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ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 3  |  Page : 172-177

Comparison of V3 sectional matrix and precontoured self adhesive matrix in class II cavities restored with composite resin: An in vivo study


Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada, Andhra Pradesh, India

Date of Submission09-Jun-2021
Date of Decision29-Jun-2021
Date of Acceptance16-Jul-2021
Date of Web Publication17-Mar-2022

Correspondence Address:
Dr. Dunnala Lakshmi Sowjanya
Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Vijayawada - 520 004, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_71_21

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  Abstract 


Context: One of the challenges associated with the use of composite resin as a posterior restorative material is to create an intact and optimal proximal area.
Aim: Aim of this in vivo study is to evaluate the proximal contacts in class II cavities restored with composite using V3 sectional matrix and precontoured self-adhesive matrix.
Settings and Design: After determining the power (0.84) of the study, 40 patients who fulfill the inclusion criteria were divided into two groups.
Methods and Material: In Group A Palodent V3 sectional matrix and in Group B precontoured self-adhesive matrix were used and evaluated for two outcomes, the primary outcome was proximal contact tightness, and the secondary outcome was proximal contour and overhangs of the restoration.
Statistical Analysis: IBM SPSS (Version 21.0) software was used. Chi-square test and Spearman's rank correlation test were performed. Statistical significance was set at P value equal to or less than 0.05.
Results: There was no statistically significant difference in contact tightness, contours, and overhangs between the two groups.
Conclusions: Within the limitations of the study. • Both V3 sectional matrix and precontoured self-adhesive matrix showed similar performance in terms of proximal contact tightness, proximal contour, and overhangs of the restoration. • However, a well-designed randomized controlled study with long-term follow-up must be performed to give valid evidence.

Keywords: Overhangs, proximal contact tightness, proximal contour


How to cite this article:
Sudha K, Malini D L, Sowjanya DL, Jyothsna K, Ashwini M, Sundar J S. Comparison of V3 sectional matrix and precontoured self adhesive matrix in class II cavities restored with composite resin: An in vivo study. J NTR Univ Health Sci 2021;10:172-7

How to cite this URL:
Sudha K, Malini D L, Sowjanya DL, Jyothsna K, Ashwini M, Sundar J S. Comparison of V3 sectional matrix and precontoured self adhesive matrix in class II cavities restored with composite resin: An in vivo study. J NTR Univ Health Sci [serial online] 2021 [cited 2022 Nov 30];10:172-7. Available from: https://www.jdrntruhs.org/text.asp?2021/10/3/172/339809




  Introduction Top


Restorative care in contemporary dentistry has three main goals, which include conservation of tooth structure, achieving optimum tooth form and function, and utilization of esthetic materials and technologies in restoring the tooth.[1] However, one of the challenges associated with the use of composite resin, as a posterior restorative material is to create an intact and optimal proximal area.

To overcome these challenges, various strategies have been proposed which includes multi-layer techniques, varying polymerization protocols, use of special instruments, variety of matrix systems, wedges, and separation rings. [2,3]

Chuang et al.[4] revealed that it was the particular matrix system and not the composite resin material that primarily affects the tooth anatomy and thus the success of treatment.

Flávio Fernando Demarco et al. stated that one of the factors that influence the restoration performance is the proximal contour, and it depends on the type and shape of the matrix system employed. [3,5]


  Aim of the Study Top


The aim of the present in vivo study was to evaluate the proximal contacts in class II cavities restored with composite resin using V3 sectional matrix system and recontoured self-adhesive matrices.


  Materials and Methods Top


To conduct this in vivo study, approval from the institutional ethical committee was taken, and the procedures followed were in accordance with the institutional ethical standards.

The power of the study (0.84) was analyzed. Hence, 40 patients with occlusoproximal caries in relation to first molars of maxilla and mandible who reported to the Department of Conservative Dentistry and Endodontics were enrolled in the study. Patients with fully erupted teeth having supragingival class II caries limited to dentin were included in the study. Exclusion criteria included teeth with dental caries extending up to the pulp and with periapical pathosis, adjacent tooth continuous with the cavity side missing, malpositioned teeth, and periodontally weak teeth.

After confirming eligibility criteria, the clinical procedure and the associated risks were explained to the patients, and informed consent was obtained from the patients.

