Editorial Type:
Article Category: Research Article
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Online Publication Date: 01 May 2006

Individualized Wedge

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Page Range: 390 – 393
DOI: 10.2341/05-58
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SUMMARY

The preparation of an individualized wedge in the gingival embrasure before cavity preparation using photo-cured resin permits rehabilitation of the interproximal space and the original contact point position. Because the individualized wedge completely fills the embrasure, the adaptation to the gingival and proximal walls of the molar to be restored is perfect, avoiding any overextension of obturation material during insertion. Furthermore, the original position of the contact point is preserved.

INTRODUCTION

The widespread application of preventive procedures, especially fluoride, has drastically reduced the prevalence and progression rate of caries (Liebenberg, 1996). Most proximal lesions develop below an apparently healthy surface. At the time of diagnosis, 60% of surfaces with radiographic caries on the external aspect of the dentin appear to be intact (Hintze, Wenzel & Danielsen, 1999).

The decision to restore proximal lesions often requires removal of the marginal ridge and contact point in order to gain access to the caries lesion. In these cases, it is mandatory to reestablish the anatomic conditions that preserve the horizontal and vertical stability of the arch (González-López & others, 1999; Keogh & Bertolotti, 2001).

Since the introduction of resin composites to fill Class II cavities in the posterior sector, the most important technical challenge has been to obtain a suitable shape that includes the proximal contact. A correct selection of the wedge is essential if this objective is to be met. The wedge must also be able to adapt the matrix to the gingival wall to avoid overextension of the obturation material (Eli & others, 1991).

The necessity of using a matrix hampers the achievement of a good contact. Usually, the pressure with which the wedge is inserted produces adequate internal displacement to compensate for the thickness of the matrix. However, this pressure can also deform the matrix towards the interior of the cavity, altering the contour of the tooth and shifting the contact point from its original position (Keogh & Bertolotti, 2001; Chan, 2001).

Although there are different sizes of wedge, they do not always match the specific characteristics of the interproximal space in each case. This problem has been addressed by the use of different matrix and attachment systems (Keogh & Bertolotti, 2001). Proposed approaches have included the insertion of small composite cylinders (Doukoudakis, 1996), use of orthodontic separators (Kraus, 1998), withdrawal of the matrix during the last moments of the restoration (Derrick, 2000), use of elastic cords (Chang, 2001) and insertion of small ceramic preforms (Bowen, Eichmiller & Marjenhoff, 1991; el-Badrawy & others, 2003) or a small amount of precured composite (Dunn, 2004).

The use of a wedge-resin system to produce an individualized wedge allows an impression to be taken of the interproximal space, transferring the tooth's original contours and contact point position to the restoration.

TECHNIQUE

Figures 1–7 illustrate the technique for preparing an individualized wedge for the correct rehabilitation of the gingival embrasure in an upper first molar with mesial caries diagnosed from a bite-wing X-ray image. Figure 1 depicts the clinical appearance of the tooth before the restoration.

Figure 1. The typical dark appearance below the marginal ridge corresponds to caries diagnosed by wing-bite X-ray. Observe the vestibular displacement of the contact point.Figure 1. The typical dark appearance below the marginal ridge corresponds to caries diagnosed by wing-bite X-ray. Observe the vestibular displacement of the contact point.Figure 1. The typical dark appearance below the marginal ridge corresponds to caries diagnosed by wing-bite X-ray. Observe the vestibular displacement of the contact point.
Figure 1. The typical dark appearance below the marginal ridge corresponds to caries diagnosed by wing-bite X-ray. Observe the vestibular displacement of the contact point.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

An individualized matrix is made after completely isolating the tooth with a rubber dam and before opening the cavity. A 1-cm piece of 0.045 mm metallic matrix without shape memory is cut (Hawe Stell Matriz Band, Hawe Neos Dental SA, Bioggio-Switzerland), then placed in the interproximal space and adapted to the mesial wall of the molar to be restored (Figure 2). LC Block-Out blue-pigmented light-cured resin (Ultradent Products, Inc, South Jordan, UT, USA) is then injected into this space. Before curing, an orangewood wedge (Hawe Sycamore Interdental Wedges, Hawe Neos Dental SA) on which Optibond Solo Plus (Kerr, Orange, CA, USA) dental adhesive has been applied is placed into the embrasure. The wedge-resin system is then light-cured for 10 seconds using an Optilux 401 lamp (Demetron Research Corp, Danbury, CT, USA), thereby binding the wedge to the resin. By this method, an individualized wedge is obtained that reproduces the gingival embrasure and preserves the contact point position (Figure 2). The wedge is then withdrawn to test that the resin has remained bound to the wedge. The wedge is replaced in the interproximal space, and a check is carried out on the stable positioning of the wedge in the proximal space on the adaptation of the individualized matrix and on the complete filling of the embrasure with blue resin (Figure 3). Once the matrix and individualized wedge are in place, a cavity opening is made to facilitate excavation of the decayed dentin with low-speed round-tip tungsten burs until no dentin is stained with caries indicator (Caries Detector, Cavex Holland BV). By performing the cavity preparation while the interproximal space is filled with the wedge-resin system, the gingival and proximal walls of the premolar are protected from possible iatrogeny.

