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INTRODUCTION

In the late 1800s the need for a matrix became apparent


when dentists recognized that the best way to treat a tooth affected
by dental caries on the approximal surfaces was by restoring its
anatomical contour and contacts with adjacent tooth. The matrix
was needed to proide the missing wall or walls and thus contain
the restoratie material during the filling of the prepared caity. !ntil
the late 1800s" the rationale for treating carious lesions on the
approximal surfaces of teeth was based on either a restoratie or a
prophylactic concept.
EARLY CONCEPTS OF TREATING APPROXIMAL CARIES
Restorative concept
The rationale for restoratie treatment was to remoe the
caries and fill the caity with a suitable material. #t this time"
howeer" restoration of the tooth to form and function was not of
general concern.
Proph!actic concept
The rationale for prophylactic treatment was premised on an
early theory of caries" which taught that caries began at the point of
contact between the teeth where pressure damaged the enamel $
the lesion being caused by the action of external corrosie agents.
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The method adocated the creation of a self $ cleansing
space by remoing diseased or healthy tooth structure from the
approximal surfaces" thereby achieing total and permanent
separation of teeth.
The self $ cleansing space was indicated for the preention of
caries" for the treatment of superficial caries" and to proide access
to deep caries.
The procedure was accomplished by the use of a file" the
oldest method of remoing tooth structure.
The procedure as described by %#&&I'(18)8* re+uired the
remoal of one $ third or more of the tooth and created a shoulder
at the cerical margin to maintain contact in this area and preent
the teeth from drifting.
In the posterior regions" the separation was referred to a , $
shaped space. If the teeth re+uired restorations" they were
designed so as not to encroach on the space created.
-en with these improements howeer" the results obsered
by the general practitioner led to condemnation of the procedure by
the profession at large. The main criticism of this techni+ue" oiced
by patients and the practitioners and patients ali.e" concerned the
disfigurement of teeth. /ot only did patients complain of disfigured
teeth" they also complained of impaction of food on the gingiae
and sensitiity of teeth due to exposed dentin.
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0y 1881" the techni+ue was contraindicated.
CONTOURED FILLINGS
#round 1820" practitioners changed the way they restored
teeth that had approximal lesions.
The concept was premised on a new theory of caries" which
taught the caries began below" not at the contact point of the teeth
as with the early theory of caries(3I44-& 120)* and adocated the
restoration of the natural" or original contour and contact of the
tooth. #s such a contoured filling
1. 5ould reestablish the proper form of the inter $ proximal space
2. 3aintain the function of the teeth
3. -nsure no breach in the continuity of the occlural aspect of the
dention.
4. 3aintain the length of the arch
5. 6reent impaction of food
6. 3aintain and promate the health of the gingiae as well as the
comfort of the patient
Thus 04#78(1820* brought a new and different meaning to
the 9, $ shaped space . #n additional concept introduced
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concurrently prescribed extending the margins of the approximal
surfaces of the caity on to facial and lingual surfaces of the tooth.
This concept not only facilitated the placement of contoured
fillings" but also placed the caity margins within the range of
protectie influences" reducing the possibility of recurrent caries.
EARLY MATRICES
The early adocates of contoured fillings included 5. %
#t.inson" 3 .% 5-00 and '.% :!I4;<&=.
They recognized that to fill a prepared caity and produce a
contoured filling the practitioner re+uired assistance in containing
the filling material without such assistance " oer contour at the
cerical leel and under contour at the occlusal leel resulted.
The assistance came in the form of a matrix" which proided
for the missing walls of the prepared tooth and transformed a caity
of two" three or more surfaces into a simple one.
In addition the matrix could be molded to assist in re$
establishing the natural contours of the tooth.
-arly in its use" the matrix was subject to criticism. 'ome
belieed that when a tooth was to be restored with direct filling gold"
the matrix did not allow for enough contour of gold to compensate
for the subse+uent polishing and adapted too closely to the
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margins" thus proiding the potential for inade+uate condensation
of gold in these areas especially at the cerical area.
ORIGINAL MATRIX
1. >#78 3#T&I?
2. %!-@ 3#T&I?
3. 6-&&@ 3#T&I?
4. 0&!/T</ 3#T&I?