After taking a clinical history, a preoperative photograph [Figure 1]a was taken, and the extent of caries into dentin was confirmed by the intraoral radiograph. Patients who fulfilled the inclusion criteria were divided into two groups (n = 20). In group A, Palodent V3 sectional matrix system (Dentsply International Inc., Milford, DE, USA) was used and in Group B recontoured self-adhesive matrix (Filay dent) was used.
Figure 1: (a) Preoperative clinical photograph. (b) Application of V3 sectional matrix. (c) Application of self-adhesive matrix. (d) Postoperative clinical photograph

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After isolation of the field with the rubber dam and before commencement of cavity preparation, anatomically contoured wedges were placed into the gingival embrasure. Prewedging not only allows slow separation (to compensate for the thickness of the matrix band) but also serves as a guide to determine the proper height of the gingival floor. Class II cavities were prepared using an airotor handpiece (NSK INC. Japan) at high speed with diamond cutting burs (Mani INC. Japan). The cavities were then refined with hand instruments (GDC marketing, Punjab, India). In group A, V3 sectional matrix (Palodent matrix bands) was used. The sectional matrix band was placed interproximally and secured with an anatomical wedge for achieving optimal adaptation of the matrix band in the cervical region. The separation ring (BiTine® Ring, DENTSPLY International Inc., Milford, DE, USA) was placed with the help of retainer forceps, the inner surface of the matrix band was burnished against the adjacent teeth [Figure 1]b.

In group B, teeth received precontoured self-adhesive matrix (Filay Dent). The matrix band was placed around the prepared tooth, the adhesive ends of the matrix bands were adhered together, and anatomical wedges were applied in the proximal area to secure the matrix [Figure 1]c.

Cavity restoration

After placing the matrix system, all prepared teeth were etched with 37% phosphoric acid gel (Prime-dental) for 15 s, water rinsed for 20 s, and gently blot dried. Then, with the help of an applicator tip, (SDI) bonding agent (3M ESPE ADPER Single bond 2) was applied and cured for 20 s with a light-curing unit (Bluephase Style LCU, Ivoclar Vivadent, Amherst, NY, USA) and restored with posterior composite restorative material (IPS Empress, Ivoclar Vivadent, Amherst, NY, USA) using the incremental technique. Each layer of composite was cured for 20 s from the occlusal surface. After removal of the matrix, restorations were postcured for 20 s from both buccal and lingual sides. Restorations were finished using fine-grit diamond burs (Mani INC. Japan) and discs (Sof-LexTM), the occlusion was adjusted and polished with composite polishing material (Prisma Gloss, Dentsply Caulk, Milford, DE, USA) [Figure 1]d. After assessing the outcomes clinically, a postoperative radiograph was taken to assess the proximal contours and overhangs.

Outcome assessment

All the restorations were placed by a single operator. The coinvestigator who was blinded to the group allocation examined the study subjects for the outcome of interest. It was determined just after the completion of the restoration.

Two outcomes were evaluated in this study, primary outcome was the tightness of the proximal contact area resulting in the two matrix band systems. It was measured using dental floss (Oral-B Satin Floss Mint) and scored according to the foreign direct investment criteria [Table 1].[6]
Table 1: Foreign Direct Investment Criteria

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The secondary outcome was the proximal contour (good or acceptable) and overhanging (presence or absence) of the restoration. [7,8] These were examined clinically with an explorer (GDC marketing, Punjab, India) and mouth mirror (GDC marketing, Punjab, India) and then on the radiograph by the blinded coinvestigator.

Statistical Analysis

IBM SPSS (Version 21.0) software was used to carry out the statistical analysis of data. Chi-square test was done to assess the association between the categorical variables and outcomes of the study. P value equal to or less than 0.05 was considered to be statistically significant. In order to correlate the values of contour and overhangs clinically and radiographically, Spearman's rank correlation test was done.


  Results Top


There was no statistically significant difference in contact tightness, contours, and overhangs between the two groups [Table 2]. Although the values are better for V3 sectional matrix, the difference was not statistically significant. Spearman's rank correlation test showed there was no significant difference in the clinical and radiographic assessment of proximal contours and overhangs.
Table 2: Comparison of V3 Sectional Matrix and Precontoured Self-Adhesive Matrix

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  Discussion Top


In the present study, first molars from all quadrants were included, so the results can be extrapolated to both maxillary and mandibular arches. Rubber dam isolation is considered as the standard of care while placing restorations, it was found to have good effects and improved contact tightness.

