J Adhes Dent. 2021;23(1):21-34. doi: 10.3290/j.jad.b916819.
The importance of the interdental anatomy of a class-2 direct composite restoration is one of the most underestimated topics in direct posterior composite restorations. The proximal emergence profile of the restoration and the contact area should be designed to maximize arch continuity and to minimize food impaction. Other restorative criteria that must be fulfilled are marginal adaptation compatible with the dental and periodontal integrity, and geometry of the marginal ridge compatible with the mechanical integrity of the restoration under load. Shortcomings will result in masticatory discomfort, caries, periodontal problems and undesired movement of teeth. In vitro and in vivo studies showed that the use a contoured sectional metal matrix band with a separation clamp results in the tightest contact point. However, this matrix system also has shortcomings and does not give the expected result in all class-2 cavities. The variation in depth, width of the box, distance between the cervical cavity margin and the adjacent tooth requires customization of the interproximal space. In order to realize this, sectional matrix bands with several profiles of curvature, variation of wedges and separation clamps, and the use of teflon tape are required. In addition, dentists should follow a protocol allowing them to build a proximal composite surface that fulfills the required restorative criteria. Pre-wedging, space evaluation, interproximal clearance, correct selection, positioning and stabilization of the matrix band are important steps in this protocol.
二类直接复合树脂修复体的牙间解剖结构的重要性是直接后牙复合树脂修复中被低估的问题之一。修复体的近中边缘形态和接触区应设计为最大限度地保持牙弓的连续性，并最小化食物嵌塞。其他必须满足的修复标准是与牙体和牙周完整性相匹配的边缘适应性，以及与负载下修复体的机械完整性相匹配的边缘嵴几何形状。缺陷会导致咀嚼不适、龋齿、牙周问题和牙齿的非预期移动。体外和体内研究表明，使用带有分离夹的有曲度分段金属基底桥架可获得最紧密的接触点。然而，这种基底桥架系统也有缺点，并且在所有二类窝洞情况下并不都能达到预期的效果。盒深度、宽度、颈部边缘与邻牙之间的距离的变化需要对邻间隙进行定制。为了实现这一点，需要使用具有多种曲率轮廓、楔子和分离夹变化的分段基底桥架以及特氟龙带。此外，牙医应遵循允许他们构建满足所需修复标准的近中复合表面的方案。预楔入、间隙评估、邻间隙、正确选择、定位和稳定基底桥架是该方案中的重要步骤。
