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Table of Contents   
CASE REPORT  
Year : 2010  |  Volume : 21  |  Issue : 4  |  Page : 596-599
Restoration of posterior teeth using occlusal matrix technique


1 Department of Semiology and Clinics, School of Dentistry, Federal University of Pelotas, Pelotas, Brazil
2 Department of Dental Pathology and Therapeutics, School of Dentistry, University of Granada, Granada, Spain

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Date of Submission05-Jun-2009
Date of Decision07-Dec-2009
Date of Acceptance16-Jun-2010
Date of Web Publication24-Dec-2010
 

   Abstract 

This article describes a technique for duplicating occlusal surface anatomy using the Biteperf device. Duplication requires an intact occlusal enamel surface and is only indicated when caries lesions are hidden. The occlusal matrix technique allows for preservation of all anatomic details. When the last layer of composite has been placed, the occlusal matrix is forced into the uncured composite to replicate the original occlusal surface, instead of performing manual curing and shaping as in the standard approach. It is technically possible to achieve this effect with any material that is able to copy anatomic details. The main benefits of the occlusal matrix technique, more precisely the Biteperf, are the technical ease of use due to its simplicity and its high accuracy in reconstructing occlusal morphology.

Keywords: Composite resin, hidden caries, occlusal matrix, occlusal morphology, posterior restoration

How to cite this article:
Martos J, Silveira LM, Ferrer-Luque CM, González-López S. Restoration of posterior teeth using occlusal matrix technique. Indian J Dent Res 2010;21:596-9

How to cite this URL:
Martos J, Silveira LM, Ferrer-Luque CM, González-López S. Restoration of posterior teeth using occlusal matrix technique. Indian J Dent Res [serial online] 2010 [cited 2020 Aug 11];21:596-9. Available from: http://www.ijdr.in/text.asp?2010/21/4/596/74231
Dental caries leads to lesions of calcified tissues, with demineralization and destruction of their inorganic and organic components. Occlusal surfaces are considered the most susceptible to caries lesions because of their morphology. [1]

In the occlusal matrix technique, moulds are made of teeth with hidden caries on which the superficial enamel is relatively intact, and the surface detail is directly transferred to the composite resin used for restoration. [2],[3] This type of lesion is diagnosed primarily by radiographic examination or clinically by observing its bluish color below the translucent enamel. [2],[3],[4],[5] However, there are some other methods for diagnosing hidden caries like endoscopic evaluation (AcuCam), laser fluorescence methods (DIAGNOdent), digital fiber-optic trans-illumination, digitalized radiography and an electrical caries monitor (ECM), among others.

The occlusal matrix technique is therefore limited to carious lesions with preserved occlusal anatomy that can be copied using a duplicate transfer device for subsequent recovery. The simplicity, predictability and reduced clinical time of this method make it a satisfactory alternative to the conventional technique. [6] One of its main attraction is that it eliminates the sculpture stage and therefore reduces the time required to finish the restoration. [2],[3],[4],[5],[6],[7]

The technique allows for registration of intact anatomic details prior to cavity preparation and is therefore indicated for small enamel defects and occlusal fissure lesions or Class II preparations with no occlusal involvement. When there is proximal involvement below the contact points, reconstitution is not an option because the matrix is limited to the occlusal surface of the tooth. In these cases, restoration of the middle or cervical thirds requires matrix strips and wedges.

Various materials can be used to make the occlusal replica, including light curable material, [3],[5] chemically activated acrylic resin, [6],[8],[9] polyvinylsiloxane bite registration material, [4] transparent silicone moulds [7] and occlusal transfer devices, which are commercially available. [2],[10]

In this article, we review an occlusal matrix technique for use with composite resin in a 22-year-old female patient.


   Case Report Top


The sequence of steps leading to the occlusal replica is similar for all types of occlusal matrix material. The procedure followed with Biteperf (Biteperf Productos Dentales, Malaga, Spain) is outlined below, as an example. The Biteperf device is manufactured in clear polycarbonate and consists of a plastic handle (50 mm long) and clear round head (13 mm in diameter and 4 mm thick). The bottom head has a circular shape with one thermoplastic impression material (polyethylene) mounted on it.