To nullify the effect of type of composite on proximal contacts, the same posterior composite resin restorative material (IPS Empress) was used in both groups. All restorations were done by a single operator, and the technique of placement was identical in both groups. The only difference was the matrix system used. Hence, any difference in proximal contact was attributed to the matrix system alone.

To overcome the influence of matrix material on the degree of conversion of the resin, postcuring was done for the light-cured restorative materials following matrix removal from all surfaces, including proximo-facial and lingual line angles.

Loomans et al. have carried out an in vitro study on proximal contours and found that the contoured matrix achieved a stronger marginal ridge than the straight matrix. Hence, in the present study, both the matrices used were precontoured to attain a stronger marginal ridge. [9,10]

In the present study, the proximal contact tightness was evaluated by passing the dental floss through the interdental contact area, and the scoring was given using the Federation Dentaire Internationale (FDI) criteria. The practice of flossing has traditionally been the method for the evaluation of proximal contact with designations of tight, weak, or open as qualifying discernments. Although this method is a practical clinical approach for the determination of postrestoration form and function, variables such as floss design and appropriate degree and direction of force are subjective factors that can produce inaccurate results.[1]

In order to minimize the inaccuracies, contacts were evaluated when the patient was in upright posture using the waxed nylon floss of 12 inches in length wrapped around the index fingers by a single observer who was well trained regarding the scoring criteria before assessing the outcomes of the study.

In the oral cavity, it was shown that saliva increases the force required for the passage of nylon floss through the contact area as the floss increases in volume under wet conditions. Waxed nylon floss is less susceptible to this influence. Hence, in the present study, waxed nylon floss (Oral-B Satin Floss Mint) was used.[11]

There are certain devices that can objectively determine the proximal contact tightness. The first instrument was designed by Loomans et al. at the University of Technology at Delft, Netherlands. This instrument measures proximal contact tightness in the unit of force, that is, Newton. Several different approaches have been developed to evaluate the interproximal area of a restoration which include interdental metal strips, a digital tension transducer, a tooth pressure meter, and 3-dimensional (3D) imaging for measurement of the interproximal frictional forces. Although these techniques can serve as tools for quantitative measurement, clinical application of these procedures in dental practice may not be feasible. [1, 10, 11]

Precontoured self-adhesive transparent matrices used in the present study are polyester matrices with a standard thickness of 0.075 mm which are available in various sizes for molars and premolars. The transparent matrix has pink adhesive ends for application without retainer and provides better contrast. As they are transparent, they have negligible influence on the composite conversion rate and provide better visual control for composite handling and filling.

V3 sectional matrix bands used in the present study had a standard thickness of 0.038 mm. The V3 nickel-titanium rings offer a consistent separation force on molars and premolars, securing the anatomically shaped V3 matrix against the preparation. The V3 ring works with the matrix and wedges to create a tight seal around the restorative field.[12]

In the present study, the circumferential self-adhesive matrix showed comparable performance with that of the palodent sectional matrix, even though there existeda variability in thickness between the two matrices. The results corresponded to prewedging done in both the groups to obtain the interdental separation necessary to compensate for the thickness of the matrix, and careful stabilization of matrix against the adjacent tooth contact during the restoration procedure might have contributed to comparable results in both the groups.[13]

There was no significant difference between the two groups in terms of proximal contours and overhangs, and a highly significant correlation existed between clinical and radiographic assessment.

The sectional matrices have few limitations; because of their rounded contours, they do not always conform to the proximal contours and sometimes if adjacent teeth are too close, they do not allow their placement without causing a dent in the matrix material, rendering it unusable. Moreover, such precontoured matrix negates the concept of customizing the contact area as per the needs of an individual case.[14]

The novel precontoured self-adhesive matrix bands have certain advantages such as the precontoured nature of band is similar to sectional bands; because of easier placement and removal due to adhesive ends, it can be used in uncooperative, pediatric, and geriatric cases; with good visibility during restorative procedure, this matrix also contributes to the surface finish of the restoration; and it serves as a good economical alternative to many of the currently available matrices.

