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Treatment of a malocclusion with the help of a new matrix system.
INTRODUCTION GC G-Bond inserting the cradle wedge. Horico polishing
Coltène Whaledent Synergy flow strips were used here because of their
Voco X-tra fil thickness.
Dentsply air block gel
Time and again there are practical problems
associated with patients that have a It is not necessary for the dentist to use any
malocclusion. other specific tools or resources.
Case report
The following are absolutely necessary for
Serious differences between the habitual and
the restoration: A 66-year-old patient who has been coming
posterior occlusion, the posterior and/or
anterior open bite, lead to a distinct to the surgery for treatment for many years,
malfunctioning of the normal or proper action returns repeatedly because of fractures to
of the masticatory muscles when there is a The cradle wedge fillings. Oral hygiene is sufficient. The
patient is willing to cooperate, is, however,
deficit in canine guided and/or group
function. The result is pronounced discomfort financially not in the position to be able to
to the patient. afford a comprehensive restoration. Distinct
differences between habitual and retral
occlusion, partial non-occlusion in the
posterior and anterior region.
Apart from recurring fractures of dental
fillings and periodontal disease both of which (Images 2 & 3)
repeatedly bring the patient to the dentist’s
surgery, the tensing of the masticatory
muscles can lead to headaches, especially in
the occipital and in the temple area, as well as
cervical spine or shoulder girdle pain or
discomfort. Abbildung 1
.
The treatment is aimed at a harmonisation of
A matrix system should strictly prevent
the occlusion. Above all, splint therapy, and
secretion of blood and/or crevicular fluid into
to begin with, the use of a mild muscle
the cavity, particularly in the apical region. It
relaxant such as Gewacalm (2-2-5 mg) as
should allow suitable preparation of the
well as anti-inflammatory medication such as
Voltaren may be used. In individual cases,
contact point and separate the cavity that is to Abbildung 2
be treated. This new matrix system fulfils all
particularly with younger patients,
these requirements. The cradle wedge (Image
orthodontic treatment would also be
1). In addition, the cradle wedge is easy to
advisable.
insert and remove, and furthermore, it allows
the patient to bite down on the filling that has
not yet polymerised. If the matrix is made of
After successful harmonisation of the a material that is too hard, the lower jaw will
occlusion by means of splint therapy, the inevitably move out of proper alignment
question arises regarding further action. when the patient bites down, the retral
Without transference of the occlusal load to occlusal position can only be achieved with
the natural teeth, the patient will be difficulty or will be lost altogether. The cradle
dependent on the splint for as long as he/she wedge is a matrix system which is connected
has his/her own teeth. Correction of the to a wedge and is made of a soft, flexible
occlusion using crowns and/or inlays/onlays material which will not interfere with the Abbildung 3:
often exceeds the patient’s financial patient’s bite.
resources. Under the given circumstances, Partial non-occlusion is also found in the
direct restoration has previously been habitual occlusion where there is a concurrent
difficult. Without the possibility of allowing deficit in the canine guided function.
the patient to bite down in the retruded Sizeable, partially insufficient amalgam
contact position on the composite inlay/onlay Composite fillings.
that has not yet hardened (as fabricated by the
The composite required for the restoration (Images 4 & 5)
dental technician), the modelling of the
(with a density of up to 4mm) should be
occlusion proves to be difficult or even
allowed to harden properly with little
impossible.
shrinkage. Voco X-tra fil was used in the
following example.
The point of this article is to show how the
dentist can achieve success with the help of a
new matrix system and with the procedure
being affordable for the patient.
Air block gel
The application of air block gel before the
The materials filling has hardened to insulate the filling’s
marginal edge when the patient bites down
and to prevent bonding with the antagonist.
Abbildung 4:
Pulpdent Caries Indicator Dentsply air block gel was used here.
KerrHawe wooden wedges
Dentsply Automatrix Polishing strips
R-U-S cradle wedge
Opening the interdental space before
Horico polishing strips
region. Ensure that the first layer of
composite leaves the marginal edge region
clear. Otherwise the patient will not be able to
bite down fully on the next layer. The second
layer of composite is then applied and
covered with a layer of air block gel.
