CONSERVATIVE DENTISTRY AND ENDODONTICS

2. 2
CONTACTS
AND
CONTOUR
Presented by:
Dr. Snehal Shelke
Guided by :
Dr. M. M. Warhadpande
Dr. Darshan Dakshindas
Dr. Sulbha Radke

3. Contents
3
• Introduction
• Contacts
• Contours
• Proximal Contact Area
• Embrasures
• Marginal Ridges
• Procedures for formulation of proper contacts and contours:
• Toothmovement
• Rapid
• Slow

4. • Matricing
• Classification
• Types
• Recent Advances
• Conclusion
• References
4

5. • From cariogenic aspect there may be only twenty occlusal surfaces but there
are sixty contacting proximal and sixty four facial and lingual surfaces.
• Presence of proper contacts & contour is important to maintain stability &
occlusal harmony.
• A thorough knowledge of the contacts & contours of various teeth is
mandatory for understanding:
5
Predisposing factors of
proximal caries like faulty
interrelationships.
Significance of marginal
ridges, embrasures for re-
establishing the form and
function of restored
teeth.
Periodontal aspect &
health of the tooth to be
restored.

6. • Benefits of an ideal contact & contour:
1. Conserves the health of peridontium
2. Prevents food impaction
3. Makes area self cleansable
4. Improves longevity of proximal restorations
5. Maintains normal mesiodistal relationship of the teeth in the dental arch
6

7. • Role of a dentist is to establish the ideal form so as to perform optimal functions,
maintaining the integrity and longevity of individual tooth.
7

8. Food we consume moves in 3 different directions:
 Occlusal surfaces
 Contact & Gingival embrasures
 Facial & Lingual sulcus
8

9. • Any decay occurring on the proximal surface is
mainly due to faulty interrelationship between :
 Contact Areas
 Marginal Ridges
 Embrasures
 Gingiva
9

10. Proximal Contact Area
10
• Area of proximal height of contour of the mesial or distal surface of a tooth
that touches the adjacent tooth in the same arch.
• According to their general shape there are three
types of teeth:
1. Tapering teeth
2. Square type
3. Ovoid type
: Wide crowns & narrow cervical region
: Bulky, angular with little rounded contour
: A transitional type between tapering & square types
: Surfaces are convex but infrequently they may be
concave

11. Types of teeth
Tapering Square ovoid

12. CONTACT TAPERING SQUARE OVOID
Between
Incisors
Contacts starts at incisal
ridge & labial, labiolingually
Starts at incisal ridge & in line
with incisal ridge labiolingually
Slightly lingual to incisal ridge
Canine Mesial: incisal ridge
Distal: middle third
Close to incisal ridge incisally Close to incisal ridge incisally
Bicuspids Buccal contact is almost at
bucco-axial angle
Buccal periphery more towards
bucco-axial angle
Buccal periphery at junction
of buccal & middle third
At junction of occlusal &
middle 3rd of crown
Occlusal periphery at occlusal
third
Occlusal periphery at
occlusal third
Contact deviated buccally
12
CONFIGURATION OF CONTACTS BETEEN DIFFERENT SHAPES OF TEETH

13. CONTACT TAPERING SQUARE OVOID
Molars
(mesial
contact)
Buccal periphery almost at
bucco-axial angle of tooth
Buccal 1/3 rd
Occlusal 1/3rd
Same as premolars
Occlusal periphery at
junction of occlusal & middle
third of crown
Large cusps
Molars
(distal contact)
middle third More lingually deviated than
mesial
Buccal periphery in line with
central groove
Embrassures Wide variations
Incisal & labial are negligible
Incisal, lingual, occlusal & buccal
embrasures are NIL
Incisal, labial, buccal &
occlusal embrasures are wider
& deeper
Gingival & lingual
embrasures between
anterior teeth are the widest
& longest in the mouth
Gingival embrasures are almost
not noticeable
Gingival & lingual are short &
broad
- Buccal embrasures are
small, lingual are long
13

15. Contours
15
• Convexities on the facial & lingual surfaces of tooth that offers the
protection & stimulation of the supporting tissues during mastication.
Functions of contour:
1. Deflecting food
2. Maintenance of periodontal tissues
3. Maintain contact with adjacent teeth