In few teeth, self-adhesive matrix failed to create adequate tight contact which would be due to failure of adaption to all anatomic contours of molars as they are precontoured. As it is a circumferential band, it is difficult to pass through the unprepared tight contacts of the teeth without prewedging.

As there is very limited data available in the literature regarding precontoured self-adhesive matrices, a well-designed randomized controlled study with long-term follow-up must be performed to give valid evidence on the proximal contact.

Limitations of the study

As the results are subjective, inclusion of more than one observer for evaluating the outcomes and comparing both observer data would have minimized the subjective errors by a single observer.


  Conclusion Top


Within the limitations of the present study.

  • Among the various influential factors, the particular matrix system used during composite restoration plays a key role in determining the tightness of proximal contact and contour which ultimately influences the long-term success of composite restoration.
  • Both V3 sectional matrix and precontoured self-adhesive matrix showed similar performance in terms of proximal contact tightness, proximal contour, and overhangs of the restoration.


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Owens BM, Phebus JG. An evidence-based review of dental matrix systems. J Gen Dent 2016;64;64-70.  Back to cited text no. 1
    
2.
Alonso V, Caserio M, Darriba IL. Use of transparent tips for obtaining tight proximal contacts in direct class II composite resin restorations. Oper Dent 2019;44:446-51.  Back to cited text no. 2
    
3.
Demarco FF, Pereira-Cenci T, de Almeida André D, de Sousa Barbosa RP, Piva E, Cenci MS. Effects of metallic or translucent matrices for class II composite restorations: 4-year clinical follow-up findings. Clin Oral Invest 2011;15:39-47.  Back to cited text no. 3
    
4.
Chuang SF, Su KC, Wang CH, Chang CH. Morphological analysis of proximal contacts in class II direct restorations with 3D image reconstruction. J Dent 2011;39:448-56.  Back to cited text no. 4
    
5.
Kampouropoulos D, Paximada C, Loukidis M, Kakaboura A. The influence of matrix type on the proximal contact in Class II resin composite restorations. Oper Dent 2010;35:454-62.  Back to cited text no. 5
    
6.
Deepak D, Nivedhitha MS. Proximal contact tightness between two different restorative materials – An in vitro study. JAPER 2017;7:153-6.  Back to cited text no. 6
    
7.
Durr-E-Sadaf, Ahmad MZ, Gaikwad RN, Arjumand B. Comparison of two different matrix band systems in restoring two surface cavities in posterior teeth done by senior undergraduate students at Qassim University, Saudi Arabia: A randomized controlled clinical trial. Indian J Dent Res 2018;29:459-64.  Back to cited text no. 7
    
8.
Sidelsky, H. Resin composite contours. Br Dent J 2010;208:395-40.  Back to cited text no. 8
    
9.
Gomes IA, Filho EM, Mariz DC, Borges AH, Tonetto MR, Firoozmand LM, et al. In vivo evaluation of proximal resin composite restorations performed using three different matrix systems. J Contemp Dent Pract 2015;16:643-7.  Back to cited text no. 9
    
10.
Loomans BA, Opdam NJ, Roeters FJ, Bronkhorst EM, Burgersdijk RC. Comparison of proximal contacts of Class II resin composite restorations in vitro. Oper Dent 2006;31:688-93.  Back to cited text no. 10
    
11.
Teich ST, Joseph J. Sartori N, Heima M, Duarte S. Dental floss selection and its impact on evaluation of interproximal contacts in licensure exams. J Dent Educ 2014;78:921-26.  Back to cited text no. 11
    
12.
El-Shamy H, Sonbul H, Alturkestani N, Tashkandi A, Loomans BA, Dörfer C, et al. Proximal contact tightness of class || bulk-fill composite resin restorations: An in vitro study. Dent Mater J 2019;38:96-100.  Back to cited text no. 12
    
13.
Varlan CM, Dimitriu BA, Bodnar DC, Varlan V, Simina CD, Popa MB. Contemporary approach for reestablishment of proximal contacts in direct class ii resin composite restorations. Timisoara Med J 2008;58:236-43.  Back to cited text no. 13
    
14.
Khan FH, Umer F, Rahman M. Comparison of proximal contact and contours of premolars restored with composite restoration using circumferential matrix band with and without separation ring: A randomized clinical trial. Int J Prosthodont Restor Dent J 2013;3:7 13.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Aim of the Study
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