(A) CUSTOM MATRICES
I. Anato"ic "atrices II# Tie $an% "atri& III# Contin'o's !oop
"atri&
1.'hellac matrix 6erry matrix %erbst
A.%erbst matrix 7lapp matrix /ew.ir. modifi
B.%utchinson matrix ;illebrown matrix 'oldred matrix
).%and matrix 0lac. matrix 'pot welded
C.5oodward matrix #ndrews matrix Tinners joint
D.&ubber matrices 0a.er matrix 5elded
circumferential
(i) =anforth matrix #bernethy matrix &iet matrix
(ii) adapto matrix %allenbac. matrix 7ollar E
band
modification
1.'weeny matrix 3ar.ley modification %arrison
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8.Ingraham $ $$$$$matrix %ampson modification 7opper band
2.'ectional matrix with 6inch band
0i$ ting ring
10.<pen face matrix
(B) MATRICES (IT) RETAINERS
#lthough the early matrices were intended for use with direct
filling golds" these matrices were also recommended for use with
amalgam which has been introduced to #merica in 18B0s.
0ecause of its plasticity amalgam re+uired a matrix for the
condensation and deelopment of proper physical properties"
contour and inter proximal contact.
T)E ORIGINAL MATRIX
The first recorded use of a matrix is of that introduced by
=5I/-44-(18CC*. The matrix consisted of a band made from a
broad" thin piece of dense gold. The band was wedged firmly
against the tooth. %oweer it was opened against the cerical
margin of the caity of the preparation to allow space for
condensation of excess gold.
#lthough his own personal testimony and that of his peers
(0rophy 188D " >ac. 1881* point =winelle as the originator of the
matrix. 4ater" the original matrix was described as the metal band
that was wedged against and supported by the adjacent tooth" but
was not attributed to any one inentor.
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IMPRO*EMENTS ON T)E ORIGINAL MATRIX
5ith the new concept of contoured fillings" the matrix too. on
added significance. The earliest matrices incorporating the new
concepts appeared in the late 1800s and included the >#78"
%!-@" 6-&&@ and 0&!/T</ 3#T&I7-'. #s a group" these
matrices used arious materials of unspecified thic.ness for the
band.
The materials included steel" platinum plate or foil" brass"
copper" phosphor $ bronze" :erman siler and tin. ;ew of these
bands were precontoured.
+AC, MATRIX
>ac. matrix introduced in 1811" was accepted as the first
matrix to satisfy the concept of contoured fillings. The matrix
consisted of a slight wedge shaped piece of steel hollowed out to
create a depression on its face to correspond to the desired
contour.
The band was made in assorted sizes and shapes and was
put into place with forceps" the #djacent tooth used for
retention. The band was then wedged with a boxwood wedge.
MATRICING
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3atricing is the procedure whereby a temporary wall is
created opposite to the axial walls surrounding areas of tooth
structure that were lost during tooth preparation.
It is used with restoratie materials that are introduced in a
plastic state.
O-+ECTI*ES
The matrix should
1. =isplace the gingiae and rubber dam away from the caity
margins during introduction of the restoratie material.
2. #ssure dryness and non$contamination of the details and the
space to be coered with and occupied by the setting restoratie
material.
3. 6roide shape of the restoration during the setting of the
restoratie material i.e band materials should be unyielding to
the enregies of insertion.
4. 3aintain shape during the hardening of the materila.
5. 7onfine the restoratie material within the caity proparation and
predetermined surface configration.
MATRICES FOR CLASS I CA*ITY PREPARATIONS
=ouble banded Toffelmire for class I.
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Turn the large ice moing .nob until the slotted ice is about
F inch from the inner end of the retainer. 4oosen the screw until its
painted end is clear of the slotted ice.
3a.e a loop out of the uniersal band creating an edge with a
narrow circumference.
The narrow circumference is placed gingially and the wide
circumference edge is placed occlusal.
The free ends of the band are inserted into the ice while the
looped end of the band extends away from the retainer.
#lways be sure the slotted end of the ice is facing gingially.
This will facilitate easy occlusal remoal of the retainer.
Tighten the ice screw to loc. the band in the ice. :uide the
looped end of the band gently oer the tooth. The size of the loop
may be increased or decreased by turning the ice moing .nob.