16. Height of Contour
• Area of greatest circumference on the facial and lingual surface of the teeth.
• Protects the gingival tissue by preventing food impaction.
ANTERIOR POSTERIOR
Cervical 3rd on facial
& lingual surface
Gingival 3rd on facial
surface
Middle 3rd on lingual
surface
16

17. Types of contour
OVERCONTOUR
• Deflects food away from gingiva
• Understimulation of supporting tissues
• Plaque accumulation
UNDERCONTOUR
• Irritation to soft tissues
ADEQUATE CONTOUR
• Stimulation of supporting tissues
• Healthy peridontium
17

18. Embrasures (spillways)
• V-shaped spaces between the teeth that originate
at the proximal contact areas between adjacent
teeth.
• Serves 2 purposes:
• Provides a spillway for passage for food during mastication
• Prevents food from being forced into the contact area
18

19. 18
• Named for the direction towards which they radicate:
facial, lingual, incisal/occlusal, gingival
Facial/Buccal
Incisal/Occlusal
Lingual/Palatal
Gingival

20. • Gingival embrasures filled with papilla – prevents food being trapped in
this region
• Anterior
• Posterior
: papilla is triangular
: tent shaped (col)
• Correct relationship of embrasures, cusps, sulci, marginal ridges & grooves of
adjacent and opposing tooth provide escape of food from the occlusal surface
during mastication
20

21. • Embrassure is reduced: additional stress is created in teeth & supporting
structures.
• Embrassures is large: less protection to supporting structures
21

22. Marginal Ridges
• Rounded borders of enamel that forms the mesial & distal
margins of occlusal surfaces of molars & premolars and
the mesial and distal margins of lingual surfaces of
incisors and canine.
• Should always be formed in 2 planes: buccolingually
meeting at a very obtuse angle
• This feature is essential when an opposing functional cusp occludes with the
marginal ridge.
22

23. • Functions:
• Helps in prevention of food impaction proximally
• Mastication
• Protection of peridontium
23
• Marginal ridges of adjacent posterior teeth should be at the same height
to have a proper contact and embrasure forms.

24. Marginal ridges with normal occlusal
23

25. • Marginal ridges with exaggerated occlusal embrasures causes drifting
of teeth which leads to wedging of food

26. Adjacent marginal ridges are not compatible in height - drives the
debris interproximally.

27. Thin marginal ridges will be susceptible to fracture or
deformation

28. Marginal ridges with no occlusal embrasures, the 2 adjacent marginal ridges
will act like a pair of tweezers grasping the food substance passing over it.

29. single planned marginal ridge in bucco lingual direction

30. Procedures of proper contacts & contours
INTRAORAL PROCEDURES:
• Tooth movement
• Matricing

31. Tooth movement
• Act of separating the involved teeth from each other, bringing them closer to
each other or changing their spatial position in one or more dimensions.

32. Objectives:
• To close space between teeth
• To move the teeth occlusally or apically to make them restorable
• Tomove teeth to a position so that when restored, they will be in
a most esthetically pleasing situation.
• To create sufficient space for thickness of matrix band

33. Tooth Movement
Rapid / Immediate Slow / Delayed

34. Rapid/ Immediate movement
• Mechanical type of separation
• Creates either proximal separation at the point of separator’s
introduction and/or improved closeness of proximal surface of opposite
side.
Indications:
• As preparatory to slow movement
• To maintain the space gained by slow movement
• Separation shouldn’t exceed the thickness of the involved tooth’s
periodontal ligament thickness. ie: 0.2 – 0.3 mm

35. Methods
1. Wedge method
• By insertion of a pointed wedge shaped device between the teeth
• The more the wedge moves facially or lingualy, greater is the separation.

36. • Elliot separator
• Indicated for short duration separation that does not necessitate
stabilization
• Useful in examining proximal surfaces in final polishing of restored
contacts.

37. Wood/ Plastic Wedges
• Used in both tooth separation for preparation and restoration
• Triangular shaped wedges (wood/synthetic resin)
• Cross-section base of triangle will be in contact with
interdental papillae.
• Two sides of the triangle should coincide with the
corresponding 2 sides of the gingival embrasure.
• Apex must coincide with the gingival start of the contact
area.

