This clinical case document describes improving proximal contours for direct resin restorations. It discusses challenges with achieving proper proximal contacts and contours using traditional matrices. The Triodent V3 matrix system is introduced as an improved option that allows for better contacts and contours, even with wide preparations or space between teeth. The case describes using the V3 system along with layering Artiste composite to restore a mandibular molar with mesial and distal preparations, achieving good anatomy and contacts. Finishing and polishing are also detailed.

1. Clinical Case
Improving proximal contours for direct resin restorations
by Dr Gregori Kurtzman
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2. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
One of the most challenging aspects of direct posterior resin
restorations is achieving good proximal contacts with proper
contours. This can become especially challenging when the
resulting proximal preparation is wide and the adjacent tooth
leaves a large space interproximally.
The goals of posterior direct restorations include: 1-3 These goals often are not met routinely as circumferential
• Tight contact with the adjacent tooth’s matrices tend to constrict the buccal and lingual contours,
proximal surface resulting in inadequate contacts and poor anatomical form.
• Contour gingival to the contact that fills the 4-5 Sectional matrix and ring retainers were introduced in an
space without food traps attempt to combat this and allow the practitioner to achieve
• Buccal and lingual contours that prevent food better contacts and contours. But those also had some
impaction interproximally challenges when the proximal preparation resulted in a box
that extended to include a portion of the buccal and lingual
walls or space was present between the tooth being treated
and the adjacent tooth. The proximal tines of most rings
would jump into the preparation and have no tooth structure
to brace against. This resulted in a constricted contact and
narrowed anatomy of the restoration.
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3. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
1 2
Triodent V3 Ring straddling the wedge placed interproximally. The Triodent V3 Rings, molar (green) and premolar (yellow).
The newest generation rings, such as the V3 (Triodent, The added benefit is that proximal separation is greater,
Katikati, New Zealand), were developed to overcome the making for a tighter final contact. As all teeth are not created
negatives of the prior rings available. These rings have wider equal, no single ring is ideal for every situation and what fits
tines that are able to contact more tooth structure even when a molar proximal may not be ideally suited for a premolar
preparation has eliminated portions of the buccal and lingual contact. With that in mind, Triodent provides two different
cusps interproximally or there is a greater distance with sized V3 Rings, a green for molar contacts and a yellow for
the adjacent tooth. As with its predecessor the V-Ring, the premolar contacts. (Figure 2)
tines are designed to straddle the wedge instead of sitting
adjacent to it, making placement easier. (Figure 1)6-8
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4. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
3 4
Stacked Triodent V3 Rings allowing placement at adjacent proximals. Preparation for a MOD direct restoration on a mandibular first molar
with an open contact on the distal.
An added improvement from their original ring is that the Case report:
tines have an increased angle to the ring’s loop, making A typical clinical situation involves the need to restore
it easier to stack the rings for placement on adjacent both proximal surfaces on the same tooth. This as
proximals when both the mesial and distal will be restored discussed can be challenging, especially when caries
on the same tooth. (Figure 3) removal requires more of the interproximal to be removed.
The goal in today’s restorative dentistry is to conserve as
much tooth structure as possible and only remove carious
dentin and enamel. But this can still result in challenges to
restoring the interproximals.
The patient presented with an open contact between the first
and second molars with resulting interproximal caries as a
result of chronic food impaction. Following caries removal
it was noted that the distal box was relatively wide, but the
mesial box preparation was narrow due to the minimal caries
in this area. (Figure 4)
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5. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
Sectional matrices were placed at both the mesial and distal The preparation was rinsed and lightly dried to eliminate
of the tooth to be restored. A medium Wave-Wedge (pink) any pooled water. A solvent-free self-etch adhesive
was placed at the mesial and a large (purple) distally. Triodent (Bond1-SF, Pentron Clinical Technologies, Wallingford,
V3 Rings were placed at both the interproximals. (Figure 5) CT) was vigorously rubbed into the prepared dentin and
enamel surfaces for 20 seconds. (Figure 6 and 7)
5 6
Sectional matrix placed on the mesial/distal along with wedges Application of Bond1-SF adhesive applied with the frocked tip on the
and V3 retainer rings are stacked. syringe to all prepared surfaces and scrubbed for 20 seconds.
7
Application of Bond1-SF adhesive applied with the frocked tip
on the syringe for 20 second and vigorous rubbing of the
prepared surfaces.
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6. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
8 9
The appearance of the prepared surface following application of The adhesive is light cured for 10 seconds.
Bond1-SF demonstrates a glistening surface on the dentin.
The resulting surface should have a glistening surface
(Figure 8) and is then light-cured for 10 seconds. (Figure 9)
10 11
Cone burnisher used to adapt Artiste shade B3 Dentin to preparation. First layer of Artiste following light curing, showing development
of lobes within the dentin layer.