5ith the band in position around the tooth" tighten the ice
moing .nob.
Ideally the retainer should be parallel and adjacent to the
facial surfaces of the +uadrant of the teeth being operated on.
#n additional small piece of matrix band material is that
contoured to the facial or lingual axial configuration of the
contemplated restoration and inserted between the tooth and the
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preiously positioned and retained matrix in the area of the facial or
lingual extension of the caity preparation.
This piece of material should oerlap oer the margins of the
extension by about 1.C $ Amm circumferentially.
5ith a beaer$tail burnisher" create a separation between the
two bands. 'elect a wedge that will create and maintain the proper
separation between the two bands and thereby enable the
formation of the proper contour facially and E or lingually.
7oer the wedges with softened compounds and insert it
between the two bands and cool to harden.
MATRICES FOR CLASS II CA*ITY PREPARATIONS
a) SINGLE.-ANDED TOFFELMIRE FOR CLASS II
This is the most practical matrix for class II caity
preparations. Its use is made uniersal by the easy application and
remoal of the band to and from its holder without disturbing the
condensed material.
PROCEDURE
The basic steps are repeated from the preiously described
double banded arrangement.
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If the caity preparation inoles one proximal surface only
and there is a substantial difference between the heights of the
interproximal gingia on the mesial and distal sides of the tooth" the
matrix band should be trimmed so that it is narrower on the side
where the interproximal gingia is more occlurally located.
It may also be possible to use matrix bands with only one
gingial projection" which should coincide with the proximal side
where the interproximal gingia is more apically located.
If the gingial extension of the proximal portion of the caity
preparation is more apically located than gingial lines facially and
lingually" there is a danger of cutting the gingial tissues facially and
lingually in using a band with a straight gingial edge.
In this situation it is necessary to reduce the occlusal $ apical
width of the band facially and lingually or to use a band with apical
projections which coincide and coer the gingial extension of the
proximal portion of the caity preparation.
In preparation with subgingial margins" especially at the axial
angles or any surface protrusion of the tooth" the edges of the band
occasionally encounter the gingial margin and become bent
inward" preenting further seating of the band.
;or this reason there should be unprepared" exposed tooth
surface apical to the gingial margin of the preparation to support
the band in its apical path and to preent its inward collapse or
bending. This may necessitate gingial retraction or cutting.
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#lso in these situations" the band edges should be guided in
their apical path by placing a flat $ bladed" blunt instrument between
the band and the adjacent unprepared tooth surface apical to the
gingial margin.
#lthough it is preferable to put the retainer in the buccal
estibule" parallel to the adjacent teeth" sometimes" due to shallow
sulcus or sizable buccal inolement of the tooth in a actiity
preparation" the retainer is placed on the lingual. This usually
necessitates a contrangled retainer.
%oweer a retainer should neer be located at right angle to
the facial or lingual surfaces of the teeth operated upon as this will
drastically change the occluso$apical contour of the band.
#s soon as the band is in place and all caity margins can be
seen inside the matrix" a wedge" comparable to the dimensions of
the future gingial embrassure is chosen and tied(always from the
opposite side of the retainer attachment*.
!sing a ball burnisher from within the caity preparation"
shape the matrix material to create the out line of the contact and
contour of the future restoration.
If the caity has buccal or lingual extension" repeat the
modifying steps in the double$banded Toffelmire application.
;or all Toffelmire applications" after the insertion and initial
hardening and manipulation of the restoratie material" the wedges
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and secondary band are remoed. Then the retainer is loosened
and disengaged. The primary band is bent against adjacent tooth
surfaces and remoed from between the teeth in an occlusal
direction" while being pressed against the adjacent tooth.
If the contact area is extremely tight and the band is resistant
to remoal" it is a good idea to cut the band on the opposite side of
the retainer" remoe the roughened portion of the band and then
pull it buccal$lingually with pressure against the adjacent tooth.
b) I*ORY MATRIX NO#/
The band encircles a posterior proximal surface so it is
indicated in unilateral class II caities.
c) I*ORY MATRIX NO#0
The band encircles the entire crown of the tooth so it is
indicated for bilateral class II caities.
%1 -LAC,2S MATRICES
i*0lac.s matrix for simple cases is recommended for a majority of
small and medium size caities
PROCEDURE
7ut a metallic band so that it will extend only slightly oer the
buccal and lingual surfaces of the tooth.