A 22-year-old female patient was brought to the Clinic of Dentistry College (UFPel) with a hidden caries lesion of the lower first molar (left). The lesion was confined to the occlusal surface with relatively intact enamel. After informed consent was obtained, the procedures for composite restoration were completed. Diagnosis of hidden caries by clinical and radiographic examinations [Figure 1] and [Figure 2] was followed by prophylaxis of the area, choice of the appropriate shade color (Vitapan 3D-master, Vita, Germany) and rubber dam isolation of the operative area. Next, the occlusal transfer matrix was plasticised by heating for 15-20 seconds or until the surface acquired a shiny appearance. It was then positioned under gentle pressure on the occlusal surface of the tooth. The occlusal matrix was kept immobile for 10 seconds and then cooled with air jets [Figure 3]. A mark was made on the outside of the mould to allow for exact positioning during the restoration. Finally, the internal detail of the occlusal replica was checked [Figure 4].
Figure 1: Occlusal aspect of molar with lesion confined to the occlusal surface and with relatively intact enamel

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Figure 2: Radiographic appearance of the compromised dentin of the first molar

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Figure 3: Application under gentle pressure of the heated occlusal matrix device (Biteperf)

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Figure 4: The occlusal matrix, showing the copied anatomic details

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Caries removal and cavity preparation began using spherical diamond burs, 1015 and 1016 (KG Sorensen Ind. Com., Sγo Paulo, Brazil), for the enamel and then clearing the lesion in the dentin with curettes and carbide drills, employing a minimally invasive approach [Figure 5]. A caries detector (Caries Detector, Kuraray Medical Inc., Tokyo, Japan) was used to reveal any remaining caries, and cavity preparation was completed by cleaning and disinfecting the area with a chlorhexidine solution (FGM Ind. Com., Joinville, Brazil). After bonding the enamel/dentin surface with adhesive (Scotchbond Multi-Purpose, 3M ESPE, St. Paul, MN, USA) according to the manufacturer's instructions, light-cure composite resin (Charisma B2, Heraeus Kulzer, Wehrheim, Germany) was inserted using the incremental technique, leaving space for a final increment on which the occlusal matrix device is to be placed [Figure 6]. Leaving this final occlusal increment unpolymerized, the occlusal replica was stabilized in the original anatomic position and pressed down firmly. The next step was polymerization of the last resin increment across the occlusal surface, applying light through the matrix while it is held under pressure to ensure perfect positioning. After polymerization, the occlusal matrix device was removed and the occlusal anatomy was evaluated. Excess composite was removed with scalpel blade or periodontal curette, and the surface was polished [Figure 7]. Occlusal adjustments are often not required if the occlusal replica was completely faithful [Figure 8]. However, a small amount of resin removal and slight adjustments may be necessary using rubber polishers (Astropol, Ivoclar Vivadent, Schaan, Liechtenstein) and abrasive silicon carbide (Astropol, Ivoclar Vivadent) instruments.
Figure 5: Cavity preparation using minimally invasive technique

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Figure 6: Incremental layering is performed in the deepest portion of the cavity

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Figure 7: Occlusal view immediately after the final layer polymerized and removal of the occlusal matrix device (Biteperf)

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Figure 8: Final appearance of the occlusal restoration showing the unchanged anatomic details

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   Discussion Top


The carious lesion usually begins in occlusal defects and fissures of premolars and molars because they are difficult to clean and often accumulate plaque. The arrangement of the dentinal tubules determines the progression of the caries lesion. On the occlusal surface of posterior teeth, this progression forms a triangular shape whose apex points away from the dentin-enamel junction, explaining why lesions with superficially intact enamel can have extensive destruction of the dentin.

According to Baratieri et al., [6] when occlusal lesions reach the dentin, it is difficult to stop them with non-invasive methods, but this does not imply that restorative intervention is always necessary. The progression of lesions can be fast or slow and they may be associated with a clinically visible occlusal cavity. The activity of the lesion does not depend on the continuity of the dental enamel. Thus, a lesion with virtually intact enamel can have extensively destroyed dentin with a soft and moist base (high-activity lesion), and a lesion with completely destroyed enamel can have a hard and dry base (low-activity lesion). [6]

Incipient occlusal lesions can be detected by clinical examination in conjunction with interproximal radiography, which should be routinely used for diagnoses in posterior teeth. [6] Nevertheless, radiographic examination is not a sensitive technique for lesions in early stages. Thus, only 33% of lesions in superficial dentin were detected on interproximal radiographic films of posterior teeth. [1]

When the diagnosis of occult carious lesions is long delayed, there may be extensive destruction of the dentin, possibly resulting in pulp involvement. [1] For this reason, early diagnosis of hidden caries is extremely important; early diagnosis accompanied by restoration via the occlusal matrix technique can reduce the need for a more invasive endodontic approach.