38. Functions:
• Hold the matrix band in position
• Slight separation of the teeth
• Provides space for placing matrix band
• Prevent gingival overhang
• Stabilizes matrix and retainer
• Assure close adaptability of matrix band to the tooth
• Protect interproximal gingiva from unexpected trauma

39. • Types:
• Wooden
• Plastic
• Elastic
• Transparent
• Medicated wedges
• Shape:
• Triangular
• Round
• Trapezoidal

40. Wedging method:
• Location : Gingival embrasure just beneath the contact area.
• Selection : Depending upon the clinical situation.
: Wooden wedges can be trimmed using a knife or scalpel blade
to produce a custom fit.
• Placement : From the lingual embrasure which is normally larger in size.
: But if it interferes with the tongue it may be placed from the
buccal side.
• Length : ½” ( 1-2 cm )so that it does not irritate the tongue or the
cheek.
After placement the wedge should be firm and stable.

41. Wedging techniques
1. Single wedge technique
• Single wedge is placed in the gingival embrasure
2. Piggyback wedging
• A second wedge is placed on top of the first wedge
to wedge the matrix against the margin
• Indicated for patients whose interproximal tissue
level has receded.

42. 3. Double wedging technique
• Here, 2 wedges, one from the facial embrasure and the other from the
lingual embrasure are used.
• Used when proximal box is wide faciolingually.
• Should be used only if the middle 2/3rd of the
proximal margins can be adequately wedged.

43. 4. Wedge wedging technique
• Used in cases when there is a gingival concavity as in the case of a
fluted root.
• Inorder to wedge a matrix band tightly against such a margin, a second
wedge is inserted between the first wedge and the band.

44. • Triangular wooden wedges are more recommended since:
• Easy to trim and adapt well to tooth surface
• When properly shaped, they remain stable during
condensation
• Absorb moisture and swell to provide adequate
stabilization

45. Light Transmitting Wedges
• Plastic wedges which are transparent and have a light reflecting core.
• Used with transparent matrices
• Can transmit 90 – 95% of the incident light : drawing the curing light to
the gingival margins of the restoration
• Provides better marginal adaptation at the cervical area of the class II
composite resin restorations

46. Prewedging
• The procedure of inserting a wedge between the interproximal surfaces of
two adjacent teeth prior to cutting a cavity involving a proximal wall.
• Purpose is to achieve some tooth separation such that, after restoration,
the teeth will return to their original position and a more positive tooth
contact area will be achieved.

47. Error’s with wedge placement
• If wedge is placed more occlusal to the gingival margin,
creates abnormal concavity in the proximal surface of the
restoration.
• If wedge is for apical to gingival margin, band will not be
held tightly against the gingival margin & creates gingival
overhangs in the restorations.

48. 2. Traction method
• Done with mechanical devices which engage the proximal surfaces of the teeth
to be separated by means of holding arms.
• Non-Interfering true separator
• Ferrier double-bow separator

49. Non-Interfering true separator
• Indicated when continuous stabilized separation is required.
• Advantage:
• Separation can be increased or decreased after stabilization
• Device is non-interfering

50. Ferrier double-bow separator
• Separation is stabilized throughout the dental operation.
• Advantage :
• Separation is shared by the contacting teeth and not at the
expense of one tooth

51. Slow/ Delayed tooth movement
Indications:
• When teeth have drifted and/or tilted considerably, rapid movement of the
teeth to proper position will endanger the periodontal ligaments.
• Therefore slow tooth movement over weeks will allow proper
repositioning of teeth in physiological manner.
Methods:
• Separating wires
• Oversized temporaries
• Orthodontic appliances

52. Separating wires
• Thin pieces of wire are introduced into the gingival contact area
• It is then wrapped around the contact area.
• The 2 ends are then twisted together to create separation not to exceed
0.5mm
• Wires are tightened periodically to increase the separation.

53. Oversized temporaries
• Resin temporaries are oversized mesio-distally to achieve slow
separation
• Resin added periodically to increase the amount of separation not to exceed
0.5mm

54. Orthodontic appliances
• Fixed appliances – most effective and predictable method
• Removable appliances can also be used – requires longer treatment

55. Matricing
• Procedure where a temporary wall is created
opposite to the axial walls, surrounding areas
of tooth structure that were lost during
preparation.