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To preent a wrap" around holding ligature from slipping off
the band and the band sliding gingially. The corners of the gingial
ends are turned up to hold the ligature.
ii) -LAC,2S MATRIX with a gingial extension to coer the
gingial margin of a subgingial caity.
In this form of extension is created in the occluso$gingial
width of a band to coer the gingial margin of a subgingial
caity. The retaining procedures are the same as for the preious
type of 0lac.s matrix.
e) SOLDERED -AND OR SEAMLESS COPPER -AND MATRIX
These are indicated for badly bro.en teeth" especially those
receiing pin retained amalgam restorations" with large buccal and
lingual extension i.e 7lass II design preparation
PROCEDURE
# stainless steel band is cut according to the measured
diameter of the crown of the tooth" then the two ends are soldered
together or a seamless copper band is selected so that it barely
clears the diameter of the tooth in the cerical area.
-ither the band could be heated in a flame until it glows red
light. It is then +uenched in alcohol thus softening the band for easy
handling.
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5ith cured scissors" fasten the band so its gingial periphery
corresponds to the gingial curature and the 7->.
The band is then smoothed to remoe rough edges cerically
and occlusally. 5ith containing pliers contour the band to produce
the proper shape in the contact area.
#reas of the band in the contact area are reduced to a paper
thinness using a coarse sand paper disc.
Then they are recontoured . /ext the band is seated on the
tooth and tightened at the cerical end by pinching a 9tuc." using a
flat bladed plier at the gingial edge in the area accessible to the
plier.
To stabilize the band and preent cerical flashes of
amalgam" wedges are placed gingial to the cerical margin of the
preparation.
The external portions of the matrix and the wedges are
coered with compound to further stabilize the matrix. # wire is
inserted facio$ lingually in the compound to further stabilize it.
#pply a heated ball burnisher from the inside of the caity to
the band" softening the external compound and insuring the proper
contour" contacts and embrasures.
#fter condensation and initial coering" the compound is
remoed and the matrix is cut at the area of the tuc..
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5ith a plier or hemostat" grip the band at either side of the
scissors" cut and tear through each thinned contact portion to
remoe the band without damaging the proximal region of the
amalgam.
f) T)E ANATOMICAL MATRIX
This is the most efficient means of reproducing contacts and
contour.
It is entirely hand made and contoured specifically" for each
indiidual case. It is specially useful in mutilated teeth. It is indicated
for class II designs.
PROCEDURE
# piece of G0.001 $ 0.00AH stainless steel matrix band 1E8
th
in
width is drawn between the handle of a pair of festooning scissors.
This procedure facilitates the adaptation of the free ends of the
matrix to the proximal surface of the tooth.
The matrix is cut to proper length. It must extend well beyond
caity margins. To obtain a proper length the centers of the
proximal buccal and proximal lingual cusps are used as a guide.
The matrix band is contoured with contouring pliers. The band is
then trimmed so that the matrix will extend well below the gingial
margin of the caity and at least Amm beyond the buccal I lingual
margin of the caity.
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# wedge is selected and shaped to conform to the gingial
embrasures" and it is then placed in warm water to soften it slightly.
Two small cones of compound are warmed in hot water.
These compound cones are forced one at a time" using thumb and
finger pressure into the buccal and lingual embrasures.
The pressure is maintained until the compound has flowed
eenly oer the entire buccal and lingual surface of the adjacent
teeth. # wire staple is constructed from a paper clip.
The staple is heated in a flame and forced into the compound
in the buccal and lingual embrasures. This adds to the stability of
the matrix by loc.ing together the A pieces of the blac.ing
compound.
# warm ball burnisher is used to soften any compound that
has been forced between the matrix and the adjacent tooth. The
matrix is burnished lightly against the contacting tooth.
#fter initial hardening of the inserted restoratie material" the
compound is crac.ed at its occlusal junctions using a sharp chisel
or .nife.
The wedges are remoed using a hemostat and the band is
curled bac.wards against the adjacent tooth and withdrawn
buccolingually" with pressure against the adjacent proximal surface.
