DTUS0610

likely that blood will infiltrate into the preparation in the gingival area and make etching and placement of the dentin bonding adhesive without contamination impossible. An excellent way to manage the proximal tissue hemorrhage quickly and completely is to apply Expa-syl (Ker) to the area, tap it to place with a dry cotton pellet, and wait one to two minutes (Fig. 3). Using an air-water mixture, rinse away the Expa-syl leaving a little bit of the material on top of the tissue, but below the gingival margin of the preparation (Fig. 4). The Expa-syl will deflect the tissue away from the preparation margin, maintain control of any hemorrhage and facilitate placement of the proxi- mal matrix without the risk of con- tamination of the operative field. Class II preparations that need a matrix band for restoration will require rebuilding of the marginal ridge, proximal contact and often a large portion of the interproximal surface. The goal of composite placement is to do so in such a way that the amount of rotary instrumentation for contouring and finishing is limited. This is especially true for the inter- proximal surface. Because of the constraints of clini- cal access to the proximal area, it is extremely difficult to sculpt and cor- rectly contour this surface of the res- toration. Proper reconstitution of this surface is largely due to the shape of the matrix band and the accuracy of its placement. After removal of caries and old restorative material, the outline form of the cavity preparation is assessed. If any portion of the proximal contact remains, it does not necessarily need to be removed. Conserve as much healthy, unaffected tooth structure as possible. If the matrix band cannot be eas- ily positioned through the remaining contact, the contact can be lightened using a Fine Diamond Strip (DS25F, Komet USA). The Composi-Tight 3D™ Matrix System was chosen to aid in the anatomic restoration of the mesial proximal tooth morphology of this maxillary first molar. The appropriate matrix band chosen is one that will best corre- spond anatomically to the tooth being restored, and also to the width and height of the proximal surface. The height of the sectional matrix should be no higher than the adja- DENTAL TRIBUNE | March 2010 Clinical 15A AD cent marginal ridge when properly placed. Because of the concave ana- tomic shape, the proximal contact will be located approximately one millimeter apical to the height of the marginal ridge. The Composi-Tight Matrix For- ceps are used to place the selected sectional matrix band in the correct orientation in the proximal area. The positive grip of this instru- ment will allow for more exact place- ment than a cotton plier, which could damage or crimp the matrix band. The sectional matrix band (Gar- rison Dental Solutions) is positioned g DT page 16A Fig. 5: A sectional matrix band gripped by Composi-Tight Matrix Forceps, an instrument that enables precise placement of ectional matrix bands without deformation. Fig. 6: The WedgeWand during clin- ical application with the wedge bent at a 90-degree angle to the handle. Fig. 6a: WedgeWands provide an excellent seal. Fig 7: The Soft Face 3D-Ring in place. Note the precision of the cavo- surface and marginal seal by the sectional matrix.