Figure 2. The individualized wedge completely fills the proximal space. A piece of matrix adapted to the proximal contour is used.Figure 2. The individualized wedge completely fills the proximal space. A piece of matrix adapted to the proximal contour is used.Figure 2. The individualized wedge completely fills the proximal space. A piece of matrix adapted to the proximal contour is used.
Figure 2. The individualized wedge completely fills the proximal space. A piece of matrix adapted to the proximal contour is used.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

Figure 3. The wedge resin system accurately reproduces the shape of the proximal space.Figure 3. The wedge resin system accurately reproduces the shape of the proximal space.Figure 3. The wedge resin system accurately reproduces the shape of the proximal space.
Figure 3. The wedge resin system accurately reproduces the shape of the proximal space.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

Figure 4. Cavity opening maneuvers are performed with the matrix and wedge in place. In this way, the gingiva and adjacent tooth are protected.Figure 4. Cavity opening maneuvers are performed with the matrix and wedge in place. In this way, the gingiva and adjacent tooth are protected.Figure 4. Cavity opening maneuvers are performed with the matrix and wedge in place. In this way, the gingiva and adjacent tooth are protected.
Figure 4. Cavity opening maneuvers are performed with the matrix and wedge in place. In this way, the gingiva and adjacent tooth are protected.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

If the piece of matrix deteriorates during cavity preparation maneuvers, it is replaced (Figure 5); alternatively, the matrix can be burnished towards the proximal contact. The cavity is disinfected by placing 2% chlorhexidine gluconate for 1 minute (Consepsis, Ultradent Products Inc) (Say & others, 2004). After etching the enamel and dentin surfaces with 37% phosphoric acid for 20 seconds, the dental adhesive Optibond Solo Plus (Kerr Manufacturing Company, Romulus MI, USA) is applied. The obturation is performed with hybrid composite in increments ≤2 mm thickness, which is light-cured for 40 seconds (Figure 6).

Figure 5. Note the good adaptation of the matrix to the gingival wall.Figure 5. Note the good adaptation of the matrix to the gingival wall.Figure 5. Note the good adaptation of the matrix to the gingival wall.
Figure 5. Note the good adaptation of the matrix to the gingival wall.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

Figure 6. The good adaptation of the matrix impedes overextension of the composite.Figure 6. The good adaptation of the matrix impedes overextension of the composite.Figure 6. The good adaptation of the matrix impedes overextension of the composite.
Figure 6. The good adaptation of the matrix impedes overextension of the composite.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

Finally, the restoration is finished with multi-blade tungsten burs, limiting the action to the cavity-surface margin, then polished with Pogo polishing system (Dentsply International Inc, Milford, DE, USA) (Figure 7).

Figure 7. Completed obturation. Compare the position of the contact point with the contact point in Figure 1.Figure 7. Completed obturation. Compare the position of the contact point with the contact point in Figure 1.Figure 7. Completed obturation. Compare the position of the contact point with the contact point in Figure 1.
Figure 7. Completed obturation. Compare the position of the contact point with the contact point in Figure 1.

Citation: Operative Dentistry 31, 3; 10.2341/05-58

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Copyright: Copyright: © 2006 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL. 2006
Figure 1.
Figure 1.

The typical dark appearance below the marginal ridge corresponds to caries diagnosed by wing-bite X-ray. Observe the vestibular displacement of the contact point.

Figure 2.
Figure 2.

The individualized wedge completely fills the proximal space. A piece of matrix adapted to the proximal contour is used.

Figure 3.
Figure 3.

The wedge resin system accurately reproduces the shape of the proximal space.

Figure 4.
Figure 4.

Cavity opening maneuvers are performed with the matrix and wedge in place. In this way, the gingiva and adjacent tooth are protected.

Figure 5.
Figure 5.

Note the good adaptation of the matrix to the gingival wall.

Figure 6.
Figure 6.

The good adaptation of the matrix impedes overextension of the composite.

Figure 7.
Figure 7.

Completed obturation. Compare the position of the contact point with the contact point in Figure 1.

Contributor Notes

*Reprint request: Campus de Cartuja, E-18071, Granada, Spain; e-mail: sglopez@ugr.es
Received: 18 Apr 2005
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