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g) ROLL . IN . -AND MATRIX 3A'to "atri&1
h) S . S)APED -AND
This is used for class II caity preparations. 6rocedural
instructions are exactly as described in class III preparations
41MATRICES FOR A CA*ITY PREPARATION FOR AMALGAM
RESTORATION ON T)E DISTAL OF T)E CUSPID
a) The S . shape% "atri&
This is an ideal matrix for class III caity preparation on the
distal of the cuspid" with either a labial or lingual access.
PROCEDURE
<ne half to one inch of regular strip matrix 0.001 $ 0.00A in
thic.ness is used. # mirror handle is used to produce the '$shaped
in the strip. The band is contoured oer the labial surface of the
cuspid and the lingual surface of the adjacent bicuspid.
5ith contouring pliers" the strip is contoured in its middle part
to create desired form for the restoration. It is then placed inter
proximally and wedged firmly apical to the gingial margin and
coered with compound at its facial and lingual ends.
The remaining procedure is similar to those of the anatomic
matrix.
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4) MATRICES FOR CLASS III DIRECT TOOT) COLOURED
RESTORATIONS
These are usually transparent plastic matrix strips. ;or resins
cellophane strips are used. 3ylar strips may also be used.
a) 3atrix for class III preparations with teeth in normal alignment.
The suitable plastic strip is burnished oer the end of a steel
instrument. -g J$ handle of a tweezer " to produce a 0-44@ in the
strip. This will allow for curature which if properly contoured and
designed" will reproduce the natural proximal contour of the tooth.
The strip is cut to allow the belly to be placed where the
contact is desired. In placing a plastic strip between the teeth" it
should be cut as wide as the tooth is long.
The corners of the strip should be trimmed therefore " to allow
for better adaptation to the tooth and to preent any excess material
from forming on and beyond the facial or lingual margins.
The length of the strip should be just sufficient to coer the
labial and lingual surfaces of the tooth.
# wedge is trimmed and applied to hold the strip in place. ;or
labial approach use fingers of the left hand for holding the strip
firmly against the lingual surface of the tooth while the material is
being placed in the caity.
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b) 3atrix for class III preparation in teeth with irregular alignment
PROCEDURE
# suitable plastic strip is contoured and adopted as described
preiously and then remoed.
;or a labial approach preparation a compound impression is
ta.en of the lingual surface. The compound is allowed to oerlap
the adjacent teeth. It is cooled and then remoed.
The compound impression should show an imprint of the
caity preparation.
The compound impression is then warmed. The surface is
softened without distorting the form of the entire impression. This
can be done by holding the impression close to the flame only for a
moment.
The strip is then placed into position again" followed by the
compound impression against the strip" assuring perfect adaptation
of the matrix to the caity on the lingual surface. The material is
then introduced from the labial.
c) MATRIX FOR T(O SMALL PROXIMAL PREPARATIONS IN
CONTACT (IT) EAC) OT)ER
#n appropriate plastic strip is folded with one end slightly
longer than the other.
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# loop K inch in diameter is formed in the matrix strip. The
loop is flattened and ceased with a finger" ma.ing a T $ shaped and
trimmed. The trimmed matrix is then placed between the teeth.
;or labial approach preparations" the strip is held oer the
lingual surface with the finger while the caities are filled.
5) MATRICES FOR CLASS I* PREPARATIONS FOR DIRECT
TOOT) COLOURED MATERIALS
a) The plastic strip for inciso proximal caities
PROCEDURE
# suitable plastic strip is folded at an angle into an 4 $ shaped
then sealed with a plastic cement or any adherence that does not
react with tooth coloured material.
<ne side of the strip is cut so that it is as wide as the
length of the tooth.
The other side is cut so that it is as wide as the width of
the tooth.
The strip with a wedge in place is adapted to the tooth
$1 ALUMINIUM FOIL INCISAL CORNER MATRIX
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These are 9stoc. metallic matrices shaped according to the
proximo $ incisal corner and surfaces of anterior teeth. They can be
adapted to each specific case.
PROCEDURE
# corner matrix closest in size and shape of the lost area of
the tooth is selected. It is trimmed gingially so that it coincides with
the gingial architecture and coers the gingial margin of
preparation.
#s it is readily deformable" shape it with the thumb and first
finger until it fits the mesio distal and labio $ lingual dimensions of
the tooth. 4oosely place the wedge allowing space for the matrix
band thic.ness.
