One ring, perfect contact point – 24 options for second class cavities: the Diamond 24

31 May 2018 - 21852

Restoration of different interproximal anatomies is a real, daily challenge; what if you could have 24 options with just one ring?

While it is unusual for a patient to complain about the color of an upper second molar, he will for sure complain if food impacts in between the restored teeth after eating or if  dental floss breaks.

In second class restorations, key is rebuilding a correct contact point, not only because it is sometimes clinically not as simple, but also as it is part of those performances that influence the quality perceived by the patient.

To get better contact points and to simplify the finishing procedures, the Style Italiano team has designed Diamond 24, a revolutionary tool to have a semi-customized ring in no time.

Fig. 1

Clinical example of the Diamond 24 in action: extremely accurate adaptation to the interproximal areas is made possible, even on the most coronal portion of the tooth, above the equator area.

Fig. 2

An occlusal view of the same case shows how the silicone tips can be angulated in the same direction. One of the coolest features of the Diamond 24 ring is that you can rotate the silicone tips in many different positions to obtain the better adaptation to the inter proximal space that you have to fill.

In the picture, the composite is in place just calibrated by Misura Posterior LM.

Fig. 3

The same situation without composite.

Fig. 4

The restoration step by step.

Always transform the class 2 cavities in class 1 restorations.

Fig. 5

D I A M O N D   2 4

Diamond 24 is a full silicone terminal to be placed on the MyRing Classico, which enables you to perform different restorations by being rotated in different positions, so that they interproximal area has the perfect adaptation.

 

Fig. 6

If you take a close look to nature it is clear that the more you move distally, the more the contact points anatomy changes to become an area of contact.

It is also pretty clear that, if we consider the interproximal points, the spaces between teeth are very different from one another. So how would be a single ring be able to fill all the interproximal spaces in a way that is considered correct?

Fig. 7

This is the reason why Polydentia in the last years developed the Tubes, a really useful tool to fill those spaces. This silicone terminal to put on the ring bars was a great idea, and from this project, the Style Italiano Idea Factory designed it evolution, the Diamond 24.

 
Fig. 8

The new Diamond tips allow 4 different angle options. 

Fig. 9

Here are some examples of how the rotation of the diamond on the terminals of the ring can help find interesting new positions to adapt to the natural anatomy.

Fig. 10

In this picture all of the 26 combinations are shown from the ring alone to the Custom Ring. In between there are other 24 positions, so My Ring Classico and Diamond24 combined, allow 26 different combinations.

Fig. 11

As you can see in the picture, in this case the best solution was to use the silicone tip only on the palatal side, both in the mesial and distal interproximal spaces.

 

 

Fig. 12
Fig. 13

If the tooth you want to restore is narrow as, let’s say, this premolar, it is better to build the walls one by one in order to avoid unpleasant contact between matrices.

Fig. 14

The modeling step by step following the Essential Lines.

Fig. 15

In this case the lateral side of the tip is the best solution to fill the space, both on the buccal and the lingual side.

 

 

Fig. 16

In this case I was able to put two matrices at the same time thanks to My Custom Ring Classico and Diamond 24

Fig. 17

In this molar the choice is only one silicone terminal from the lingual side.

 

 

Fig. 18

Opened cavity and matrix adaptation

Fig. 19

Restoration step by step in pure Essential Lines

Fig. 20

If the space between the teeth is wide, the lateral side of the Diamond 24 turns out very helpful to stabilize the matrix, without collapsing onto the cavity.

Fig. 21

Matrix in place and matrix open after the polymerization of the marginal wall.

 

 

Fig. 22

The distal part of this upper first molar is restored with just one Diamond 24 silicone on the palatal side

Fig. 23

The mesial part, with just a mesial silicone tip but with a different rotation.

Fig. 24

My Rings Classico in place.

In the picture you can see the walls after the polymerization.

Fig. 25

Another great advantage is thatThe restoration is polishable when the walls are built with the Diamond 24. Even though, some details of the restoration will need to be polished, these parts are far from the interproximal area, and are thus easier to be perfected.

Thanks to the silicone tip, the matrix is better embraced in between the tool and the tooth.

Fig. 26

It’s strange to me how we try to make a curved surface be embraced by a curved metal foil while adapting it with a straight metal tube.

Fig. 27

When the ring touches the matrix, a line meets a curve, the result is just the contact point.

Fig. 28

On the tooth we have a contact point.

Fig. 29

Highlighted in purple you can see the areas in which the matrix is a challenge to fix because of the ring’s geometry

Fig. 30

So it’s obvious how the silicone terminal can easily adapt to a curved surface and this specific one is removable, autoclavable and Can be cut shorter if needed

Fig. 31

So when this silicone tool meets the curved surface the result is the contact area

Fig. 32

This situation allows a super contact between the matrix and the tooth, the better is the contact the easier is the finishing of the restoration.

Fig. 33

From the occlusal point of view the same concept , traditional ring can help but does not gives the best matrix adaptation on the tooth 

Let’s consider the same concept from an occlusal point of view: a traditional ring can help but does not provide the best matrix adaptation on the tooth

Fig. 34

But when the MyRing Classico is wearing a Diamond 24 tip the adaptation will be nearly perfect. 

This nichel-titanium ring is a special one as it’s made to keep, in the long run, the same physical properties.

Fig. 35

The combination of this Ni-Ti ring called the MyRing Classico and the Diamond tips, allows a great contact area between matrix and tooth.

Different plastic and silicone rings are available on the market but all of them present only one check only one way of inserting it into proximal space.

Fig. 36
Fig. 37

Many clinical examples on how this silicone tips can adapt the matrix to the tooth. 

Fig. 38
 

Conclusions

Start today thinking about ring and matrix for second class restorations in a whole new way. Your new ring:

• It’s modular; able to adapt to the interproximal anatomies you can also cut them.

• The flexible silicone material allows to carefully bend the matrix to shape without collapsing it

• It’s perfect to embrace the matrix allowing the achievement of optimal contact points and areas

• Features multiple combinations which enhance the adaptability to the clinical situation

• It’s autoclavable and tips are replacable: no need to dispose of the ring when they get damaged

 

 so start thinking a new way about to ring

A modular ring will be able to adapt to the interproximal anatomyAnd wouldBe suitableFor reshapingAnd cutting

Embracing the matrix allows the achievement of optimal Contact points

 

 

 

 

 

Bibliography

Dietschi D,  Spreafico R. Adhesive metal free restorations. Quintessence 1997

Dhadwal AS, Hurst D. No difference in the long -term clinical performance of direct and i indirect inlay /onlay composite restorations in posterior teeth. Evid Based Dent  2017 dec 22 18(4)  121-122

da Veiga AM , Cunha AC, Ferreira DM, da Silva Fidalgo TK, Chianca TK, Reis KR, Maia LC. Longevity of direct and indirect resin composite restorations in permanent posterior teeth: A systematic review and meta-analysis. J Dent. 2016 Nov;54:1-12