One of the main advantages of the occlusal matrix technique is its faithful reproduction of the original anatomy of the tooth, allowing the occlusal balance to be re-established. Additionally, this technique maintains the health of the periodontal and pulp complexes and of the entire stomatognathic system while also being esthetically acceptable. [2]

The occlusal replica technique can be carried out with several materials, all of which have their advantages and disadvantages. Echeverria et al. [5] opted for the use of the photopolymerizable cement Fermit (Ivoclar Vivadent), and Mandarino et al. [3] for the use of a photopolymerizable surgical cement (Barricaid, Caulk-Dentsply, Milford, DE, USA, EUA) to make the premolded matrix. Chemically activated acrylic resin was proposed by Zenkner et al., [9] Guimarγes et al. [8] and Baratieri et al. [6] Liebenberg [4] used a polyvinylsiloxane (PVS) matrix for a more faithful reproduction of the occlusal anatomy and Goracci and Mori [7] used a transparent silicone mold. The prefabricated occlusal matrix (Biteperf Productos Dentales S.L., Malaga, Spain) was developed by Castro et al. [2] and used by others.

Almost all these materials possess the same advantages: they copy the occlusal anatomy faithfully, are easy to handle and they reduce the required clinical time by eliminating the restoration sculpture phase and simplifying the finishing procedure. [2],[3],[4],[5] The benefits of the occlusal matrix technique, more precisely the Biteperf, are the technical ease of use, including its simplicity and its high accuracy in reconstructing occlusal morphology compared to other methods of reproduction. Besides these advantages, there are numerous important features. It has a low viscosity, and light can be transmitted through it. Additionally, the Biteperf blocks out air, and the technique demands less clinical time and is disposable. [2] The cost of some materials, e.g., PVS and Biteperf, may represent a drawback.

Depending on its thickness and the material used, the matrix can interfere with polymerization of the composite resin. In these cases, an additional light curing is required after removal of the matrix device to ensure polymerization of the largest possible amount of the remaining monomer. In classic restorations, a thin superficial layer of composite resin inhibits polymerization due to its contact with oxygen. The layer needs to be removed by polishing. This contact with oxygen is avoided with the use of an occlusal matrix. Although the light-curing unit must then be held further away from the resin to be polymerized, this can be compensated for by a longer application of the light.

The length of the composite resin's exposure to light from the light-curing unit directly influences the degree of polymerization, which is also influenced by the thickness of the resin and its distance from the tip of the light-curing unit. The effect of the occlusal matrix cannot be considered negative. In fact, there is some similarity with the "soft-start" polymerization technique, in which the curing is started at a greater distance (as when an occlusal matrix is used) and finished as close as possible to the restoration, leading to a lesser contraction of the resin during polymerization.


   Conclusion Top


The occlusal matrix technique offers an easy and accurate reconstruction of the occlusal morphology and the clinical adjustment.

 
   References Top

1.Botelho AM, Menezes TP, Soares AC, Tavano KT. Hidden caries: the importance of a precocious diagnosis. Rev Ibero-am Odontol Estet Dent 2005;13:12-20.  Back to cited text no. 1
    
2.Castro JJ, Keogh TP, Cadaval RL, Planas AJ. A new system for the transferral of the occlusal morphology in posterior direct composite resin restorations. J Esthet Dent 1997;9:311-6.  Back to cited text no. 2
    
3.Mandarino F, Dinelli W, Oliveira Júnior OB. A new technic of composite resin restoration in posterior teeth. RGO 1989;37:460-6.  Back to cited text no. 3
    
4.Liebenberg WH. Occlusal index-assisted restitution of esthetic and functional anatomy in direct tooth-colored restorations. Quintessence Int 1996;27:81-8.  Back to cited text no. 4
    
5.Echeverria SR, Imparato JC. Occlusal matrix technique: an alternative for anatomic structures restoration. J Bras Clin Estet Odontol 2000;24:49-52.  Back to cited text no. 5
    
6.Baratieri LN, Monteiro S Jr, Correa M, Ritter AV. Posterior resin composite restorations: A new technique. Quintessence Int 1996;27:733-8.  Back to cited text no. 6
    
7.Goracci G, Mori G. Esthetic and functional reproduction of occlusal morphology with composite resins. Compend Contin Educ Dent 1999;20:643-8.  Back to cited text no. 7
    
8.Guimarães R, Reis R. Rebuilding oclusal morphology throught the custom acrilic matrix technique - a clinical case report. Rev Ibero-am Odontol Estet Dent 2004;10:154-9.   Back to cited text no. 8
    
9.Zenkner JE, Alves LS, Jϊnior LM. Restoring anatomy, function and aesthetics through the technique of occlusal replica. Clin Int J Braz Dent 2008;4:198-203.  Back to cited text no. 9
    
10.Robles Gijón V, Lucena Martín C, González Rodriguez MP, Ferrer Luque CM, Navajas Rodríguez de Mondelo HM. Odontol Conservadora 1999;2:49-56.  Back to cited text no. 10
    

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Correspondence Address:
Josué Martos
Department of Semiology and Clinics, School of Dentistry, Federal University of Pelotas, Pelotas
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.74231

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

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