(Image 8)
Abbildung 11:
Abbildung 5: Proceed as before:
Etch and prime
Flow-composite
The individual steps of the Composite layering using at least 2 layers of
procedure air block gel
After assessment of the X-rays and Abbildung 8: The patient bites down
development of an occlusion concept with the
help of the articulated gypsum models, a Polymerization in the buccal region with the
In the retruded contact position, the patient patient’s mouth closed.
composite bite is created in the retruded bites down on the frontal occlusion and the
contact position (image 6) without damage to Polymerization with the patient’s mouth
composite is hardened in the buccal region.
the anterior region. Do not forget to use the open. Finally the filling is finished.
(Image 9)
air block gel!
Image 12
Image 6
n essence proceed as before in the posterior
region.
(Image 12 )
Abbildung 9:
Subsequently the filling is hardened with the
patient’s mouth open. This is what the filling
looks like after the removal of the cradle
wedge. One can clearly see the impressions Abbildung 12:
Abbildung 6: made by the antagonist.
Anterior teeth
n this way three points are used to define a (Image 10) Anterior bite-raising should be left until last.
plane - the two temporomandibular joints and The procedure differs somewhat from the
an anterior tooth as the anterior point, and procedure carried out in the posterior region.
using this to ensure the same occlusion All fillings that are necessary due to either
throughout treatment. insufficiency or secondary caries should have
been put in before the bite-raising procedure
Posterior teeth is carried out. This can be done in a single
step.
Replacement of the fillings began in the
lower jaw with tooth 37. After removal of the
filling and bevelling of the preparation edges The teeth are separated using cradle wedges.
a 2mm cradle wedge was introduced into the Image 13
sulcus.
(Image 7) Abbildung 10: Tooth 22 has been capped and is left out.
Etch and prime, flow, composite, air block
Lastly the filling is finished using rotating gel.
instruments and the next tooth is prepared.
Tooth 36 has had root treatment and has an
amalgam filling already reaching far into the
apical region.
In order to avoid an insufficient filling in the
apical region, a Dentsply Automatrix is used
in the first step of the procedure. In this way a
higher marginal edge is built up in the distal
region which can then be sealed safely using
a cradle wedge. A wooden wedge is inserted
Abbildung 7: in the buccal region to ensure better
adaptation. A 3mm cradle wedge is used in
the distal region and a 2mm cradle wedge is
Etch and prime using the one-bottle system.
GC G-Bond was used here. The first layer of used in the mesial region. Abbildung 13:
composite is applied and hardened after (Image 11) Hardening and finishing procedures
application of flow-composite in the apical
An check-up three months later (Images 18 &
19) shows good contact points with the
antagonist, close contact points with the
adjacent teeth and no gingival irritation. The
patient is extremely satisfied with the
treatment. At long last he is able once again
to bite firmly.
Abbildung 14:
This is what the upper front region looks like
after the finishing procedure has been
completed. Canine guidance was built up on
the eyeteeth. (Image 14).
The time involved for the patient was approx.
4 hours in total split into three sittings, Abbildung 18:
including the time needed for the numerous
photos. The amalgam filling was not replaced
in tooth 35, but the chewing surface was built
up with the help of retentions in the amalgam.
No changes could be made to tooth 22 due to
a porcelain fused-to-metal crown (PFM)..
Final results/findings
The bite harmonization is documented with
the help of the gypsum model.
(Image 15)
Abbildung 19:
Discussion
Restoration using the cradle wedge appears to
be a safe option when replacing amalgam
fillings and it can also used as bite raising
appliance/aid. Expenditure of time and
practicability are both justifiable. With a
little practise it is possible to put in light,
Abbildung 15: tightly-sealed composite fillings that have
well supported marginal edges and tight
contact points. All in all a clearly defined bite
harmonization is achieved within an
The X-rays show clearly accessible acceptable period of time which is not
interdental spaces and tightly-sealed fillings. possible with any other matrix systems that
(Images 16 & 17) are currently on the market. The possibility of
allowing the patient to bite down on the
composite before it has hardened
considerably broadens the potential of the use
of composite. The correction of a
malocclusion is therefore relatively easy and
inexpensive for the patient. The result is a
leak-proof, resilient composite filling with a
high, well supported contact point. The
interdental space is free of excess and an
interdental brush can be used.
Writer of this article:
Abbildung 16:
Dr. Harald Rus
A-8950 Stainach
Gschlösslgasse 330
Dr.Rus@medway.at
Abbildung 17:
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