56. Matrix
• Matrix is a device that is applied to a prepared tooth before the insertion
of the restorative material to assist in the development of the appropriate
axial tooth contours and inorder to confine the restorative material excess.
• Primary function of a matrix is to restore the anatomic contours and
contact areas.

57. Parts of a Matrix system involves:
• Band
• Retainer
Matrix Band
• Supplied as strips of various dimensions
• Thickness of 0.001” or 0.002”
• Width may be ¼”, 3/8”, 5/16” or 1/8”
• Depending on the height of the proximal surface, suitable size is
selected.

58. Retainer
• Device by which a band can be maintained in its designated
position and shape.
• Can be a mechanical device, dental floss, a metal ring or an
impression compound.

59. Qualities of a good matrix includes:
1. Rigidity
2. Establishment of proper contour
3. Prevention of gingival excess
4. Convenient application
5. Ease of removal
6. Inexpensive

60. Classification of matrices:
1. Based on mode of retention:
i. With retainer (Tofflemire matrix)
ii. Without retainer (Automatrix)
2. Based on type of band
i. Metallic non transparent
ii. Nonmetallic transparent
3. Based on type of cavity for which it is used
i. Class I cavity
a. Double banded Tofflemire (barton’s matrix)

61. ii. Class II cavity
a. Single banded Tofflemire
b. Ivory matrix No. 1
c. Ivory matrix No. 8
d. Copper band matrix
e. Automatrix
iii. Class III cavity
a. Mylar strip
b. S-shaped
iv. Class IV cavity
form
a. Mylar strip
b. Transparent crown
matrix
c. Modified S-shaped
v. Class V
a. Window matrix
b. Cervical matrix

62. Universal Matrix (Tofflemire matrix)
• Designed by BR. Tofflemire
• Ideally indicated posterior teeth
• Commonly used for class II restorations
• 2 types:
• Straight
• Contra-angled

63. Advantages:
• Can be placed facially/lingually
• Retainer and band are stable when in place
• Retainer is separated easily from the band
• Retainer helps to hold the cotton roll (for isolation) in place

64. Ivory Matrix No.1
• indicated in unilateral class II cavities.
• Band is attached to the retainer via a wedge shaped
projection.
• Adjusting screw at the end of the
retainer adaptsthe band to the
proximal contour of the prepared tooth.

65. Ivory Matrix No. 8
• Consists of band that encircles the entire crown of the
tooth.
• Indicated for class II cavities.
• Circumference of the band can be adjusted by adjusting
the screw present in the retainer.

66. Black’s matrices
• Metallic band is cut so that it will extend only slightly over
buccal & lingual extensions of cavity
• Held in place by a wire or a dental floss.
• recommended for majority of small & medium size
cavities

67. Blacks matrix with gingival extension
• To cover gingival margin of a subgingival cavity
• Corners are rounded to prevent wounding the soft tissues.
• Held in place by a wire or a dental floss

68. Copper Band Matrix / Soldered Band
• Indicated for badly broken down teeth such as those receiving pin retained
amalgam restorations & in complex class II restorations with buccal or lingual
extensions
• Cylindrical in shape
• Band with appropriate dimensions of crown are taken and the 2 ends are
soldered.

69. • With curved scissors, the band is festooned in the cervical region to fit the
gingival contour of the tooth.
• Then with the contouring pliers, the band is contoured to reproduce the
proper shape of the contact areas.

70. Anatomical Matrix
• Most efficient means of reproducing contacts & contours.
• Hand-made and contoured especially for individual teeth.
Procedure:
• Stainless steel band 0.001” – 0.002” in thickness and 1/8 “ in width is
drawn between the handle of a pair of festooning scissors.
• Band is cut to appropriate length.

71. • Must extend beyond the cavity margins
• Wedge is placed.
• Small cones of compound material are warmed and then
forced into the buccal and lingual embrasures.
• Pressure is maintained until compound has evenly
flowed into the buccal and lingual surfaces of adjacent
teeth
• Staple is heated and forced into the compound in the
buccal and lingual embrasures.
• Restoration is then placed

72. Roll in band matrix ( Automatrix)
• Retainerless matrix system with 4 types of bands that are designed to fit all
teeth regardless of circumference and height.
• Types:
• 3/16” (4.8mm), 0.002” thickness
• 1/4” (6.35mm), 0.002” & 0.0015” thickness
• 5/16” (7.79mm), 0.002” thickness

73. • Advantages:
• Convenience
• Improved visibility because of absence of retainer
• Ability to place the autolock loop on facial/lingual surface
• Disadvantages:
• Band is flat, difficult to burnish
• Sometimes unstable even with the use of wedges
• Development of proximal contour is difficult.

