Clinical Cases: ProxyPal
ProxyPal is a transparent 3D contoured matrix for the front area. The pre-shaped progressive curvature aids to create incisal fillings with a correct anatomical shape and is especially designed for large proximal fillings and closure of frontal diastemas, preventing “black triangle disease”. In order to achieve a perfect filling the matrix has been designed such that the curvature of the matrix escalates linearly along its total length.
How to use ProxyPal?
ProxyPal Proximal (pic.1) & ProxyPal folded around the tooth (pic.2).
The matrix can either be applied straight inter-proximally (see picture above) or folded around the tooth palatal, passing through the proximal contacts on both sides of the tooth to be restored (see picture to the right). The anatomical contour of the tooth can be fully adjusted by carefully selecting the desired curvature on the matrix band. This is possible due to the progressive increase of the curvature on the matrix band.
In the case where the matrix is applied straight inter-proximally the anatomical contour of the crown is shaped by the matrix and the rest of the restoration is carried out freehand and finished with a scalpel blade, composite finishing burs and abrasive discs. To prevent any interproximal “overhangs” an instrument can be used to push the matrix against the tooth while curing the composite with the curing light.
Apical directed pressure on the ProxyPal matrix increases the curvature. When dealing with a healthy gingiva no bleeding should occur when this action is performed, it is comparable with using a toothpick or dental floss. If adjacent cavities are restored at the same time, complete the restoration of one tooth, then remove the matrix on this tooth before beginning with the restoration on the second tooth. This will ensure as little gap as possible between the two restorations. The gap can also be minimized by keeping a supporting finger palatal and pressing it buccally when the composite material is cured. You can use the natural mobility of the teeth to obtain separation; as the pressure is released the teeth will go back to their natural position – resulting in a tight inter-proximal contact.
Restoration of large class IV cavity.
Last picture shows the results after 2 years. Tecnique with Empress Direct.
Case from Mats Norman, DDS, Sweden
Closure of diastema using ProxyPal
Note that there is no black triangles (pic.2). ProxyPal is a universal matrix for all anterior restorations. The innovative design of the ProxyPal, allows you to easily restore a broken down tooth to it’s original anatomy. Reshaping and closing of a diastema is also very easy with the ProxyPal. The primary purpose of ProxyPal is to get the correct anatomy of the inter- proximal part of a restoration. ProxyPal will save you time and money and you will easily achieve an aesthetic result and emulate the anatomical contour of a natural tooth. This minimally invasive procedure is preferred to excessive removal of precious enamel and dentine. Diastema closure techniques with direct composites prove to be complicated and complications like chronic gingivitis in the area is not uncommon. ProxyPal will assist you to get a smooth transition between the filling and the tooth. ProxyPal is the answer to the undesirable black triangles.
Directly after finished restorations - a small black triangles (pic.1) and 3 week follow up- the small black triangles has disappered (pic.2).
Closure of diastema, step by step
- No preparation is required.
- Airflow/Sand blasting can be very beneficial and will enhance the bonding of the composite to the etched enamel.
- Use two ProxyPal matrixes turned against each other and determine where the best contour on the matrix is found.
- Cut the matrix.
- Fold the incisal part of the axial angle.
- Rubber Dam will be useful to manipulate the inter-dental papilla and to ensure the correct contour of the newly placed restoration.
- Now start with the first tooth by inserting the edge of the matrix strip into the gingival sulcus.
- Close the diastema by building up the tooth to the middle of the diastema.
- Measure the width of the newly constructed tooth using callipers. Check the space with the callipers on the neighbouring tooth to make sure symmetry will be achieved when the neighbouring tooth is build up. Polish gently with fine polishing paste without changing the contour of the filling.
- When you are satisfied with the first build up, insert the second matrix so that it has the same contour as the first one. The matrix can be supported palatal with the finger and contact can be achieved against the already shaped tooth. The build up can now be completed to close the diastema.
The above pictures shows failed direct composite restorations, used for the diastema closure. The situation was corrected with an invasive and more costly procedure involving laboratory made porcelain jacket crowns. The final result is excellent but the technique is very invasive.
By Dr. Sven Scholander.