth. This was probably something to do with an improperly contoured wedge but I figured as long as the band could be moved to the right spot with light finger pressure then the outcome would be good. What I normally do is hold the band over against the next tooth with my finger during the bonding stage, composite placement and light curing. To keep the process hands free, today I did something different. I placed some composite near the incisal edge position in the interproximal area and held the band against the adjacent tooth. This was then light cured by my assistant.Once I let go, the cured composite was holding the band in the desired position and I was able to place composite around this to fill the space between the band and the tooth (Figure 1). The benefit of taking this extra step is that I had one hand free to ensure that I could more carefully place the remaining composite and properly contour the materials and avoid excess extrusion. Normally when I hold the band with my finger I have to quickly pack as much composite in as possible with the least amount of voids and cure it before my finger slips. Then I have to come back and clean up the mess. This new addition to my technique made the whole process much smoother and stress free.

 

Figure 1: Schematic diagram of a diastema closure. The band isn't adapting well to the adjacent tooth (above). A blob of composite is cured between the tooth and the band to hold the band in place and composite will then be placed around this to fill the rest of the space (below).