74. S-shaped Matrix Band
• For class III, class II and with facial/lingual extensions of
class V
• Matrix band of 0.001” – 0.002” is used
• Mirror handle is used to produce the S-shape in the strip
• Strip is contoured in its middle part with contouring pliers
to create desired form for the restoration
• Compound material is used to hold the band in position in
the facial and lingual aspect and also in the gingival aspect.

75. T-shaped matrix
brass/ stainless steel matrix
• Premade T-shaped
bands
• Longer arms of the matrix is bent to encompass the
tooth circumferentially and to overlap the short
horizontal arm of ‘T’

76. Indications:
• Class II cavities involving 1 or both proximal surfaces of a posterior
tooth
Advantages:
• Simple
• Inexpensive
• Rapid
• Easy to apply
Disadvantages:
• Flimsy in structure and not stable

77. Mylar Strips
• For composite restorations in Class III and Class IV
cavities.
Advantages:
• Easy to apply
• Inexpensive
Disadvantages
• flexibility

78. Aluminium Foil Incisal Corner Matrix
• Stock metallic matrices shaped according to proximo-incisal corner and
surfaces of anterior teeth.
• Cannot be used for light cured resin materials.

79. Transparent Crown Form Matrix
• Stock plastic crowns
• Can be used for light cured resin material
• For Class III and Class IV

80. • Indications:
• Large bilateral/unilateral class IV cavity
• Oblique fractures of anterior teeth
• Advantages:
• Easy to use
• Good contours can be established
• Disadvantages:
• Time consuming
• Expensive

81. Window Matrix
• For class V cavities
• Formed using either a Tofflemire matrix or copper band.
Procedure:
• A window is cut slightly smaller than the
outline of the cavity.
• Wedges are placed, mesially & distally to
stabilize the band.

82. Preformed Transparent Cervical Matrix
• For use with light cured resin material or RMGIC
• Matrix must be held in place while the
restoration is setting
• Indications:
• Class V restorations with composite or RMGIC
• Advantages:
• Provides good contour for restorations
• Disadvantages:
• Expensive

84. Contact Forming Instruments
• These are special instruments designed to create good contacts with
posterior composites.
• They push the matrix toward the contact area during light curing.
Eg:
• Contact Pro
• Optra contact

85. Contact Rings
• Work by providing slight separation of the contacting teeth.
• Spring action applies equal and opposite forces against the teeth thus
providing optimum separation.
• After separation, the composite is incrementally built and cured in a passive
manner.
• Finally, the ring is removed and
the teeth are brought back into contact.

86. • According to their evolution, categorized as
• First generation systems
• Second-generation systems
First generation systems
•Introduced in the late 1990s
Include :-
• Palodent
• Contact matrix
• Composi-Tight
Palodent Bitine
Composi-Tight

87. Palodent BiTine I and BiTine II
which are
• First system that was available.
• Rings have rectangular tines
parallel.
• Provide optimum separation (0.55 kg/mm).
• Lack retentive design because of the parallel
tines but are easy to place on wide
preparations.
• BiTine II is an elongated ring to allow
stacking over the main ring in case of MOD
preparations.

88. Contact matrix
• These rings have rectangular tines which are converging and hence
are more retentive.
• Provide optimum separation (0.38 kg/mm).
• A reverse ring is available for MOD preparations.

89. Composi-Tight matrix
• Two separate rings are available for premolar and molar teeth.
• The rings have converging tines with retentive balls at the end for
firmer grip on the teeth.
• Omnidirectional.
Drawback:
• Contacts produced are not so tight (0.27 kg/mm).
• Large diameter of the rings can lead to their collapse if used in wide
cavities.

90. Precontoured sectional matrix bands
• All these systems rely on precontoured sectional soft metal
matrices
• Available in various shapes, thicknesses and sizes.

