What’s up everyone , Welcome back to the channel. Today I want to talk about Class II Restorations & a little bit about my favorite layering technique (centripetal). Let’s go!

So Class II restorations are definitely a staple in dentistry. In fact, Most of you out there do this procedure every single day.

& in my experience establishing a tight but flossable contact can do wonders for our patients. Now contacts that are open can be incredibly uncomfortable. Patients have to deal with constantly cleaning the food that gets wedged between their teeth & they are at a much higher risk of developing a cavity.

So what can we do to achieve a more predictable outcome in our class ii fillings 

Well Lets start with what materials are available to us. I to have experience with both the tofflemeire and sectional matrix system & To be frank, they both have their place in dentistry. 

Now The tofflemeire is probably one of the most commonly used tools to restore fillings. It wraps around the entire tooth & gives us a pretty easy way to restore a broken down tooth. However, it does have its complications. 

The thickness of the band can prevent dentists from establishing a tight contact. Which is why we typically use it with a wooden wedge or a garrison ring to create a slight separation that will compensate for the thickness of the band.

Now what a lot of you may not know is that they have tofflemeires that are thinner. These Ultra thintofflemerires are what I use if I choose to use this system over the sectional matrix.

 The thinness of the band helps me create a beautiful contact & adapts incredibly well to the gingival margin of the tooth. However because it’s so thin, I typically need to spend more time finishing because of the lack of adaptation along the Bucco and linguo proximal walls 

Ok so what about the sectional matrix system. 

A lot of brands have come out with this system  to restore teeth & it really is incredible because it solves some of the adaptation & contact problems that the tofflemeir gives us. 

Let me show you what I mean.

Here  i tried to mimic a cavity you might see in practice. The cavity extends well beyond the buccoproximal line angle which makes it difficult to achieve proximal adaptation. the first step is to place the sectional matrix with the anatomical wedge (show clip). Check it out.

As you can see, we have incredible adaptation along the gingival margin. This is important because if this area isn’t completely sealed off then you have to deal with cleaning the flash towards the end of the appointment 

& as many of you know that’s not fun to deal with. S o the first rule to live by is that if you don’t have adaptation, don’t start the filling. Try switching to a larger wedge  or using a different sectional matrix. These little steps will go along way in helping you achieve a beautiful finished product.

Now if you’re using the tofflemeire, you’re gonna have some trouble with the box collapsing if you place a wooden wedge or garrison ring too early. 

So if you have a  preparation similar to this and the tofflemmekr is the only thing you can use layer a small increment of composite over the gingival floor. Cure it. And then place a your wedge. This will prevent the box from collapsing on you and make the contours a lot more functional. If anyone out there wants to visually see this two step technique please leave a comment down below and I’ll try to make a video on this with my microscope 

Ok back to the sectional matrix. 

after you get everything where you want it,  you can now place your ring system. Notice how the ring creates a slight separation between the teeth to compensate for this thickness of the matrix. 

I always burnish the band to ensure I have the best contact possible with my adjacent tooth. Sometimes I’ll even contour the adjacent tooth to with a fine diamond or red disc before placing my setup to ensure I get a nice contact

Now  so the next steps I show are going to be different for everyone watching but this is how I predictably layer my composite fillings. 

I start by etching and bonding the tooth. I personally use Kursray Clearfil Se which is an incredible product but there are so many awesome bonding agents out there. 

After, i use a tiny amount of flowable composite to the gingival floor for excellent adaptation.  After curing this layer, I perform something called the centripetal layering technique. 

The idea is to establish the marginal ridge first and transform your difficult class ii restoration to a relatively simple class I restpration. So let me show you how that works. 

I Place a small amount of composite resin into the box and use condenser or flat instrument to condense the resin gingivally and then push proximally towards the contact point. 

This combination helps me slowly develop the contour of the tooth. After getting the height to match the adjacent tooth, I blend with a flat instrument and sometimes even an explorer

 I take my time with step. An extra minute perfecting this moment with my patient goes a long way in helping reduce my finishing time after the procedure is done. So take your time and blend the composite with the natural tooth

After you cure this layer you can continue to pack composite Incrementally or take the ring system completely off and then finish the packing. If you take the ring system off it will give you more working room but there’s the potential for irritated gums to start bleeding and possibly to interfere with the rest of your filling. So, plan accordingly. 

Finally I would mention somedetails with how you finish your composite filling. I like to increment in small layers to keep in my c factor as low as possible. And then, i try to leave 1/2 to 1 mm for my final layer. 

I place my composite in and blend with a round ended instrument. This blending helps reduce the amount of finishing i have to do with a bur. I also like to use a micro brush with wetting resin to manipulate my composite and create a relatively seamless junction between the filling and natural tooth. 

Now it’s hard to show this on a typodont so let me show you this on a live patient. This will give you a more global perspective 

Commentary on live patient

Alright so this was a longer video about class ii composite fillings. I hope this gives you some perspective on how to avoid complications. If anyone has any questions on how I do this technique or the purpose behind my steps let me know down below. I love doing videos like this and if you have any other ideas please message me. Check out my Instagram channel and I’ll see you for the next one!