6artially fill the preparation and then the corner matrix
preferably after enting the corner.
#pply the partially filled matrix oer the partially filled tooth
preparation at its predetermined location between the loosened
wedge and the tooth.
c) TRANSPARENT CRO(N FORM MATRICES
These are 9stoc. plastic crowns which can be adapted to
tooth anatomy.
In bilateral class I, preparations use the entire crown form.
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In unilateral class I, cut the plastic crown inciso $ gingially
into two hales and use only the side corresponding to the
location of the preparation.
PROCEDURE
7hoose the crown form with the size and shape close to the
tooth to be restored.
;or a unilateral class I," after cutting the crown from inciso $
gingially" so that the correct incisal angle of the crown form
matches the last tooth incisal angle. If for bilateral class I, .eep the
crown as it is.
Trim the crown form gingially" so that it coincides with the
gingial architecture and completely coers the gingial margin of
the preparation.
7hec. the matrix to ensure that it will recreate proper contact
and contour. Then remoe the matrix and thin it at its contact area
with a sand paper disc. It should be perforated at the incisal angle.
7ompletely fill the matrix with the restoratie material and
partially fill the preparation with the restoratie material.
6lace the filled crown form on the tooth in the desired
location. The wedge is then tightened.
d) ANATOMIC MATRIX
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6rior to preparing the teeth" study model for the affected tooth
together with at least one intact adjacent tooth on each side is
made.
It is preferable" especially in multiple inolement. The
defectie area is restored on the study model in a fairly heat
resistant material ( plaster" acrylic resin" blac.ing compound"
plasticine" etc* to the appropriate configuration.
# plastic template is made for the restored tooth on the model
using a comb of heat and suction conse+uently to draw the
mouldable material onto the study model.
The template is trimmed gingially to fit the tooth and
adjacent peridontal architecture. It should seal on atleast one
unprepared tooth on each side.
This is the matrix which should be ented by perforating the
corners of its part corresponding to the future restoration.
6) MATRICES FOR CLASS * AMALGAM RESTORATION
a) (INDO( MATRIX
This matrix is formed using either a Tofflemire matrix or
copper band matrix.
PROCEDURE FOR USING T)E TOFFLEMIRE MATRIX
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The contrangle retainer is applied at the side of the tooth that
does not hae the preparation. # window is cut in the band slightly
smaller than the outline of the caity (perforated windowed bands
are aailable*. 5edges are placed mesially and distally to stabilize
the band.
PROCEDURE FOR USING T)E COPPER -AND
# seamless copper band is selected that is just larger than
the prepared tooth. ;asten and adjust the band to the tooth.
# window is cut coinciding with the caity but smaller in
diameter. The edges are smoothed.
b) T)E S . S)APED MATRIX
This is usually indicated for a proximal extension of a buccal
or lingual class , preparation.
7) MATRICES FOR CLASS * PREPARATIONS FOR DIRECT
TOOT) COLOURED RESTORATIONS
a) #natomic matrix for non light cured direct tooth colored
materials.
PROCEDURE
The class , caity may be preliminary filled with inlay wax or
gutta $ percha and trimmed to the proper contour. The wax and the
tooth are then coated with cocoa butter or mylar strip and
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compound impression is ta.en of the tooth surface to be restored.
#djacent surfaces are to be included in the impression. #fter the
compound has cooled" it is remoed and the wax is remoed from
the caity.
# mix of the restoratie material is made and placed into the
caity" and the compound matrix is placed into position and held
securely in place under pressure until the material sets.
SUMMARY 5 CONCLUSION
#lthough there hae been ery few inestigations conducted
on this subject" it is clear that no matrix techni+ue is capable of the
exact replication of normal anatomic contour of restored teeth.
<erall the anatomic matrix procedures must closely reproduce
normal tooth contours.
5edging is uniersally imperatie in order to eliminate cerical
flash of restoratie material.
'ome of the clinical significance is the fact that circumferential
matrix bands retained by tightening deices(Toffelmire* hae
been shown to deform tooth structures.
6assiely inserted matrix bands li.e anatomic matrix and T $
shaped bands etc hae no deformatie effect on the remaining
tooth structure.
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