We are all on the search for the perfect matrix system. Our hope would be to find one system that works every time. Working would be defined as sealing the margins of the prep so we have minimal to no excess to finish off, replicating the original shape of the tooth, and creating tight interproximal contacts. My experience is that there isn’t any one system that works in every clinical situation. Exceptional results are dependent on having multiple matrix systems and choosing the appropriate one based on the tooth preparation.
Most of us have moved to sectional matrix systems . In a class two preparations, when the buccal and lingual walls of the preparation do not extend beyond the line angles these systems are phenomenal. As soon as on either the buccal or lingual the prep wall has gone beyond the line angle the band is pushed into the preparation when the ring is placed. This creates a shape that can increase the risk of food impaction and have a negative impact on gingival health and development of recurrent decay
In these situations moving to a more traditional matrix band that is held with a Tofflemire or a circumferential band system can be superior. True Circumferential systems are indicated when the preparation is replacing all or most of a buccal cusp. When using a Tofflemire as the band approaches the holder it bows out to the buccal and makes placing restorative material in an ideal tooth form on the buccal very challenging.
Every matrix system had things it does well, and situations where it will be insufficient to the task. I utilize multiple systems in my office and the preparation is one driver in which system will produce the best results.
Yet how many matrix systems is enough? I have two systems in a drawer that did not work “as advertised” in my hands and recently abandoned a third to the trash-heap during yearly inventory. I keep returning to the “KISS” principle and use my 2 favorites (Garrison ‘Composi-Tight’ & Standard Tofflemire with SureDental ‘Trimax’ contact maker instrument) combined with layering & sculpting before curing.
If there was a benchtop work-shop to try competing systems I may be encouraged to invest again. A photo-series decision tree of when to use each system may also be useful. Bottom-line, the fewer times my assistant has to get up from chairside while still creating a filling I’d be proud to show my colleagues, the better.
Thanks for this post Lee. Keep writing.