Clinical Tips: ProxyPal
3D Contoured Matrix

 

ProxyPal is a transparent 3D contoured matrix for the front area. The pre-shaped progressive curvature aids to create incisal fillings with a correct anatomical shape and is especially designed for large proximal fillings and closure of frontal diastemas, preventing “black triangle disease”.In order to achieve a perfect filling the matrix has been designed such that the curvature of the matrix escalates linearly along its total length.

In one end the curvature is vague which is ideal for lower jaw incisors. In the other end the matrix curvature is distinct thus suitable i.e. a diastema closure. By pushing/pulling the matrix it is easy to find a suitable curvature for every tooth. The matrix has an cervical edge which inserted into the gingival pocket stabilizes the matrix during insertion of filling material. The cervical edge prevents moisture from the surrounding tissue that interfers with the cavity.

 

 

 

 

The shape of the matrix

The inter- proximal anatomical contour differs from tooth to tooth. In order to achieve a perfect restoration the ProxyPal matrix has been designed so that the curvature at the side of the matrix progressively increases along the total length of the clear matrix. At one end the curvature is shallow or subtle making it great for even a very subtle anatomical contours as found in mandibular incisors. On the other end the curvature is more profound to enable the operator to close even a considerable diastema. By sliding the matrix along the tooth, the optimum position of the curvature can be found. The folded edge sliding into the gingival sulcus provides great degree of moisture control and stabilises the matrix while the clinician is extruding the composite restorative material, guided by the matrix.

 

Clinical Tips

- After preparation of the cavity, carefully position the matrix band so that the cervical edge goes into the gingival sulcus.
- The 3D contour ensures a stable matrix during the procedure.
- Always cut the matrix for best comfort. Due to the curved, tapered design, the matrix can be wrapped around the palatal surface under the gingiva and back through both the inter-proximal spaces.
- Position the ProxyPal so that the cervical edge goes into the gingival sulcus. Select the optimum position of the matrix strip, using the 3D contour to get the best end result of the restoration or diastema closure.
- The matrix can be manipulated to get the desired angle and contour of the restoration without losing the cervical guidance.
- A wedge can be used a as a stabilising device but is not necessary.
- The restoration can be built up in increments.
- Finish according to the instructions of your selected composite system.
- Remove the matrix and adjust, finish and polish your restoration.

 

Why should I use ProxyPal?

ProxyPal is a universal matrix for all anterior restorations. The innovative design of the ProxyPal, allows you to easily restore a broken down tooth to it’s original anatomy. Reshaping and closing of a diastema is also very easy with the ProxyPal. The primary purpose of ProxyPal is to get the correct anatomy of the inter- proximal part of a restoration.ProxyPal will save you time and money and you will easily achieve an aesthetic result and emulate the anatomical contour of a natural tooth. This minimally invasive procedure is preferred to excessive removal of precious enamel and dentine. Diastema closure techniques with direct composites prove to be complicated and complications like chronic gingivitis in the area is not uncommon. ProxyPal will assist you to get a smooth transition between the filling and the tooth. ProxyPal is the answer to the undesirable black triangles.

 

Tooth 12 Class IV cavity. Teeth 11 and 21 with a diastema to be closed (pic.1). ProxyPal applied for the closure of the diastema (pic.2). ProxyPal in place forming a perfect matrix for the Class IV filling (pic.3)

How to use ProxyPal?

The purpose of ProxyPal is to achieve an anatomically correct form when performing a diastema closure or a Class IV filling, involving the cervical part. The matrix has a progressive contour, a slight curvature at one end and a more dominant curvature at the other end. Place ProxyPal around the tooth with the about 1 mm cervical edge in apical direction. Push into the gingival pocket on the side to be restored. Pull the matrix gently in either direction, until you find the proximal contour you prefer. Cut the excess of the matrix. Keep the matrix in place with a finger on the palatal/lingual surface. Etch/rinse/dry/ bond. Apply composite, pull gently the matrix on the “working“ side to spread the composite. Add more composite if necessary. Do not pull the strip! Light cure. Do the final finishing and contouring with paper discs. Polish and inspect the nice proximal contour.