A layer of Artiste dentin shade B3 (Pentron Clinical prepared dentin surfaces. Lobes were formed and pits/
Technologies, Wallingford, CT) a nano composite was fissures developed with a cone burnisher then light-cured.
adapted to the pulpal floor, proximal boxes and over all (Figure 10 and 11)
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7. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
12 13
Artiste Maverick posterior pit tint applied with an endodontic file Acorn burnisher being used to adapt the Artiste shade B
to accent the pits and fissures then light cured. enamel layer.
To replicate a more natural esthetic appearance, a brown A layer of Artiste enamel nano composite, shade B (Pentron
tint, Artiste Maverick posterior pit tint (Pentron Clinical Clinical Technologies, Wallingford, CT) was placed over the
Technologies, Wallingford, CT), was applied with a #8 dentin composite and an acorn burnisher was used to adapt
endodontic hand file to the pits and fissures created in the it and create the anatomy. (Figure 13)
dentin layer of composite and light-cured. (Figure 12)
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8. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
14 15
Restoration is light cured. Direct resin restoration following placement of Artiste nano composite
prior to finishing.
16 The restoration was light-cured from the buccal, followed
by the lingual and finally the occlusal surfaces. (Figure 14)
The restoration is now ready for finishing and polishing.
(Figure 15)
The Triodent V3 Rings, wedges and matrices are removed.
(Figure 16) As the proximal contacts are often very tight
as a result of this ring system, it may be necessary to use
a locking hemostat to remove the matrix. Needle-shaped
finishing carbides and diamonds are used to remove any
flash on the buccal and lingual. This was followed by football
shaped carbides and diamonds to contour the cavosurface
margin. (Figure 16) Final polishing was performed by Fini
polishing disks (Pentron Clinical Technologies, Wallingford,
CT) followed by polishing paste on a felt point (Pentron
Retainers, wedges and sectional matrices removed.
Clinical Technologies, Wallingford, CT).
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9. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
17 18
Direct resin restoration following contouring with finishing carbides Direct resin restoration following finishing and polishing, which was
and diamonds. accomplished with Fini finishing system.
Conclusion:
Posterior direct resin restorations can be accomplished
resulting in good proximal contours and tight contacts with
the Triodent V3 Ring, matrices and wedges. Combined with a
simple layering technique using Artiste composite, this allows
replication of natural esthetics and anatomy.
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10. Improving proximal contours for direct resin restorations
Gregori M. Kurtzman, DDS
Author information: References:
Dr. Kurtzman is in private general practice in Silver Spring, 1. Strydom C. Handling protocol of posterior
Maryland, and is a former Assistant Clinical Professor at composites-part 3: matrix systems. SADJ.
the University of Maryland, Department of Endodontics, 2006 Feb;61(1):18, 20-1
Prosthetics and Operative Dentistry. He has lectured both
2. Loomans BA, Opdam NJ, Roeters JF,
nationally and internationally on the topics of Restorative
Bronkhorst EM, Plasschaert AJ. Influence
dentistry, Endodontics and Implant surgery and prosthetics,
of composite resin consistency and placement
removable and fixed prosthetics, Periodontics and has over
technique on proximal contact tightness
140 published articles.
of Class II restorations. J Adhes Dent. 2006
Oct;8(5):305-10
He is privileged to be on the editorial board of numerous
dental publications, a consultant for multiple dental 3. El-Badrawy WA, Leung BW, El-Mowafy O,
companies, and a former Assistant Program Director for Rubo JH, Rubo MH. Evaluation of proximal
a university-based implant maxi-course. He has earned contacts of posterior composite restorations
Fellowship in the AGD, ACD, ICOI, Pierre Fauchard, with 4 placement techniques. J Can Dent
Mastership in the AGD and ICOI and Diplomat status in Assoc. 2003 Mar;69(3):162-7.
the ICOI. He can be contacted at dr_kurtzman@maryland-
implants.com. 4. Peumans M, Van Meerbeek B, Asscherickx
K, Simon S, Abe Y, Lambrechts P , Vanherle
G. Do condensable composites help to achieve
better proximal contacts? Dent Mater. 2001
Nov;17(6):533-41.
5. Loomans BA, Opdam NJ, Roeters FJ,
Bronkhorst EM, Burgersdijk RC, Dorfer CE. A
randomized clinical trial on proximal contacts of
posterior composites. J Dent. 2006
Apr;34(4):292-7. Epub 2005 Sep 12.
6. Keogh TP, Bertolotti RL. Creating tight,
anatomically correct interproximal contacts.
Dent Clin North Am. 2001 Jan;45(1):83-102.
7. Gonzalez-Lopez S, Bolanos-Carmona MV,
Navajas-Rodriguez de Mondelo JM.
Individualized wedge Oper Dent. 2006 May-
Jun;31(3):390-3.
8. Cueto Suarez MA, Pena Lopez JM, Fernandez
Teran A, Villa Vigil MA. Passive wedge.
Quintessence Int. 1996 Apr;27(4):243-8.
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products, go to www.triodent.com/product-information-request.
roducts, go to www.triodent.com/product-information-request. Case Study 10