91. Benefits with the Sectional Matrices and Contact Rings
• Ease of use and good visibility.
• Anatomic contour of the bands ensures optimal contact areas and
embrasures.
• Less tension on the teeth and greater comfort for the patient
• No need for pre-wedging.
• Contact dimensions are adequate and in the correct anatomic location.
• Gingival adaptation of the restoration is good.

92. Problems with early contact rings
• Ring collapse or displacement in case of wide proximal boxes.
• Ring stacking that is, placing one ring over the other in case of MOD
restoration is a problem.
• Most importantly, since the contact rings are made of stainless steel,
repeated usage and sterilization effects make them lose their
springiness over time.
92

93. Second - Generation Rings
Eg:-
• Composi-Tight 3D soft face ring
system
• V3 ring system.

94. Composi-tight 3D Soft Face Ring System
The orange Soft Face 3D-Ring
• Used in most circumstances
• Ease of placement
• Ability to adapt to a wide
anatomies
variety of tooth
The gray thin tine G-Ring
• Burnished tine ends
• Used where the shape of the dentition makes ring
retention more problematic

95. V3 Ring System
• Developed by Dr. Simon McDonald in 2008
• System has two types of rings for bicuspid and molar teeth
• Precontoured matrix bands
• Special wedge called the ''wave wedge'' to provide optimum gingival
adaptation of the matrix band.

96. It has two major innovations
• Fully made of Nickel-Titanium ;imparts more springiness and
longevity than stainless steel.
• V-shaped plastic tines to accommodate the wedge.
• The tines have extra width that enables the ring to contact more
tooth structure buccally and lingually.

97. Fender Wedges
• For protection and separation during tooth
preparation.
• Combination of a steel plate and a plastic wedge.
• Inserted into the inter dental space it provides a
protector for the tissue and separates the teeth,
simplifying the following application of a matrix.
• Can be applied buccally or lingually for optimal access
and vision.

98. • Available in four color coded sizes
• Should be inserted with firm pressure providing a tight stable fit
throughout preparation.

99. Conclusion-
• The tapered-ovoid incisor
tooth form for females is
preferred to the square form
• dental professionals are
more critical than patients
with respect to the shapes of
maxillary incisors.
• Dental professionals should
take the individual
variability in patient
response into consideration
during treatment planning,
to produce an aesthetic
outcome that is acceptable
for the patient

100. Conclusion:
Use of the sectional matrix
system in two-surface Class II
cavities resulted in statistically
significantly tighter proximal
contacts than the use of the
circumferential matrix system.

101. • Conclusion:
Within the limitations of this study,
tighter contacts can be obtained
when sectional matrices and
separation rings are applied to both
proximal surfaces prior to placement
of the resin composite in MOD
cavities.

102. Conclusion
• Proper restoration of the anatomical landmarks is important for
enhancing the longevity of restorations as well as to maintain the occlusal
health and harmony.
• Matricing is a vital step during the placement of different restorations.
• Selection of the matrix should be based on its ease of use and efficiency to
provide the optimum contacts and contours..
• The dentist should select the right method according to the needs of
individual case.

103. References
1. Operative Dentistry – MA Marzouk
2. Art & science of operative Dentistry – Sturdevants (5th edition)
3. Art & Science of Operative Dentistry – Sturdevants (South Asian Edition)
4. Textbook Of Operative Dentistry – Vimal K Sikri (1st Edition)
5. Dental Anatomy, Physiology & Occlusion – Wheeler’s (9th Edition)
6. Optimizing tooth form with direct posterior composite restorations JCD
Oct-Dec 2011 | Vol 14 | Issue 4

104. References
7. Hussain, A., Louca, C., Leung, A., & Sharma, P. (2016). The influence of varying
maxillary incisor shape on perceived smile aesthetics. Journal of Dentistry, 50,
12–20.
8. Loomans, Bas & Opdam, Niek & Bronkhorst, Ewald & Roeters, Franciscus &
Dörfer, Christof. (2007). A Clinical Study on Interdental Separation Techniques.
Operative dentistry. 32. 207-11. 10.2341/06-73.
9. Wirsching, E., Loomans, B. A. C., Klaiber, B., & Dörfer, C. E. (2011). Influence of
matrix systems on proximal contact tightness of 2- and 3-surface posterior
composite restorations in vivo. Journal of Dentistry, 39(5), 386–390.