 

”Specially designed for Diastema
Closure and treatment of Black Triangles”

Closure of diastema

- No preparation is required.
- Airflow/Sand blasting can be very beneficial and will enhance the bonding of the composite to the etched enamel.
- Use two ProxyPal matrixes turned against each other and determine where the best contour on the matrix is found.
- Cut the matrix.
- Fold the incisal part of the axial angle.
- Rubber Dam will be useful to manipulate the inter-dental papilla and to ensure the correct contour of the newly placed restoration.
- Now start with the first tooth by inserting the edge of the matrix strip into the gingival sulcus.
- Close the diastema by building up the tooth to the middle of the diastema.
- Measure the width of the newly constructed tooth using callipers. Check the space with the callipers on the neighbouring tooth to make sure symmetry will be achieved when the neighbouring tooth is build up. Polish gently with fine polishing paste without changing the contour of the filling.
- When you are satisfied with the first build up, insert the second matrix so that it has the same contour as the first one. The matrix can be supported palatal with the finger and contact can be achieved against the already shaped tooth. The build up can now be completed to close the diastema.
> Learn more in these clinical cases!

 

Indications for use

- After preparation of the cavity, carefully position the matrix band so that the cervical edge goes into the gingival sulcus.
- The 3D contour ensures a stable matrix during the whole procedure. By pushing/pulling search the bands ideal position for the best proximal shape. Cut the matrix.
- The band should be fixed by allowing it to go around the palatinal surface and back into the interdental space on the other side and stabilized by a finger on the palatinale side.
- Finish according to the instructions of your selected composite system.
- Remove the matrix and adjust, finish and polish your restoration.

 

It is important to allow the matrix band to keep the right cervical shape...

...by not pushing it towards the tooth to be treated.

Clinical Cases: ProxyPal

ProxyPal is a transparent 3D contoured matrix for the front area. The pre-shaped progressive curvature aids to create incisal fillings with a correct anatomical shape and is especially designed for large proximal fillings and closure of frontal diastemas, preventing “black triangle disease”. In order to achieve a perfect filling the matrix has been designed such that the curvature of the matrix escalates linearly along its total length. 

Restoration of large class IV cavity. 

Last picture shows the results after 2 years. Tecnique with Empress Direct.

Case from Mats Norman, DDS, Sweden

Closure of diastema using ProxyPal

Note that there is no black triangles (pic.2). ProxyPal is a universal matrix for all anterior restorations. The innovative design of the ProxyPal, allows you to easily restore a broken down tooth to it’s original anatomy. Reshaping and closing of a diastema is also very easy with the ProxyPal. The primary purpose of ProxyPal is to get the correct anatomy of the inter- proximal part of a restoration. ProxyPal will save you time and money and you will easily achieve an aesthetic result and emulate the anatomical contour of a natural tooth. This minimally invasive procedure is preferred to excessive removal of precious enamel and dentine. Diastema closure techniques with direct composites prove to be complicated and complications like chronic gingivitis in the area is not uncommon. ProxyPal will assist you to get a smooth transition between the filling and the tooth. ProxyPal is the answer to the undesirable black triangles.

Directly after finished restorations - a small black triangles (pic.1) and 3 week follow up- the small black triangles has disappered (pic.2).

Closure of diastema, step by step

- No preparation is required.
- Airflow/Sand blasting can be very beneficial and will enhance the bonding of the composite to the etched enamel.
- Use two ProxyPal matrixes turned against each other and determine where the best contour on the matrix is found.
- Cut the matrix.
- Fold the incisal part of the axial angle.
- Rubber Dam will be useful to manipulate the inter-dental papilla and to ensure the correct contour of the newly placed restoration.
- Now start with the first tooth by inserting the edge of the matrix strip into the gingival sulcus.
- Close the diastema by building up the tooth to the middle of the diastema.
- Measure the width of the newly constructed tooth using callipers. Check the space with the callipers on the neighbouring tooth to make sure symmetry will be achieved when the neighbouring tooth is build up. Polish gently with fine polishing paste without changing the contour of the filling.
- When you are satisfied with the first build up, insert the second matrix so that it has the same contour as the first one. The matrix can be supported palatal with the finger and contact can be achieved against the already shaped tooth. The build up can now be completed to close the diastema.

The above pictures shows failed direct composite restorations, used for the diastema closure. The situation was corrected with an invasive and more costly procedure involving laboratory made porcelain jacket crowns. The final result is excellent but the technique is very invasive.

By Dr. Sven Scholander.